What is a Health Home?
The Health Home is a federally defined initiative in the Affordable Care Act (ACA). The initiative is designed for Medicaid recipients with multiple chronic conditions.
Health Homes are part of a person centered system of care that achieves improved outcomes and better services for recipients, as well as value for state Medicaid programs.
The Health Home is an enhanced service delivery model that promotes a better patient experience and better results than traditional care. The Health Home has many characteristics of the Patient-Centered Medical Home but is customized to meet the specific needs of Medicaid recipients with chronic medical conditions or behavioral health conditions.
Health Homes must provide 6 federally mandated Core Services:
Health Homes are encouraged to utilize health information technology to more efficiently and effectively coordinate the care of Health Home patients.
Through the provision of the 6 core services, the Health Home initiative aims to reduce inpatient hospitalization and emergency room visits, increase the integration between physical and behavioral health services, and enhance transitional care between institutions and the community.
The work began as a recommendation of the Medicaid Solutions Workgroup. The Medicaid Solutions Workgroup, convened by Governor Dennis Daugaard during legislative session 2011, was tasked with identifying ways Medicaid could realize cost savings and better serve recipients. The Final Report of the Medicaid Solutions Workgroup can be viewed here: Final Reports of the Medicaid Solutions Workgroup.
Why is South Dakota implementing Health Homes?
South Dakota is implementing Health Homes to improve health outcomes and experience of care for eligible Medicaid recipients, while also realizing cost savings from better coordinated care for that population,
In April 2012, the Department of Social Services convened a Health Home Workgroup to guide the process of evaluating and implementing Health Homes. The Health Home Workgroup concluded its work in October 2012. Information considered included federal requirements, other states’ Health Home models, SD Medicaid diagnostic and claims data, and other research.
Who will be eligible for Health Homes?
South Dakota has two types of Health Homes -- those led by Primary Care Providers and those led by a Community Mental Health Centers -- to serve Medicaid recipients with complex health care needs resulting in high costs to Medicaid. Individuals who are eligible for these two health homes include:
Why not just call it a Patient Centered Medical Home instead of a Health Home?
The Health Home terminology is the Centers for Medicaid and Medicare (CMS) driven by the Affordable Care Act (ACA). While most of the services provide by a Health Home are similar to those provided by a patient center medical home such as comprehensive care managed, care coordination, referral to community services and a focus on Health Information Technology, they are designed to serve a different population as required by ACA. The patient-centered medical home is population based while the Health Home focuses on Medicaid recipients. Eligible recipients must meet eligibility requirement outlined above.
Where will Health Homes be located?
Health Homes will be located where there are qualified designated providers are willing to serve the needs of those eligible.
Who will be the providers of Health Home Services?
Each Health Home will be led by one or more designated providers. Each designated provider will lead an individualized team of health care professionals and support staff to meet the needs of each recipient. A designated provider team may include a health coach/care coordinator/care manager, chiropractor, pharmacist, support staff, and other services as appropriate and available.
Designated providers for primary care health homes can be primary care physicians (e.g., family practice, internal medicine, pediatrician or OB/GYN), physician’s assistants, or advanced practice nurse practitioners, working in a Federally Qualified Health Center, Rural Health Clinic or clinic group practice.
Designated providers for behavioral health health homes include mental health professionals working in a community mental health center or other behavioral health setting.
What do I need to do to be a Health Home Provider?
Providers who would like to serve as a designated provider and feel they meet the required provider standards will complete an application. The application will be available on this website on April 1, 2013.
When the application is released, the Department of Social Services will provide training about health homes and instruction for how to complete the application. The Department will review completed applications to ensure each provider meets the standards.
How will I be reimbursed for Health Home Services?
Medical Services will be funded exactly as they are now. The Health Home provider will be paid a per-member per-month (PMPM) based on the Tier of the recipients to cover the cost of providing the 6 core services required by Health Homes.