1

Section 2703 Health Homes

Overview

Charles A. Townley

Policy Analyst

National Academy for State Health Policy

June 14th, 2012

1

Section 2703 of the Affordable Care Act (ACA) Created Section 1945 of the Social Security Act

“State Option to Provide Coordinated Care through a Health Home for Individuals with Chronic Conditions”

Authorized states to submit a Medicaid State Plan Amendment (SPA) to implement health homes

Enhanced Federal Medical Assistance Percentage (FMAP) 90 percent for the first eight quarters Applies only for the specific health home services

Planning Grants: Each state eligible for a planning grant up to $500,000 – allows

state to draw regular FMAP for health home planning activity. Two-page Letter of Request

2

What are Health Homes?

Health Home Services: Comprehensive Care Management Care Coordination Health Promotion Comprehensive Transitional Care Individual and Family Support Referral to Community and Social Support Services

Better Coordination/Integration of Primary Care, Behavioral Health, and Long-Term Care

State Medicaid Director Letter released November 16, 2010 (SMDL #10-024)

3

HI

NHMA

ME

NJ

CTRI

DE

VT

NY

DCMD

NC

PA

WV

FL

GA

SC

KY

IN OH

MI

TN

MSAL

MO

IL

IA

MN

WI

LA

AROK

TX

KS

NE

ND

SD

MT

WY

UT

CO

AZ

NM

IDOR

WA

NV

CA

Section 2703 Health Home State Plan Amendments (SPAs)

Approved: 5 States (7 SPAs)Submitted: 4 StatesPlanning Grant:14 States and Washington, D.C.

As of June 1, 2012 4

Eligibility

Medicaid enrollees with: One serious and persistent mental health condition Two or more chronic conditions One chronic condition with the risk of developing a

second Eligible Conditions listed in the ACA:

Mental Health Condition; Substance Use Disorder; Asthma; Diabetes; Heart Disease; Overweight (defined as BMI>25)

States can include additional conditions subject to approval

5

Financing

States have flexibility in developing payment methodologies ACA identifies tiered payments for provider

capabilities or patient complexityStates may propose alternatives.

Per-Member Per-Month payments the most common approach taken thus far.

6

NASHP’s Learning Community

Section 2703 Learning Community part of 3rd Medical Home Consortium, supported by The Commonwealth Fund.

Six states: Colorado New Mexico New York North Carolina Oklahoma Washington

7

Learning Community (cont.)

Series of six technical assistance webinars Identified five salient issues important for

states to keep in mind when pursuing the Health Home Option1. Coordination with Existing Programs2. Financing and Payment3. Integrating Behavioral and Physical Health4. Sharing Data across Providers5. Health Home Evaluation

Upcoming NASHP Publication

8

Coordination with Existing Programs

Building on existing state programs Developing new programs Managed Care Plans and Health Homes

9

Financing and Payment

Payment Methodologies Health home infrastructure and training

Examples of infrastructure:Staff (e.g., Case Managers)Systems (e.g., Health Information Technology)

How states are paying for managed care enrollees

10

Integrating Behavioral and Physical Health

Models of Integration Coordinated Care: Behavioral health working

with primary care Integrated Care: Behavioral health working

within and as a part of primary care

Source: Chris Collins et al., Evolving Models of Behavioral Health Integration in Primary Care (New York, NY: Milbank Memorial Fund, May 2010

11

Sharing Health Data

Sharing data across providers and health systems

Using health information technology (HIT)

12

Health Home Evaluation

ACA requires two reports to Congress (2014 and 2017) Hospital Admissions Emergency Department Utilization Skilled Nursing Facility Admissions

Hospital Re-admissions; Disease Management; Care Coordination; Cost Savings

State-specific Goals

13

SAVE THE DATE

My e-mail: ctownley@nashp.org

SAVE THE DATE:National Academy for State Health Policy

25th Annual State Health Policy ConferenceOctober 15-17, 2012

Baltimore, MD

Visit: www.nashp.org

Follow us on Twitter: @nashphealth