State Option to Provide Health Homes for Individuals with Chronic Conditions in Medicaid
Creates a new Medicaid state plan option under which enrollees with at least two chronic conditions, or with one chronic condition and at risk of developing another, or with at least one serious and persistent mental health condition, could designate a provider, a team of health care professionals, or a health team as their health home. Qualifying providers would have to meet certain standards established by the Secretary, including demonstrating that they have systems and infrastructure in place to provide comprehensive and timely high-quality care either in-house or by contracting with a team of health professionals. The
designated provider or team would offer comprehensive care management; care coordination and health promotion; comprehensive transitional care, including appropriate follow-up, from inpatient to other settings; patient and family support; referral to community and social support services, if relevant; and as feasible use health information technology to link such services. Teams of providers could be a freestanding, virtual, or hospital-based, community health center, community mental health center, clinic, physician’s office, or physician group practice. Designated providers would be required to report to the state on all applicable quality measures in the state Medicaid program.
The state would develop a mechanism to pay the health home, and the state plan amendment would include a plan for tracking avoidable hospital readmissions and for calculating savings resulting from improved chronic care coordination and management. States will also include in their state plan amendments “a proposal for use of health information technology in providing health home services under this section and improving service delivery and coordination across the care continuum (including the use of wireless patient technology to improve coordination and management of care and patient adherence to recommendations made by their provider).” Requires providers to report on applicable measures and to use health information technology to report these measures, where feasible and appropriate. When appropriate the state will consult and coordinate with the Substance Abuse and Mental Health Services Administration specifically in addressing the prevention and treatment of mental illness and substance abuse.
Provides an enhanced match of 90% FMAP for 2 years for states that take the option. Small planning grants may be available to help states intending to take the option. FMAP rules would apply.
Requires the Secretary to survey states and report to Congress on the nature, extent, and use of this option, particularly as it pertains to hospital admission rates, chronic disease management, and coordination of care for the chronically ill. The state option would be available beginning on January 1, 2011. An independent evaluation of the impact of this option on reducing hospital admissions, emergency room visits, and admissions to skilled nursing facilities would be conducted. (Sec. 2703)
Navigation: ( ←Previous | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 | Next→ )