The Missouri Department of Social Services has become the first state Medicaid agency to win approval from the Centers for Medicare and Medicaid Services (CMS) of a state plan amendment under which the state will qualify for 90 percent Federal financial participation (FFP) on expenditures for “health home” services under section 2703 of the Affordable Care Act (ACA). The approval is effective January 1, 2012. The enhanced federal matching rate will be available for two years. DSS will implement a community mental health center (CMHC) based health home model designed to coordinate primary, acute, behavioral health, and long term care services and supports for individuals with serious and persistent mental illness as well as individuals with less severe behavioral health needs combined with chronic medical conditions. Rhode Island, Oregon, and other states have also designed excellent health home plan amendments that CMS should approve soon.
The California Department of Health Care Services (DHCS) has announced that it is ready to implement health/medical home and accountable care organization (ACO) models for children with special health care needs under the California Children’s Services (CCS) provisions of DHCS’ “Bridge to Reform” section 1115 demonstration waiver. The CCS program seeks to improve service integration and quality of care for children with conditions such as congenital heart disease, kidney disease, cancer, spina bifida, sickle cell anemia, and cerebral palsy. Pilot projects to serve up to 20,000 such children will begin on January 1, 2012 in Alameda, Imperial, Los Angeles, Orange, San Diego, and San Mateo counties. DHCS will evaluate each of these pilots to determine next steps, including the potential for expansion to other counties.
At a national level, CMS launched a Medicare health home initiative, the Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) demonstration project, on November 1. The Medicare project is authorized under section 3021 of the Affordable Care Act (ACA). CMS selected 500 FQHCs in 44 states to participate in the project, which is designed to implement and test various health home models over the next three years. Each FQHC participating in the project will be paid a monthly care management fee, on top of standard encounter fees, for Medicare beneficiaries receiving most of their primary care through the FQHC. FQHCs will use physician and nurse-practitioner led teams, electronic health records, training for patients in self-management of chronic conditions such as diabetes and hypertension, expanded hours of operation for patients, availability of same day appointments for priority conditions, and other “best practices” endorsed by the National Committee for Quality Assurance (NCQA) to improve care and to help curtail unnecessary recourse to costly service settings such as hospital emergency rooms. CMS expects to pay $42 million in care management fees to the 500 FQHCs to coordinate care for 195,000 Medicare beneficiaries over the next three years. The CMS Center for Medicare and Medicaid Innovation will contract for an independent evaluation of the demonstration project to rigorously assess its impact over time on hospital admission rates, emergency room visits, access to services, costs, and quality of care.
Other important service integration initiatives that continue to move forward include the Multi-Payer Advanced Primary Care Practice Demonstration, under which CMS has selected eight states to participate (Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island, and Vermont); the State Demonstrations to Integrate Care for Dually Eligible Individuals, under which CMS has awarded contracts to 15 states (California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, and Wisconsin); and other innovative models pioneered concurrently at the state level such as Colorado’s regional care collaborative organizations and Oregon’s regional care coordination organizations.