Care act creates a new medicaid optional service for

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Care Act creates a new Medicaid optional service for health homes and this is certainly an area that we think holds a lot of promise for providing some of that financial stability to organizations interested in becoming health homes. So this new state option - so just to look a little step back, the way the Medicaid program is set up is that it’s a Federal-State partnership. The Federal government mandates that states cover a small list of mandatory services and then provides states with a list of optional services that they might want to provide in their state Medicaid program and that those are services that are eligible for Federal financial participation or Federal matching funds. And states avail themselves of these optional services through the filing of a State ______________________________________________________________________________________ 25193ea6062d74eaa1fb4080b67349c6a7de8baf.doc Page 10 of 20
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Plan Amendment. So every state maintains a state plan for it Medicaid program and any time it wants to change on something that it does in its State Medicaid Program, it does that by filing a State Plan Amendment. So that is a - as of January 1 of this year, there’s a new optional service available to state Medicaid programs for health homes. This was Section 2703 in the Affordable Care Act and it’s targeted towards individuals that have chronic illnesses. The statue reads people who have two chronic illnesses or people who have one chronic illness and are at risk for a third. And amongst those chronic illnesses are both mental health and addiction disorders. And the third category is individuals who have serious mental illness. [0:46:27] Now, why does this provide some potential to support a viable business model? Teah (ph) if you go to the next slide, the statute then allows for enhanced Federal matching for a list of services that are contained in the statute as essential health home services. So a state that chooses to create a health home option has to determine what population it’s going to serve, as well as then who the providers will be of that service. And then the statute provides for a list of services that has to be provided and then provides enhanced Federal match rates for those services for eight quarters. So that states can get 90 percent Federal money for these services and the state will have to come up then with a definition of what these services are. For those of you who practice in the substance use or mental health field, there are some ones here that you might find interesting, like patient and family support, referrals to community and social support services, as well as the other ones that you might expect - comprehensive care management, care coordination, health promotion I think is there also, we’re going to talk about health promotion, and comprehensive transitional care from inpatient to upper setting. So the goal of providing these services is to reduce hospital admissions, reduce emergency room use, reduce the development of other chronic illnesses. So these services aren’t provided just to provide these services, the goal
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  • Fall '19
  • Center for Integrated Health Solutions, Teah, LARA HOKEN, Mr. Chuck Ingoglia

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