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MaineCare Behavioral Health Homes. January, 2014 https://www.maine.gov\dhhs\oms\vbp. Overview. A new service being offered by MaineCare in April, 2014 Per the Affordable Care Act, a Health Home offers: Care Management of physical and mental health needs

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Mainecare behavioral health homes

MaineCare

Behavioral Health Homes

January, 2014

https://www.maine.gov\dhhs\oms\vbp


Overview

  • A new service being offered by MaineCare in April, 2014

  • Per the Affordable Care Act, a Health Home offers:

    • Care Management of physical and mental health needs

    • Care Coordination and health promotion

    • Help in transitional care, including follow up

    • Support to help self-manage physical and mental health conditions

    • Referral to other services

    • The use of Health Information Technology to link services

1


Maine’s Health Homes

“Stage A”

Primary Care Health Home Practice (HHP)

Community Care Team (CCT)

Health Homes

Serves adults and children with

chronic health conditions

2


Maine’s Behavioral Health Homes –

“Stage B"

Behavioral Health

Home Organization (BHHO)

A Primary Care Practice (HHP)

Behavioral Health Homes

Serves adults and children with significant behavioral health needs


Key Features

  • BHHOs are community-based, licensed mental health providers that partner with one or more HHPs to manage and coordinate the physical and behavioral health care of individuals with significant mental health and co-occurring needs

  • The BHHO provides comprehensive care management, health promotion, individual and family support, and other services

  • Members are enrolled if they receive case management /community integration services from a participating BHHO

  • Members must select an HHP that partners with that BHHO

  • Members may choose to participate in Behavioral Health Homes, or opt out of BHH at any time.




Quality Framework

  • Goal 1: Reduce inefficient healthcare spending

  • Goal 2: Improve chronic disease management

  • Goal 3: Promotion of wellness and prevention

  • Goal 4: Recovery and effective management of behavioral health conditions

  • Goal 5: Improved experience of care for consumers/families

    Measures build on/are aligned with

    Stage A and Accountable Communities measures

7


Provider Requirements: BHHO

Mental health providers must:

  • Be licensed community mental health providers

  • Provide medication management OR have an MOA with a MM provider

  • Have expertise in co-occurring disorders

  • Adopt an EHR within a timeframe specified by MaineCare (no more than two years after approval as a Behavioral Health Home Organization).

  • Participate in the Behavioral Health Home Learning Collaborative

  • Partner with at least one qualified practice

  • Commit to meeting and reporting on Core Expectations, including enhanced access to care, comprehensive consumer/family directed care planning ,commitment to reducing waste and unnecessary health care spending, integration of Health Information technology

8


Provider Requirements: BHHO

Ability to deliver team-based care:

  • Clinical Team Leader

    • independently licensed mental health professional, including an Licensed Clinical Social Worker, Licensed Clinical Professional Counselor, Licensed Marriage and Family Therapist, psychologist, psychiatrist

  • Health Home Coordinator

    • Qualified TCM case management providers for children or Mental Health Rehabilitation Technician/C certified providers for adults

  • Peer Support Specialist

    • Certified Intentional Support Specialist (adults) or other designated training for parents/youth

  • Nurse Care Manager

    • Licensed Practical Nurse, Registered Nurse, Nurse Practitioner

  • Medical/Psychiatric consultation

9


Health Home Practice Requirements

Primary care providers must:

  • Be an approved Health Home Practice OR complete a Health Home primary care practice application

  • Have implemented an Electronic Health Record (EHR) system.

  • Provide Twenty-Four Hour Coverage, as defined in MaineCare Benefits Manual, Ch. VI - Section 1: Primary Care Case Management.

  • Have received National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home recognition by date determined by MaineCare

  • Have established member referral protocols with area hospitals, which include coordination and communication on enrolled or potentially eligible HHP members.

  • Must partner with a community mental health provider that is approved to deliver Behavioral Health Home services.

  • Commit to Core Expectations for Health Home practices

  • Application for HHPs is open until January 24, 2014

10


Reimbursement

Payment is structured to support both the PCP and the community mental health provider to coordinate care:

Mainecare is also proposing to CMS an additional $35.00 PMPM during the first three months of start up for additional engagement, education, and outreach

11


Service expectations

  • Minimum billable service for Health Home Practices aligns with current Stage A expectations:

    • scan for gaps in care

    • attestation of members via HHES portal

  • Minimum billable service for the BHHO is one hour of service per member, per month

12


SIM Supports

  • Behavioral Health Homes Curriculum Development (TBD)

  • Behavioral Health Home Learning Collaborative (QC)

  • RFP for EHR supports and connectivity (HIN)

  • Behavioral Health Quality Measures (MHMC)

13



More information

MaineCare’s Value-Based Purchasing Website:

http://www.maine.gov/dhhs/oms/vbp/

[email protected]

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