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Public Notice: Proposed Medicaid State Plan Amendment Governing Health Homes for Individuals With Serious Mental Health Conditions

Friday, June 13, 2014
The Department of Health Care Finance (DHCF), in accordance with the requirements set forth in 42 CFR § 447.205, announces the upcoming submission of an amendment to the District of Columbia State Plan for Medicaid Assistance requesting authority from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) to create Health Homes for individuals with serious and persistent mental health conditions. Health Homes will be responsible for coordinating the full spectrum of health care needs for eligible individuals who, in addition to serious and persistent mental health conditions, may also have co-occurring chronic medical conditions.
The purpose of this notice is to summarize the contents of the Health Home for Individuals with Serious and Persistent Mental Health Conditions State Plan Amendment (SPA), and request comments from the public. This proposed SPA is posted on the DHCF webpage at http://dhcf.dc.gov/publication/proposed-spa. Copies of the SPA may also be obtained by contacting Dena Hasan at (202) 535-2178 or [email protected].
Comments on the Health Home for Individuals with Serious and Persistent Mental Health Conditions SPA may be submitted in writing to Claudia Schlosberg, Interim Senior Deputy Director/State Medicaid Director, Department of Health Care Finance, 441 4th Street, NW, 9th Floor South, Washington, DC 20001, via telephone on (202) 442-8742 or via e-mail at [email protected], within thirty (30) days after the date of publication of this notice in the DC Register. Additionally, comments may be submitted in person during a public meeting on Friday, June 27, 2014, from 10 am to 12 pm, at 1300 1st Street, NE, Washington, DC 20002, Room 340.
Program Overview
The Department of Health Care Finance (DHCF) and the Department of Behavioral Health (DBH) have partnered to develop a Health Home State Plan benefit that will target individuals with severe and persistent mental illness, and aim to: (1) improve the integration of physical and behavioral health care; (2) lower rates of hospital emergency department use; (3) reduce avoidable hospital admissions and re-admissions; (4) reduce healthcare costs; (5) improve the experience of care, quality of life and consumer satisfaction; and (6) improve health outcomes. DHCF and DBH intend to implement this program in January 2015.
Medicaid providers that deliver Health Home services will be Core Services Agencies and Assertive Community Treatment (ACT) agencies that meet specific standards as part of DBH’s Health Home certification process. Health Home providers will serve as the central point for coordinating patient-centered and population-focused care, and will be responsible for integrating behavioral and primary care for eligible individuals.
Health Home providers will use a team-based approach, built on evidence-based care management guidelines. Providers will also collaborate with DC Medicaid Managed Care Organizations (MCOs), Dual-Eligible Special Needs Plans (D-SNPs), primary care providers (PCPs) and hospitals for the exchange of data critical to ensuring that the right people receive services, at the right time. The DHCF and the DBH will continuously evaluate the impact of the Health Home program against performance measures as part of the agencies’ ongoing quality improvement efforts.