Health Homes Implementation Process, Frequently Asked Questions

FAQ Categories

Miscellaneous Questions

How will we ensure cooperation by the hospitals to provide admit/discharge information so that the care manager can contact patients within 72 hours?
Each practice site participating in the Primary Care Health Home Program must enter into a Memorandum of Understanding (MOU) with the hospitals with which they have patients in common to ensure proper coordination of services.
What is the definition of “plan of care”? What plan of care will be monitored?
A plan of care is a written plan for services developed by the Care Management team and the patient to assess and determine the patient’s status and needs. The plan of care also outlines the services that will be provided to the patient to meet their identified needs and goals. The plan of care for patients enrolled in the health home will be monitored.
Are we to be using the ICD-9 codes for BMI’s? We are using the generic overweight codes and not the BMI specific codes per previous guidance.
No, For Reporting BMI and tobacco use the practice will have to provide an EMR extract file of the actual values to the MPCA data warehouse. MPCA will be handling data aggregation and reporting from the PC-HH practices to MHD. On a separate note regarding claims submission, all claims submitted to MO HealthNet for payment must use the appropriate ICD-9 codes with the highest level of specificity to describe the patient’s condition and/or status.
What are the essential elements that need to be addressed in the care plans?
In the primary care health home program, key components include care coordination, care management, behavioral health integration, and quality. Additional assistance with care plans may be offered in the Learning Collaboratives.
I understand the PCMH organizations have been decided, but when will the sites be defined?
MHD has forwarded reports to each organization, including projected staffing ratios and salaries, projected initial patient volumes, and a projected fiscal impact. Please take some time to review this information. Organizations will need to determine how they would like to proceed in the health home process based upon this information, including how many sites will participate for your organization. In many cases, this will be a business decision to be made by the individual organization.
What date range do you want for Tobacco Use and BMI? Is it on straight Medicaid and Medicaid Managed Care? What age ranges?
The most recent Information regarding tobacco use and BMI within the previous 12 months must be provided on both fee-for-service and MO HealthNet Managed Care participants. We are looking for both adult and pediatric obesity data.
Do we have to have the site operational in order to get full reimbursement beginning in February? If we are trained in April, will we be able to participate for 2 years after that date?
Once MHD has obtained approval by CMS to start the program, there will be federal funding for a full 8 quarters. Your site must be operational and reimbursement will depend on evidence of patient contact during the prior quarter.
When do we anticipate formal sign-up/contract finalized between us and the department?
We anticipate beginning the program in the first quarter of 2012. Agreements would need to be completed prior to that time.
Is this call being recorded so it can be played back at a later date?
The call was not recorded but a document outlining the highlights of the call is available at http://www.dss.mo.gov/mhd/cs/health-homes/ under “October 13, 2011 Health Home Conference Call Highlights”.
Will there be specific quality measures other than UDS or other standard reports such as health disparities data that will be required to report?
Both the CMHC and primary care health homes will be reporting measures that have been decided upon by the health home work groups. These measures may need to be modified once CMS finalizes its set of health home measures. Please see Attachment 1.
Will agreements be between the Health Centers and MO HealthNet, or through definition in regulation?
MO HealthNet is currently exploring whether an MOU type of agreement will be needed.
Is signing the letter of intent binding?
No. Such letters are nothing more than communication with the State. It is hoped that organizations will attend and participate through the 8 quarters, but there is no expectation that this is required.
What does SMI stand for?
Serious mental illness.
We are included and actively participating in the St. Louis-Central learning collaborative, so is it still necessary for us to send a letter of intent to MO HealthNet?
Yes. MHD still requires a letter of intent to demonstrate not only your organization’s attendance at the Learning Collaborative, but also the ability to meet minimum staffing requirements, supply required reports, and satisfy all other requirements for participating as a Health Home.
Will MHD be releasing a template for the Letter of Intent and/or specifics around address and to whose attention the LOI is to be sent?

MHD does not have a specific template for the letter of intent. However, we are requesting that the letter include: (a) the sites will be participating; (b) the counties served by those sites; (c) the DCNs that you wish to assign to those sites; and (d) your intent to meet minimum staffing requirements, supply required reports, and satisfy all other requirements for participation as a Health Home. The letter of intent and accompanying DCN information should be sent to:

Dr. Samar Muzaffar, Medical Director, MO HealthNet Division, PO Box 6500, Jefferson City, MO 65102-6500.

And/or emailed to Samar.Muzaffar@dss.mo.gov.

Will data pieces and data flow be identified prior to the required date for signing the Letter of Intent, as we would need to be sure we have the resources capable of producing the required reports.
Data requirements for required reports are still being finalized. Your letter of intent is a non-binding document: should your organization be unable to meet the requirements, you may still withdraw from the Health Home program at a future date.
The initial information indicated that the program would include a “shared savings” component around a reduction in total medical spending. Is that still a part of the program?
This is still under consideration by the State and CMS. A State Plan Amendment will have to be submitted and approved by CMS before this can be implemented.
What benefit in potential shared savings would an agency derive from grouping multiple primary care sites?
By grouping multiple sites, the combined volume of patients may contribute to a greater shift in utilization and achievement of desired outcome measures, thus allowing for more shared savings.
When can we expect to receive the request for the one-on-one call from MO HealthNet to hospital-owned practices, which was mentioned in this week’s call?
MHD is currently scheduling two additional conference calls, one on December 15th and one on December 23rd. We will provide additional updates at those calls and as available, including when the one-on-one or small group calls will occur.
Is there a definition somewhere of what a “contact” is with the identified participants in the MO HealthNet plan for each month that we receive the PMPM payment?
A contact includes the provision of one of the six health home services of: Comprehensive Care Management, Care Coordination, Health Promotion, Comprehensive Transitional Care, Individual and Family Support Services, and Referral to Community and Social Support Services.
Do we submit a bill each month?
A bill should be submitted for each health home participant as the health home services are provided.
There is a concern, according to our revenue projections/spreadsheet, that if we don’t see every person every month and generate that revenue, we will still have the expense for staffing but not enough revenue to support the expense. Or, if we don’t perfectly submit a bill for reimbursement, the revenue will also be affected. There is little margin for error when you look at the projected profit. Or, do we automatically receive the monthly PMPM per participant regardless?
There will be a monthly “attestation form” that providers will submit to MHD through CyberAccess to confirm they have provided at least one of the six health home services for their assigned patients during the month being considered for payment . MHD will also do a look-back to make sure there was at least one medical claim in history for each assigned patient within the past 3-month period. Once this is confirmed, the PMPM payment will be made to the health home provider.