Health Homes Implementation Process, Frequently Asked Questions

FAQ Categories

Patient Auto-Assignment Questions

Are the managed care Medicaid participants covered the same as those with straight Medicaid?
MO HealthNet Managed Care participants are included in the population of MO HealthNet participants eligible to participate in this program.
Can patients be auto-assigned by system, what if we are at capacity?
The initial auto-assignment of patients will be based on claims submitted to MO HealthNet by each practice site. As a result, the patients assigned to each Health Home site should be patients that are currently treated at that site. Patients can then be added or removed from the practice site or Health Home program at the provider’s and/or patient’s discretion.
Are there geographic limits to auto-assign?
No, The initial auto-assignment of patients will be based on claims previously submitted to MO HealthNet by each practice site. As a result, the patients assigned to each Health Home site should be patients that are currently treated at that site. Eligible patients have the ability to choose their health home and can be added or removed from the practice site or Health Home program at the provider’s and/or patient’s discretion. Health Homes and MHD are required to notify persons auto-enrolled or considering enrollment that they can choose any designated Health Home that is available. Accordingly, we will be requesting that all designated Health Homes provide a list of counties of patient residence that their Health Home services will cover. This information will be used to make a table that Health Homes can use to provide the CMS required patient choice.
How many total patients do you anticipate to be enrolled?
Our current estimate is approximately 25,000 MO HealthNet eligible participants initially enrolled in the Health Home program.
Do patients have to agree to participate/what is the sign-up process?
Initially auto-enrolled participants will remain enrolled unless they decline Health Home Services or request to switch to another Health Home. The letter that MHD will mail to auto-enrolled patients will explain that they can choose to decline Health Home Services or choose a different Health Home than the one in which they are auto-enrolled. The first time that a member of your Health Home Team meets with a newly auto-enrolled health home patient they will have to provide the same written notice of the right to decline services and choice of Health Home and document that notification in some manner. They do not have to sign any agreement to participate. Providers have the option to add or remove participants from their practice/site at their discretion. Patients have the ability to opt out of the program or to request to change their Health Home site.
Will the Health Home project for MO HealthNet include individuals with dual eligibility?
Yes, dual Medicaid – Medicare participants are included in the population of MO HealthNet participants eligible to participate in this program.
If a patient who does not qualify initially, develops eligibility over time, how will that be handled?
A checklist/communication mechanism will be developed to indicate which disease states/chronic conditions have been developed to enable such individuals to become eligible.
Can we have a list of diagnosis codes that satisfy the chronic conditions?
MHD will be sharing the range of codes that it used for the disease groups that qualify a participant for the health home initial auto-enrollment and MHD's process with the related caveats.
Can the state auto-assign patients to a particular practice? Is so, what is the basis for these assignments?
Yes, the state can auto-assign patients to a particular practice, based on the number of recent claims submitted by a practice for that individual. If later on the patient or the practice does not believe it is the appropriate assignment, a request can be made to reassign the patient to a different participating practice. Within an organization with multiple sites, the practice must identify the sites which will be participating and assign patients to the most appropriate site.