CSAC Bulletin Article

DHCS Proposes Updates to Health Homes Program

September 29, 2016

The Department of Health Care Services (DHCS) is proposing to amend the Medi-Cal 2020 waiver Special Terms and Conditions to try to implement the Health Homes Program in the Medi-Cal managed care delivery system.

Under the Affordable Care Act, the Medicaid Health Home State Plan option is afforded to states to encourage the creation of health homes that can better coordinate a full range of physical health, behavioral health, and community-based long-term services and supports for patients with chronic conditions.

According to DHCS’s proposal, managed care plans will serve as the lead entity and will be responsible for the overall administration of the program. Plans will enter into contracts directly with DHCS and will receive payments directly from DHCS that will flow to other entities participating in the Health Homes Program. Plans will be responsible for contracting with the Community Based Care Management Entities for the provision of health homes services.

Health Homes will provide 6 core services:

  • Comprehensive care management
  • Care coordination
  • Health promotion
  • Comprehensive transitional care
  • Individual and family support services
  • Referral to community and social supports

These services would be provided to a target population chosen by the state from one or more of the following categories:

  • Two or more chronic conditions
  • One chronic condition and at risk for a second
  • A serious and persistent mental health condition

Community Based Care Management Entities will be the frontline providers of health home services. They will be selected and certified by managed care plans and can be one of the following types of organizations:

  • Community mental health center
  • Community health center
  • Hospital or hospital-based physician group or clinic
  • Local Health Department
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