CSAC Bulletin Article

DHCS Releases Updated Health Homes Concept Paper

The Department of Health Care Services (DHCS) released its third iteration of their Health Homes for Patients with Complex Needs Concept Paper – Version 3.0 for comment on December 14. Recall, the Medicaid Health Home State Plan option is afforded to states under Section 2703 of the Patient Protection and Affordable Care Act enacted in March 2010. Section 2703 allows states to create health homes to coordinate a full range of physical health, behavioral health and community-based long term services and supports (LTSS) for members with chronic conditions.

According to DHCS’ 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 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; and
  • Referral to Community and Social Supports.

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;
  • Primary care or specialist physician or physician group;
  • Substance use disorder treatment provider;
  • Providers serving individuals experiencing homelessness; or
  • Other organizations as certified by the managed care plan.

The proposal also goes on to discuss the roles and models of the community based care management entities, the structure of the multidisciplinary teams, and reporting requirements. In addition, DHCS also notes the interaction between the Health Homes Program and other existing Medi-Cal programs. DHCS is working to ensure that the program and funding provided in counties implementing both Health Homes and Whole Person Care are complementary and not duplicative.

DHCS envisions a county rollout of the Health Homes program beginning as early as January 2017. The anticipated county-by-county rollout schedule is condensed into three groups:

Group 1: Del Norte, Humboldt, Lake, Marin, Mendocino, Napa, San Francisco, Shasta, Solano, Sonoma and Yolo

  • Members with Serious Mental illness – January 1, 2017
  • Other Eligible Members – July 1, 2017

Group 2: Imperial, Lassen, Merced, Monterey, Orange, Riverside, San Bernardino, San Mateo, Santa Clara, Santa Cruz, Siskiyou, Ventura

  • Members with Serious Mental illness – July 1, 2017
  • Other Eligible Members – January 1, 2018

Group 3: Alameda, Fresno, Kern, Los Angeles, Sacramento, San Diego, Tulare

  • Members with Serious Mental illness – January 1, 2018
  • Other Eligible Members – July 1, 2018

Other key implementation dates for the Health Homes Program include:
January 2016

  • Release Managed Care Plan Request for Application for Group 1 counties
  • Release Service Provider Requests for Information (Provider RFI) for Group 1 counties

March 2016

  • Projected CMS approval of 2703 SPA
  • Begin to provide technical assistance, build health home networks and prepare for implementation (ongoing)

January 2017

  • Begin operating the health homes program (first SPA effective date for enhanced match purposes)

Questions and/or comments regarding this iteration of DHCS’ Health Homes program concept paper should be directed to HHP@dhcs.ca.gov by December 24, 2015.

DHCS released its first iteration – HHPCN Version 1.0 - in November 2014 and its second iteration – HHPCN Version 2.0 – in April 2015.

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