MaineCare
Behavioral Health Homes
January, 2014
https://www.maine.gov\dhhs\oms\vbp
Overview
• A new service being offered by MaineCare in April, 2014
• Per the Affordable Care Act, a Health Home offers:
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Care Management of physical and mental health needs
Care Coordination and health promotion
Help in transitional care, including follow up
Support to help self-manage physical and mental health conditions
Referral to other services
The use of Health Information Technology to link services
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Maine’s Health Homes
“Stage A”
Primary Care Health Home Practice (HHP)
Community Care Team (CCT)
Health Homes
Serves adults and children with
chronic health conditions
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Maine’s Behavioral
Health Homes –
“Stage B"
Behavioral Health
Home Organization (BHHO)
A Primary Care Practice (HHP)
Behavioral Health Homes
Serves adults and children with significant behavioral health needs
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Key Features
• BHHOs are community-based, licensed mental health providers
that partner with one or more HHPs to manage and coordinate
the physical and behavioral health care of individuals with
significant mental health and co-occurring needs
• The BHHO provides comprehensive care management, health
promotion, individual and family support, and other services
• Members are enrolled if they receive case management
/community integration services from a participating BHHO
• Members must select an HHP that partners with that BHHO
• Members may choose to participate in Behavioral Health Homes,
or opt out of BHH at any time.
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Key Features
Member enrolls
via BHHO
Selects HHP
from practice
that is
partnering with
BHHO
Receives
coordinated
BHH services
from the BHHO,
in coordination
with the HHP
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Eligibility
STAGE A
BEHAVIORAL HEALTH HOMES
Chronic Obstructive Pulmonary
Disease (COPD)
Hypertension
Hyperlipidemia
Tobacco use
Developmental Disabilities & Autism
Spectrum
Acquired brain injury
Cardiac & circulatory congenital
abnormalities
Seizure disorder
Mental health
Substance abuse
Asthma
Diabetes
Heart disease
Overweight (BMI > 25) & Obesity
Adults with Serious Mental Illness
Children with Serious Emotional
Disturbance
This initiative closely aligns with
current eligibility for community
mental health services. People
eligible for the following services
will also generally be eligible for
Behavioral Health Homes:
Adults: Community Support
Services
Children: Targeted Case
Management
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Quality Framework
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Goal 1: Reduce inefficient healthcare spending
Goal 2: Improve chronic disease management
Goal 3: Promotion of wellness and prevention
Goal 4: Recovery and effective management of
behavioral health conditions
• Goal 5: Improved experience of care for
consumers/families
Measures build on/are aligned with
Stage A and Accountable Communities measures
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Provider
Requirements: BHHO
Mental health providers must:
• Be licensed community mental health providers
• Provide medication management OR have an MOA with a MM
provider
• Have expertise in co-occurring disorders
• Adopt an EHR within a timeframe specified by MaineCare (no
more than two years after approval as a Behavioral Health Home
Organization).
• Participate in the Behavioral Health Home Learning
Collaborative
• Partner with at least one qualified practice
• Commit to meeting and reporting on Core Expectations,
including enhanced access to care, comprehensive
consumer/family directed care planning ,commitment to
reducing waste and unnecessary health care spending,
integration of Health Information technology
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Provider
Requirements: BHHO
Ability to deliver team-based care:
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Clinical Team Leader
– independently licensed mental health professional, including an Licensed
Clinical Social Worker, Licensed Clinical Professional Counselor, Licensed
Marriage and Family Therapist, psychologist, psychiatrist
Health Home Coordinator
– Qualified TCM case management providers for children or Mental Health
Rehabilitation Technician/C certified providers for adults
Peer Support Specialist
– Certified Intentional Support Specialist (adults) or other designated
training for parents/youth
Nurse Care Manager
– Licensed Practical Nurse, Registered Nurse, Nurse Practitioner
Medical/Psychiatric consultation
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Health Home Practice
Requirements
Primary care providers must:
• Be an approved Health Home Practice OR complete a Health Home
primary care practice application
• Have implemented an Electronic Health Record (EHR) system.
• Provide Twenty-Four Hour Coverage, as defined in MaineCare
Benefits Manual, Ch. VI - Section 1: Primary Care Case Management.
• Have received National Committee for Quality Assurance (NCQA)
Patient-Centered Medical Home recognition by date determined by
MaineCare
• Have established member referral protocols with area hospitals,
which include coordination and communication on enrolled or
potentially eligible HHP members.
• Must partner with a community mental health provider that is
approved to deliver Behavioral Health Home services.
• Commit to Core Expectations for Health Home practices
• Application for HHPs is open until January 24, 2014
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Reimbursement
Payment is structured to support both the PCP and the
community mental health provider to coordinate care:
Primary Care
practice
Behavioral Health
Organization
$15/PMPM
$290.00/PMPM for
children
$330.00/PMPM adults
Mainecare is also proposing to CMS an additional $35.00
PMPM during the first three months of start up for
additional engagement, education, and outreach
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Service expectations
– Minimum billable service for Health
Home Practices aligns with current Stage
A expectations:
• scan for gaps in care
• attestation of members via HHES portal
– Minimum billable service for the BHHO is
one hour of service per member, per
month
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SIM Supports
– Behavioral Health Homes Curriculum
Development (TBD)
– Behavioral Health Home Learning
Collaborative (QC)
– RFP for EHR supports and connectivity
(HIN)
– Behavioral Health Quality Measures
(MHMC)
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Next Steps
Milestone
Date
Finalize list of participating
BHHOs
January 13th, 2014
Application for new HHPs
Member notification
Currently accepting
applications for new HHPs;
application will remain open
until January 24, 2014
February, 2014
Implementation
April 1, 2014
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More information
MaineCare’s Value-Based Purchasing Website:
http://www.maine.gov/dhhs/oms/vbp/
kitty.purington@maine.gov
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