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MaineCare Behavioral Health Homes

Discover Maine's Health Homes program, offering coordinated and comprehensive care for physical and mental health needs. Improve wellness and reduce healthcare spending through integrated services. Eligible providers join to enhance patient experience.

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MaineCare Behavioral Health Homes

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  1. MaineCare Behavioral Health Homes January, 2014 https://www.maine.gov\dhhs\oms\vbp

  2. Overview • A new service being offered by MaineCare in April, 2014 • Per the Affordable Care Act, a Health Home offers: • 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 1

  3. 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 2

  4. 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

  5. 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.

  6. Key Features

  7. Eligibility

  8. Quality Framework • 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 7

  9. 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 8

  10. Provider Requirements: BHHO Ability to deliver team-based care: • 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 9

  11. 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 10

  12. Reimbursement Payment is structured to support both the PCP and the community mental health provider to coordinate care: 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 11

  13. 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 12

  14. 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) 13

  15. Next Steps 14

  16. More information MaineCare’s Value-Based Purchasing Website: http://www.maine.gov/dhhs/oms/vbp/ kitty.purington@maine.gov 15

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