MaineCare Behavioral Health Homes

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