MaineCare Behavioral Health Homes January,

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 Overview

Primary Care Health Home Practice (HHP) Community Care Team (CCT) Health Homes Serves adults and children with chronic health conditions 2 Maine’s Health Homes “Stage A”

Behavioral Health Home Organization (BHHO) A Primary Care Practice (HHP) Behavioral Health Homes Serves adults and children with significant behavioral health needs 3 Maine’s Behavioral Health Homes – “Stage B"

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. 4 Key Features

5 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

6 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

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 Quality Framework

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 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 Provider Requirements: BHHO

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, Health Home Practice Requirements

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 Reimbursement Primary Care practice $15/PMPM Behavioral Health Organization $290.00/PMPM for children $330.00/PMPM adults

– 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 Service expectations

– 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 SIM Supports

14 Next Steps MilestoneDate Finalize list of participating BHHOs January 13 th, 2014 Application for new HHPsCurrently accepting applications for new HHPs; application will remain open until January 24, 2014 Member notificationFebruary, 2014 ImplementationApril 1, 2014

MaineCare’s Value-Based Purchasing Website: 15 More information