1. Title text here Health Homes: The 4 th Long-Term Care Policy Summit September 5, 2012 Wendy Fox-Grage AARP Public Policy Institute

2.  In 2007, four physician associations developed a set of joint principles for a “patient-centered” medical home  Physician-Centered  Care Coordination  Patient Outcomes and Evidence-Based Care  Expanded Hours of Care  Payment  23 states have medical home initiatives in Medicaid/CHIP programs 2

3.  Option for Medicaid State Plans  Comprehensive system of care coordination for Medicaid enrollees with chronic conditions  Primary, acute, behavioral health, and long- term services and supports for “whole person” care 3

4.  Improved quality of care/outcomes for individuals  Improved experience of care for beneficiaries  Reduction in hospital admissions and readmissions  Reduction in emergency room use  Less reliance on nursing homes  Reduction in overall health care costs 4

5.  Comprehensive care management  Care coordination  Health promotion  Comprehensive transitional care  Patient and family support  Referral to community and social support services, if relevant  Encourages use of health information technology as feasible 5

6. AlabamaArkansas ArizonaCalifornia District of ColumbiaIdaho MaineMississippi NevadaNew Jersey New MexicoNorth Carolina WashingtonWest Virginia Wisconsin 6

7. States with Approved State Plan Amendments as of August 2012:  Missouri (two Approved SPAs)  Rhode Island (two Approved SPAs)  New York  Oregon  North Carolina  Iowa States with SPAs on the Clock:  Alabama  New York (3)  Ohio  Wisconsin Draft Proposals : Oklahoma, West Virginia, Maine, Idaho, Massachusetts 7

8. Medicaid eligible individual having:  two or more chronic conditions,  one condition and the risk of developing another, or  or at least one serious and persistent mental health condition 8

9. The chronic conditions listed in statute:  mental health condition,  substance abuse disorder,  asthma,  diabetes,  heart disease, and  being overweight (a BMI of > 25). Through Secretarial authority, States may add other chronic conditions for approval by CMS. 9

10.  Examples include Multiple Disciplines:  Physician and/or Group Practice  Rural Health Clinic  Community Health Center  Community Mental Health Center  Managed Care Organization  Home Health Agency  Hospital * States may include many other providers, subject to CMS approval 10

11.  90% enhanced federal match for 1 st 8 quarters for health home services for each enrollee  CMS will NOT reimburse for duplicative services  Health home needs to be in place before reimbursement can begin 11

12.  Building onto existing medical home and primary care case management program or vs. a new model  Interdisciplinary team  Geographic coverage  Training and IT infrastructure  Payment 12

13. Providers: Report quality measures to the State to receive payment State : Collect utilization, expenditure, and quality data for an interim survey and an independent evaluation CMS Reports to Congress : Survey of States & Interim Report to Congress in 2014; and Independent Evaluation & Report to Congress in 2017 13

14. 1. Adult BMI Assessment 2. Ambulatory Care-Sensitive Condition Admission 3. Care Transition – Transition Record Transmitted to Health care Professional 4. Follow-Up After Hospitalization for Mental Illness 5. Plan- All Cause Readmission 6. Screening for Clinical Depression and Follow-up Plan 7. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment 14

15.  Service Utilization  Institutional Admissions  Emergency Room Visits  Cost Savings  Use of Health Information Technology  Quality and Outcomes 15

16.  Health Information Technology: Electronic medical records and data requirements  Conflict Free Case Management  Financial Sustainability: Only 8-quarters of enhanced Medicaid match 16

17.  Health Homes State Medicaid Director Letter  Health Homes information on Medicaid.gov http://www.medicaid.gov/Medicaid-CHIP- Program-Information/By-Topics/Long-Term- Services-and-Support/Integrating- Care/Health-Homes/Health-Homes.html http://www.medicaid.gov/Medicaid-CHIP- Program-Information/By-Topics/Long-Term- Services-and-Support/Integrating- Care/Health-Homes/Health-Homes.html  Integrated Care Resource Center (TA contractor) www.integratedcareresourcecenter.com 17

18.  Health Homes Mailbox at CMS healthhomes@cms.hhs.gov healthhomes@cms.hhs.gov  Wendy Fox-Grage, AARP Public Policy Institute wfgrage@aarp.orgwfgrage@aarp.org ; 202-434-3867 18 Where to Go for More Info and Help?