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Defining & Recognizing a Medical Home

Medical Homes help establish provider expectations and implement processes to recognize primary care practices that meet those expectations.

Alabama
Recognition:
ACA Section 2703 Health HomesAlabama Medicaid does not require formal recognition or certification for health home providers. Health home providers requirements are aligned with requirements for primary medical providers (PMPs) within the Patient 1st and Patient Care Networks of Alabama programs. Expectations for Patient 1st PMPs can be found in the Patient 1st Handbook.
Alaska
Definition: A 2011 Department of Health and Social Services (DHSS) Medicaid Task Force report offers the following definition: “The medical home: (1) puts the patient at the center of their health care decisions, (2) makes it easier for patients to get care and advice when they need it, (3) provides the right care at the right time and eliminates unnecessary procedures, (4) improves health outcomes, (5) coordinates care across multiple providers, and (6) partners patients with their own team of primary care providers.”
 
Recognition: Within 18 months of pilot launch, participating practices must achieve medical home accreditation or recognition under one of three national programs – NCQA PPC PCMH, Joint Commission, or Accreditation Association for Ambulatory Health Care (AAAHC).
 
In addition to the recognition requirements described above, the practice selection process favored sites that had a focus on behavioral health integration and mature health information technology capacity.
 
The AK-PCMH-I Request for Proposals (RFP) also identifies five core medical home competencies:
  1. Facilitate ongoing provider-patient relationship
  2. Coordinate continuous patient centered care
  3. Provide highly accessible medical home services
  4. Reduce unnecessary healthcare spending, reduce waste, and improve cost-effectiveness of the health care services
  5. Take part in a quality improvement process
Arizona No known activity at this time.
Arkansas
Definition: The Payment Improvement Initiave defines medical homes as “a doctor or care team that takes responsibility for the overall health of a patient.”
 
Recognition: Practices were selected for participation in CPCi through a competitive application process. Under CMS’s Comprehensive Primary Care Initiative, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commission, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
  • Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extenson Center (REC);
  • Percentage of practice revenue earned from participating payers; and
  • Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives.
California
No known activity at this time.
Colorado
Definition:
Medical Homes for Children Program: Chapter 346 of the 2007 Session Laws provided a state-developed definition of medical homes for children as follows: “[A]n appropriately qualified medical specialty, developmental, therapeutic, or mental health care practice that verifiably ensures continuous, accessible, and comprehensive access to and coordination of community-based medical care, mental health care, oral health care, and related services for a child. A medical home may also be referred to as a health care home. If a child's medical home is not a primary medical care provider, the child must have a primary medical care provider to ensure that a child's primary medical care needs are appropriately addressed. All medical homes shall ensure, at a minimum, the following:
  1. Health maintenance and preventative care;
  2. Anticipatory guidance and health education;
  3. Acute and chronic illness care;
  4. Coordination of medications, specialists, and therapies;
  5. Provider participation in hospital care; and
  6. Twenty-four-hour telephone care.”
Recognition
Medical Homes for Children Program: Certification using the Medical Home Index; Eleven state-developed qualification standards across eight domains (Accessible; Family-Centered; Comprehensive; Culturally Competent; Compassionate; Coordinated; Continuous; and Community-based).
 
Accountable Care Collaborative (ACC) Program: Under the Accountable Care Collaborative (ACC) Program, practices and providers can become participating Primary Medical Care Providers (PMCPs) if they:
  • Are certified Medical Home for Children Program providers; or
  • Focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology.
Furthermore, PCMPs must commit to nine additional principles that ensure care is patient/family-centered; whole-person oriented and comprehensive; coordinated and integrated; provided in partnership with the patient and promotes patient self-management; outcomes-focused; consistently provided by the same provider as often as possible so a trusting relationship can develop; and provided in a culturally competent and linguistically sensitive manner.
 
Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CMS’s Comprehensive Primary Care Initiative through a competitive application process. Under CPCi, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commissioner, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
  • Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extension Center (REC);
  • Percentage of practice revenue earned from participating payers; and
  • Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives. 
HealthTeamWorks Multi-payer Pilot: The HealthTeamWorks multi-payer pilot used National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH) recognition standards.
Connecticut
Recognition: Participating medical homes must meet Level 2 or Level 3 NCQA medical home recognition standards (2008 or 2011, depending on time of NCQA application).
 
Additionally, Connecticut mandates that medical home practices must:
  • Meet Federal Early Prevention Screening Diagnostic and Treatment (EPSDT) screening requirements;
  • Participate in a specific smoking cessation incentive program;
  • Participate in initiatives to decrease racial and ethnic health disparities; and
  • Adhere to consumer protection standards.
Practices that choose the Glide Path option will participate in a structured program that culminates in NCQA Level 2 or Level 3 recognition. The purpose of this option is to assist practices that would not currently receive Level 2 or Level 3 NCQA PCMH recognition, a requirement to receive full payment incentives. Practices choosing this option progress through three phases:
 
Phase I: Practices must meet three of the following requirements:
  1. NCQA Level 1 recognition;
  2. Receipt of Medicaid electronic health record (EHR) incentive payments;
  3. Orientation of clinical and non-clinical staff to medical home requirements and strategies to meet medical home requirements;
  4. Ongoing monthly learning activities for clinical and non-clinical staff; or
  5. Documentation for the adoption/implementation of a new Meaningful Use Certified EHR OR development of a workplan to upgrade an existing EHR to meet Meaningful Use Certification. 
Phase II: Practices must meet three of the following requirements:
  1. Use of a Meaningful Use Certified EHR for electronic prescribing, problem list generation, medication management, and progress note generation;
  2. A contract with the eHealth Connecticut Regional Extension Center with the goal of becoming a meaningful user of an EHR;
  3. Employ or contract care coordination and disease education resources;
  4. Use of an EHR or registry to identify and serve patients with chronic conditions; or
  5. Enhanced access to clinical sites (including expanded hours and/or electronic communication)
Phase III: NCQA Level 2 or Level 3 recognition.
 
Practices have six months to complete each phase of the program. However, practices may take extensions totaling no more than six additional months. If a practice does not receive NCQA Level 2 or Level 3 recognition within 24 months from the start of their participation, the practice is no longer qualified to participate in the Glide Path.
Delaware No known activity at this time.
District of Columbia
No known activity at this time.
Florida
Definition: The Medicaid Medical Home Task Force has recommended that the state’s definition of a medical home specify that medical home providers (1) are available on a 24/7 basis, (2) coordinate care with other providers serving a patient, and (3) address both physical and behavioral health needs.
 
Recognition: The Task Force has suggested using the National Committee for Quality Assurance (NCQA) as a starting point for developing recognition criteria. The task force also recommended maintaining the three-tier structure of NCQA recognition.
Georgia No known activity at this time.
Hawaii No known activity at this time.
Idaho
Definition
Idaho Medical Home Collaborative (IMHC): The IMHC identifies 11 “critical elements” of a patient-centered medical home:
  1. Engaged leadership
  2. Empanelment
  3. Patient/familu/peer/advocate/caregiver-centeredness
  4. Multi-disciplinary team-based approach to care
  5. Planned visits and follow-up care
  6. Population-based tracking and analysis with patient-specific reminders
  7. Care coordination across settings, including referral and transition management
  8. Integrated clinical care management services focused on high-risk patients
  9. Patient self-management support and family education
  10. Evidence-based care delivery and integration of quality improvement strategies
  11. Enhanced access
ACA Section 2703 State Plan Amendment: Idaho's state plan amendment states that health home providers will "identify and lead the team based care coordination aproach between the clinic and specialist so the whole person's care is taken into account in both chronic disease and mental health treatment."
 
Recognition
Idaho Medical Home Collaborative (IMHC):There are common minimum standards for participating pilot practices. These common standards include:
  • Attain 2011 NCQA PCMH Level 1 recognition by the end of the two-year pilot
  • Utilize an electronic registry with reporting functionality
  • Attend pilot learning collaborative and training events
  • Meet data reporting requirements
Practices must qualify for enhanced reimbursement from two or more payers to participate in the pilot, which requires practices to also meet additional standards set by the insurers with whom they contract. The IMHC describes provider requirements by payer: Idaho Medicaid, Blue Cross of Idaho, Pacific Source, and Regence Blue Shield of Idaho. To learn more, visit the IMHC’s matrix of Multi-Payer Pilot provider requirements.
 
ACA Section 2703 State Plan Amendment: In addition to the common standards required to participate in the IMHC pilot, daho health homes are required to be participating providers in the state's Health Connections program (primary care case management).
Illinois
Definition: According to the Illinois Health Connect website, “your medical home is the doctor’s office or clinic where you go to see your Primary Care Provider.”
 
Recognition: Primary care providers in Illinois Health Connect sign a participation agreement that includes the following requirements, among others:
  • Develop, “a symptom-based action plan of care to be shared with Enrollees with chronic diseases including asthma, diabetes, coronary artery disease, congestive heart failure and chronic obstructive pulmonary disease.”
  • “Provide direct access to enrollees through an answering service/paging mechanism or other approved arrangement for coverage twenty-four hours a day, seven days a week (24/7). Automatic referral to hospital ER does not qualify.”
  • “Perform periodic preventive health screenings in accordance with established standards of care.”
  • “Schedule, or coordinate with a case manager to schedule, diagnostic consultation and specialty visits.”
  • Ensure that, “routine, preventive care appointments [are] available within five weeks, and within two weeks for infants.”
  • Ensure that, “urgent care appointments not deemed emergency medical conditions [are] triaged and, if deemed necessary, provided within 24 hours.”
Under Illinois Health Connect, specialists may be considered primary care providers.
Indiana No known activity at this time.
Iowa
Definition: 
IowaCare: According to Iowa’s 2008 Health Care Reform Act (House File 2539), a patient-centered medical home means an, “approach to providing health care that originates in a primary care setting; fosters a partnership among the patient, the personal provider, and other health care professionals, and where appropriate, the patient’s family; utilizes the partnership to access all medical and nonmedical health-related services needed by the patient and the patient’s family to achieve maximum health potential; maintains a centralized, comprehensive record of all health-related services to promote continuity of care; and has all of the characteristics specified in section 135.158.” Section 135.158 identifies the following characteristics:
  • Personal provider
  • Provider-directed medical practice
  • Whole person orientation
  • Coordination and integration of care
  • Quality and safety
  • Enhanced access to health care
  • Appropriate payment
Recognition: 
IowaCare: Participating IowaCare medical homes are expected to obtain recognition from either the National Committee for Quality Assurance (NCQA) “or the equivalent, as determined by the” state. This is specified in the IowaCare 1115(a) waiver.  Iowa has agreed to accept the Joint Commission primary care medical home designation as an acceptable alternative to NCQA recognition.
 
In addition to medical home recognition (NCQA) or certification (Joint Commission) practices are expected to meet standards related to:
  • Development of continuity of care documents to aid in communication across care settings
  • Development of personal treatment plans
  • Comprehensive patient evaluations
  • 24-hour provider accessibility
  • Use of a protocol or standards for tracking patient referrals
  • Provision of same-day services when appropriate
  • Designation of a dedicated care coordinator
  • Establishment of a disease management program (practices must focus on diabetic patients in year one)
  • Establishment of a wellness/disease prevention program
  • Use of health information technology
  • Use of a system to remind patients about preventive services
  • Establishment of a system to share information with the University of Iowa Health Center for specialty care
Further details on the additional standards are available on pages 36-38 of the IowaCare 1115(a) waiver.
 
ACA Section 2703 Health Homes: Participating practices are required to achieve NCQA PCMH recognition under the 2011 standards, as well as complete a self-assessment and submit the results to the state. Health homes are also required to meet additional standards, such as maintaining continuity of care documents for eligible patients; designating a dedicated care coordinator with responsibility for health home enrollees; adopting electronic health records; implementing a formal behavioral health screening process; and reporting annually to the state on process and outcome measures.
Kansas
Definition: In Kansas a medical home is defined in statute as “a health care delivery model in which a patient establishes an ongoing relationship with a physician or other personal care provider in a physician-directed team, to provide comprehensive, accessible and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality and health outcomes in a cost effective manner.” See page 26 of Sub. SB 81 (New Section 13).
Kentucky No known activity at this time.
Louisiana
Definition: Act 243 of the 2007 Regular Legislative Session defined a medical home system as: “a health care delivery system that is patient and family centered and is guided by a personal primary care provider who coordinates and facilitates preventive and primary care that improves patient outcomes in the most cost-efficient manner possible. By providing a coordinated continuum of care, the cost of the current health care delivery system shall be reduced, health outcomes shall improve, and the disparities in access to health care among the state's populations shall be reduced. The medical home system of care shall consist of an integrated system of public, private, or public and private primary care providers, specialty care groups, and hospital providers that are willing to participate in the integrated system and meet participation criteria.”
 
In 2008, the Louisiana Health Care Quality Forum’s Board of Directors defined a medical home using an abridged version of the Joint Principles of the Patient-Centered Medical Home: “An approach to providing comprehensive primary care that facilitates partnerships between individual patients, and their personal physicians, and when appropriate the patient’s family.” It is important to note that the Louisiana Health Care Quality Forum stressed that (1) there are times when a medical home need not be physician-led and (2) medical homes should not be restricted to one particular degree or license.
 
Another definition was included in the 2011 Bayou Health Request for Proposals (RFPs): “Systems of care led by a team of primary care providers who partner with the patient, the patient’s family and the community to coordinate care in all settings, from specialists and hospitals to pharmacies, nursing homes and home health agencies. Primary care providers are inclusive of physician-led and nurse-practitioner-led primary care practices.”
 
Recognition: The Louisiana Health Care Quality Forum’s spring 2008 report notes that the Forum’s Board of Directors endorsed the 2008 NCQA PCMH standards
 
As part of the Bayou Health RFPs, care coordination networks are required to promote and facilitate NCQA recognition or Joint Commission (JC) Primary Care Medical Home accreditation. 
 
Networks must meet the following thresholds:
  • End of Year 1: 20% of practices must be NCQA Level 1 recognized or JC accredited;
  • End of Year 2: 30% of practices must be NCQA Level 1 recognized or JC accredited, and 10% of practices must be NCQA Level 2 recognized or JC accredited;
  • End of Year 3: 10% of practices must be NCQA Level 1 recognized or JC accredited; 40% of practices must be NCQA Level 2 recognized or JC accredited, and 10% of practices must be Level 3 recognized or JC accredited.
  • Subsequent Contracts: 80% of practices must receive NCQA recognition or JC accreditation.
Maine
Definition:
Maine PCMH Pilot: According to the Maine Commission to Study Primary Medical Practice, “Principles of a patient centered medical home include a personal physician who leads a medical team that collectively takes responsibility for the ongoing care of patients with a whole-person orientation. Under the model, primary care is coordinated and integrated, and quality, safety and access are of the utmost importance. Hallmarks of the patient-centered medical home include planning, evidence-based medicine, clinical decision support tools, accountability, active participation in decision making by the patient and appropriate information technology supporting an environment of continual quality improvement and increased access through means including expanded hours, open scheduling and new options for expanded communication between doctor and patient.”
 
Recognition:
Maine PCMH Pilot: Under the Patient-Centered Medical Home (PCMH) Pilot, practices are expected to attain at least National Committee for Quality Assurance (NCQA) Level 1 PCMH recognition within six months of beginning participation in the pilot. Practices are also expected to meet ten “core expectations”:
  1. Leadership
  2. Team based approach
  3. Population risk stratification and management
  4. Enhanced access
  5. Integrated care management
  6. Behavioral/physical health integration
  7. Inclusion of patients and families
  8. Connection to community (through local Healthy Maine Partnership)
  9. Commitment to reducing waste, unnecessary spending, and improving cost-effectiveness
  10. Integration of information technology.
ACA Section 2703 Health Homes: Health home practices are required to attain at NCQA Level I recognition, to meet ten “core expectations” required of practices participating in the Maine PCMH Pilot (listed above), and to participate in the state’s PCMH learning collaborative. In addition, practices must agree MaineCare’s Primary Care Case Management standards, which include additional standards around enhanced access, patient-education, and care management.
Maryland
Definition: SB 855/HB 929 defined a patient centered medical home (PCMH) as: “a primary care practice organized to provide a first, coordinated, ongoing, and comprehensive source of care to patients to:
  1. Foster a partnership with a qualifying individual;
  2. Coordinate health care services for a qualifying individual; and
  3. Exchange medical information with carriers, other providers, and qualifying individuals.”
Recognition: National Committee for Quality Assurance (NCQA) medical home recognition, with additional expectations. Practices without NCQA recognition or with recognition expiring after March 2011 must meet the NCQA 2011 standards; others may meet the NCQA 2008 standards. The additional expectations are specified on page 25/B-3 of the practice participation agreement, and include capabilities around 24/7 access, registry use, medication reconciliation, e-prescribing and more. Practices show that they have these additional capabilities by achieving certain NCQA elements that are optional under the standard NCQA system. 
 
Practices were required to achieve Level 1+ recognition no later than March 31, 2012. The state announced that, as of April 2012, all pilot practices achieved this milestone. Practices were required to submit an application for Level 2+ recognition no later than September 30, 2012.
 
Nurse practitioner-led practices are eligible for state recognition as medical homes.
Massachusetts
Definition:
Chapter 224 of the Acts of 2012 defines a medical home as: “a model of health care delivery designed to provide a patient with a single point of coordination for all their health care, including primary, specialty, post-acute and chronic care, which is (i) patient-centered; (ii) comprehensive, integrated and continuous; and (iii) delivered by a team of health care professionals to manage a patient’s care, reduce fragmentation and improve patient outcomes.”
  
Massachusetts Patient-Centered Medical Home Initiative: The Massachusetts Patient-Centered Medical Home Initiative (PCMHI) has identified 12 core competencies for participating practices:
  1. Patient/family-centeredness
  2. Multi-disciplinary team-based approach to care
  3. Planned visits and follow-up care
  4. Population-based tracking and analysis with patient-specific reminders
  5. Care coordination across settings, including referral and transition management:
  6. Integrated care management focused on high-risk patients
  7. Patient and family education
  8. Self-management support by all members of the practice team
  9. Involvement of the patient in goal setting, action planning, problem solving and follow-up
  10. Evidence-based care delivery, including stepped care protocols
  11. Integration of quality improvement strategies and techniques
  12. Enhanced access
Primary Care Payment Reform Initiative (PCPRI): The PCPRI has identified ten core competencies for participating practices, many of which overlap with the PCMHI core competencies listed above:
  1. Patient-centeredness
  2. Multi-disciplinary team-based approach to care
  3. Planned visits and follow-up care
  4. Population-based tracking and analysis with patient-specific reminders
  5. Care coordination across settings, including referral and transition management
  6. Clinical care management services focused on highest-risk panel enrollees
  7. Self-management support of panel enrollees by the multidisciplinary care team
  8. Integration of quality improvement strategies and techniques
  9. Enhanced access to services
  10. Clinic system integration
Recognition:
Chapter 224 of the Acts of 2012 requires a newly formed Health Policy Commission, with consultation from the Office of Medicaid, to develop and implement medical home certification standards by January 1, 2014. The legislation requires the commission to consider existing accreditation standards, including those developed by the National Committee for Quality Assurance (NCQA). The legislation requires the standards to include:
  • Enhanced access;
  • Expanded providers, including care coordinators and social workers;
  • Shared decision-making;
  • Care planning and risk assessment. 
Chapter 224 also requires certified medical homes to use adopt an electronic medical record by December 31, 2016.
 
Massachusetts Patient-Centered Medical Home Initiative: PCMHI practices were required to achieve at least National Committee for Quality Assurance (NCQA) Level 1 recognition, including three otherwise optional NCQA standards. Participating practices were required to achieve NCQA Level 1 “plus” recognition within 18 months of project launch.
 
Primary Care Payment Reform Initiative (PCPRI): PCPRI practices are required to achieve NCQA Level 1 recognition within 24 months of joining the program.
 
Participating practices must also have:
  • Achieved Stage 1 Meaningful Use standards, or to have received Medicaid Adopt/Implement/Upgrade incentives and attest that they plan to achieve Stage 1 Meaningful Use by October 1, 2014; pediatric practices or others ineligible for Meaningful Use due to low Medicaid volume are to provide evidence of this.
  • An electronic medical record (EMR) with patient registry to support chronic disease management, document treatment plans, and have the ability to assign a primary care provider to each patient.
  • 24/7 access by phone or in-person.
  • Hired or contracted with a clinical care manager to identify and service high-risk patients (within 6 months).
  • Meet the ten core competencies listed above (within 18 months).
Participating practices are required to provide integrated primary care and behavioral health services, with coordination and information sharing between primary care and behavioral health providers. Participating practices must pursue one of three behavioral health integration strategies which align with the requirements listed below: non-co-located but coordinated; co-located; and clinically integrated.
 
Participating practices are assigned a Comprehensive Primary Care Payment (CPCP) Tier based on the level of behavioral health covered services provided by the practice (see Attachement K of the PCPRI RFA for a list of behavioral health covered services):
  • CPCP Tier 1: Practices do not provide behavioral health services as defined by the PCPRI.
  • CPCP Tier 2: Practices provide a minimum set of covered behavioral health services. In addition to the standards listed above, Tier 2 practices are required to provide a full-time behavioral health provider (master’s or doctoral level) on-site, with ability to schedule behavioral health appointments within 14 days of request.
  • CPCP Tier 3: Practices provide the maximumset of covered behavioral health services. In addition to Tier 2 requirements, Tier 3 practices must include an on-site psychiatrist as part of the multidisciplinary care team for at least .2 FTE; maintain 24/7 access for behavioral health services; and ensure providers have 24/7 access to a behavioral health record for each enrollee including diagnosis, medications, and acute safety issues.
For more information, see section 3 of the PCPRI RFA.
Michigan
Definition: A multi-stakeholder workgroup convened by the Michigan Primary Care Consortium adopted the Joint Principles of a Patient Centered Medical Home as the statewide consensus definition of “Medical Home,” with the inclusion of four Michigan-specific footnotes further defining ‘patient-centered’, ‘personal physician’, ‘quality and safety’, and ‘payment’.
 
Recognition:
The Michigan Primary Care Transformation (MiPCT) Project requires participating practices to meet either insurer-developed Physician Group Incentive Program (PGIP) standards or 2008 NCQA PPC-PCMH standards (Level 2 or 3 required).
 
Practices that are designated under the BCBSM Physician Group Incentive Program (PGIP) must meet guidelines within twelve “domains of function.” The specific domains are: patient-provider partnerships; patient registries; performance reporting; individual care management; extended access; test results tracking & follow-up; preventive services; linkages to community services; self-management support; patient web portals; coordination of care; and specialist referral processes.
Minnesota
Definition: According to the Minnesota Health Care Homes website, a health care home is: “an approach to primary care in which primary care providers, families and patients work in partnership to improve health outcomes and quality of life for individuals with chronic health conditions and disabilities.”
 
Recognition: The state-developed certification standards include expectations related to:
  1. Access and communication
  2. Participant registry and tracking participant care activity
  3. Care coordination
  4. Care plan
  5. Performance reporting and quality improvement
  6. Patient- and family- centered care
  7. Team-based care delivery
  8. Submission of quality data to Minnesota Community Measurement
The certification rule is available hereAdditional information for practices is also available.
Mississippi Definition: HB 1192 states that patient-centered medical homes "provide a whole-person orientation that includes care for all stages of life, including acute care, chronic care, preventive services and end-of-life care." It goes on to state that "care in a apatient-centered medical home is coordinated across all elements of the health care system and the patient's community to assure that the patient receives the indicated care when and where the patient needs the care in a culturally appropriate manner."
Missouri
Definition: Under Missouri’s state plan amendment to provide health homes for MOHealthNet enrollees served by community mental health centers (CMHCs), health homes must provide accessible, coordinated, person-centered, culturally-competent, and linguistically-capable care that is quality driven and cost effective.

Recognition:
NCQA PPC-PCMH, with additional expectations.
 
Missouri Health homes participating under Missouri's state plan amendment for patients with chronic physical health conditions are required to achieve NCQA Level 1 recognition as well as three otherwise-optional standards. See the provider standards section of the state plan amendment (pages 5-7) for additional requirements.
Montana Definition: In March 2010, stakeholders initially agreed on the following definition of the patient-centered medical home: “In Montana, a patient-centered medical home is health care directed by primary care providers offering family centered, culturally effective care that is coordinated, comprehensive, continuous, and, when possible, in the patient's community and integrated across systems. Health care is characterized by enhanced access, an emphasis on prevention, and improved health outcomes and satisfaction. Primary care providers receive payment that recognizes the value of medical home services.” Senate Bill 84, passed in April 2013, echoes this language.
Nebraska
Definition: 
Nebraska Medicaid Patient-Centered Medical Home Pilot and Multi-Payer Patient-Centered Medical Home Pilot: In Nebraska, a medical home is defined as a health care delivery model in which a patient establishes an ongoing relationship with a physician in a physician-directed team, to provide comprehensive, accessible, and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality, safety, access, and health outcomes in a cost effective manner. For further information, see the Medical Home Pilot Program Act (LB 396).
 
Recognition: 
Nebraska Medicaid Patient-Centered Medical Home Pilot: The Nebraska developed two tiers of recognition. Tier 1 practices were required to meet 29 standards in five “core competencies,” with eight additional standards required to meet Tier 2 recognition standards.
 
Multi-Payer Patient-Centered Medical Home Pilot: Payers participating in the pilot are not required to use certification or recognition standards. The pilot participation agreement specifies that if participating insurers do require practices be certified or recognized as medical homes, they will accept NCQA PCMH recognition, Joint Commission PCMH certification, URAC achievement, or Nebraska Medicaid PCMH Pilot Program standards.
Nevada No known activity at this time.
New Hampshire No known activity at this time.
New Jersey
Definition:
New Jersey Medicaid Medical Home Demonstration Project: P.L. 2010, c.74 defined the medical home model as, at a minimum, including, “a multi-disciplinary team that provides patient-centered care coordination through the use of health information technology and chronic disease registries across the patient’s life-span and across all domains of the health care system and the patient’s community.”  The legislation further specified that health centers may be considered primary care providers.
 
New Jersey’s contract with Medicaid managed care organizations (MCOs) specifies that the MCO demonstration projects are to be executed in accordance with the Joint Principles of the Patient Centered Medical Home.
 
Recognition
New Jersey Medicaid Medical Home Demonstration Project: The Medicaid MCO medical home pilots must use the National Committee for Quality Assurance (NCQA) PCMH standards for practice recognition. All practices must achieve NCQA Level 1 recognition by the end of year 1 and NCQA Level 2 recognition by the end of year 2. See page 440 of the MCO contract for further details.
 
Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CMS’s Comprehensive Primary Care Initiative through a competitive application process. Under CPCi, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commissioner, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
  • Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extension Center (REC);
  • Percentage of practice revenue earned from participating payers; and
  • Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives.
New Mexico
Definition: Chapter 143 of the 2009 Laws defined a medical home as “an integrated care management model that emphasizes primary medical care that is continuous, comprehensive, coordinated, accessible, compassionate and culturally appropriate. Care within the medical home includes primary care, preventive care and care management services and uses quality improvement techniques and information technology for clinical decision support.”  The statute [NMSA 1978 27-2-12.15 (1978)] also enumerates 18 specific attributes that may be included in a medical home.
 
Recognition: Chapter 143 of the 2009 Laws specified that medical doctors, physician assistants, and nurse practitioners are eligible for recognition as offering medical homes. Chapter 43 of the 2010 Laws expanded eligibility to osteopathic physicians, osteopathic physician assistants and pharmacist clinicians.
 
The SALUD! managed care organizations are funding Medicaid pilots and using contractual definitions based on NCQA PCMH principles and modules for PCMH implementation, including: Electronic Medical Record (EMR); Patient Tracking and Registry Functions; Test Tracking; Referral Tracking; e-Prescribing; Access and Communication; and Performance Reporting and Improvement.
New York
New York medical home programs are aligned on the following principles and recognition process:
 
Definition:
 
New York Medicaid further describes a medical home as a physician-led care team that is responsible for providing all of a patient's health care needs, including referrals to other physicians as necessary. Medical homes provide enhanced care that is accessible and culturally and linguistically appropriate.
 
Recognition
 
ACA Section 2703 Health Homes: Health homes are not required to achieve formal certification or recognition. They are required to meet state-developed qualification standards in five areas:
  • Comprehensive care management (includes individualized, patient-centered care plans);
  • Care coordination and health promotion (includes care manager assigned to each patient);
  • Comprehensive transitional care (includes admission and discharge notifications, coordinated transfers, and follow-up post-discharge);
  • Patient and family support (includes a culturally competent care plan is accessible to patients and families); and
  • Referral to community and social support services (includes collaboration with community-based resources and supports). 
Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CMS’s Comprehensive Primary Care Initiative through a competitive application process. Under CPCi, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commissioner, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
  • Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extension Center (REC);
  • Percentage of practice revenue earned from participating payers; and
  • Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives.
North Carolina
Definition:
Community Care of North Carolina (CCNC): CCNC describes a medical home as a place to receive preventative and sick care; where patients have continuous relationships with their providers and staff know patients’ medical histories; where patients have enhanced access; and have access to care coordination services. Please see the CCNC member handbook for more information.
 
Recognition:
Community Care of North Carolina (CCNC): While Community Care of North Carolina (CCNC) actively supports providers seeking NCQA PCMH Recognition, this recognition is not required for CCNC participation. However, the Division of Medical Assistance does require CCNC/Carolina Access providers to:
  • Perform primary care that include certain preventative services;
  • The ability to create and maintain a patient/doctor relationship for the purpose of providing continuity of care;
  • Establish hours of operation for treating patients at least 30 hours per week;
  • Provide access to medical advice/services 24/7;
  • Maintain hospital admitting privileges or have a formal agreement with another doctor based on ages of the members accepted;
  • Refer or authorize services to other providers when the service cannot be provided by the PCP;
  • Use reports provided by the DMA managed care section as guides in maintaining the level of care that meets the goals of CCNC and patient needs.
Additionally, providers must complete a provider agreement that stipulates additional requirements for the practice. A similar provider agreement exists for pregnancy medical homes.
 
ACA Section 2703 Health Homes: North Carolina’s health homes program is delivered through the Community Care of North Carolina program; health home providers must meet CCNC’s basic participation requirements, described above.
 
Medicare Advanced Primary Care Practice (MAPCP) Demonstration:Practices participating in the MAPCP Demonstration program must achieve NCQA Recognition. Furthermore, participating practices in the seven demonstration counties must also achieve Blue Cross Blue Shield North Carolina (BCBSNC) Blue Quality Physician Program recognition by September 2013.
North Dakota No known activity at this time.
Ohio
Definition: Substitute House Bill 198 (128th General Assembly) specifies that: “the patient centered medical home model of care is an enhanced model of primary care in which care teams attend to the multifaceted needs of patients, providing whole person comprehensive and coordinated patient centered care.”
 
Recognition: 
PCMH Education Pilot Project: Substitute House Bill 198 (128th General Assembly) specifies that: “the patient centered medical home model of care is an enhanced model of primary care in which care teams attend to the multifaceted needs of patients, providing whole person comprehensive and coordinated patient centered care.”
 
The state's PCMH website expands on this, outlining core features of a patient-centered medical home: 
  • "Patient-centered: Supports patients in learning to manage and organize their own care at the level they choose, and ensures that patients and families are fully informed partners in developing care plans.
  • Comprehensive: A team of care providers is wholly accountable for a patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.
  • Coordinated: Ensures that care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports.
  • Accessible: Delivers accessible services with shorter waiting times, enhanced in-person hours, 24/7 electronic or telephone access, and alternative methods of communication through health IT innovations.
  • Committed to quality and safety: Demonstrates commitment to quality improvement through the use of health IT and other tools to guide patients and families to make informed decisions about their health."

ACA Section 2703 State Plan Amendment - Community Behavioral Health Centers (CBHCs): Participating CBHCs are required to achieve The Joint Commission's Behavioral Health Care Accreditation Program Standards for Primary Physical Health Care or NCQA Level 1 PCMH recognition. In additon, providers are required to provide all core health home services; to integrate physical and behavioral health care; to have agreements with primary care providers if not co-located; to establish partnerships with managed care plans to support coordination between health homes and plans; and to have a variety of data collection and reporting capabilities.

 
CMS's Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CPCi through a competitive application process. Under CMS’s Comprehensive Primary Care Initiative, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commission, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
  • Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extenson Center (REC);
  • Percentage of practice revenue earned from participating payers; and
  • Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives.
Oklahoma
Definition:
 
Recognition:
SoonerCare Choice: Oklahoma has developed a three-tiered recognition tool for Medicaid providers. The Physician’s Agreement Addendum (attachment B-MH) contains the entire list of requirements for each tier.
 
Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CPCi through a competitive application process. Under CMS’s Comprehensive Primary Care Initiative, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commissioner, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
  • Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extension Center (REC);
  • Percentage of practice revenue earned from participating payers; and
  • Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives.
Oregon
Definition:
Oregon Patient-Centered Primary Care Home (PCPCH) Program: Chapter 590 of the 2009 Oregon Laws statutorily defines “primary care home” as a delivery system that promote the minimum elements:
  • A patient-provider relationship at the center of all health care activities;
  • Patient access, including same-day visits;
  • A team approach to care, with all team members utilizing the full scope of their license;
  • Behavioral health integration (need not be colocation);
  • Culturally competent care, with translation and other culturally sensitive services provided as necessary;
  • Managed and coordinated care across the community services system;
  • Proactive, comprehensive care
  • Expanded nursing roles, including, but not limited to: care coordination; telephone outreach; school-based health; home visits; telephone triage and clinical case management; and coordination of information-sharing among community providers;
  • Patient accountability for adhering to said patient’s health goals; and
  • Efficient and timely case management for managing chronic diseases, behavioral health and end-of-life care.
Recognition
Oregon Patient-Centered Primary Care Home (PCPCH) Program and ACA Section 2703 Health Homes: The Standards Advisory Committee enumerated the core attributes and standards (standards in parenthesis) of a PCPCH as follows:
  1. Access to Care (In-person, Telephone/electronic, Administrative)
  2. Accountability (Performance Improvement, Cost and Utilization)
  3. Comprehensive Whole Person Care (Scope of Services)
  4. Continuity (Provider, Information, Geographic)
  5. Coordination and Integration (Data management, Care coordination, Care planning)
  6. Person and Family Centered Care (Communication, Education and self-management support, Experience of Care)
See the full report for more information.
 
Like NCQA, Oregon uses a three tiered approach to provide incentives for practice transformation, but the state developed criteria within each tier differ from NCQA. Oregon will accept NQCA-recognized practices at the NCQA level provided that the practice contractually attests to NCQA recognition and submits additional information on specific areas where the two recognition models diverge. See the 2014 Technical Specifications and Reporting Guide for more information.
 
Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CMS’s Comprehensive Primary Care Initiative through a competitive application process. Under CPCi, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commissioner, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
  • Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extension Center (REC);
  • Percentage of practice revenue earned from participating payers; and
  • Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives.
Pennsylvania
Definition:
Pennsylvania has adopted the Joint Principles of the Patient Centered Medical Home as the state’s medical home definition.
 
Recognition:
The Chronic Care Initiative (CCI) uses a National Committee for Quality Assurance (NCQA) plus approach to practice recognition: in addition to achieving at least NCQA Level 1 recognition, practices are expected to achieve certain otherwise optional standards at specified levels of performance. As practices’ NCQA 2008 recognitions expire, they are required to achieve obtain recognition under the NCQA 2011 standards.
Rhode Island
Definition
Chronic Care Sustainability Initiative (CSI-RI): The Chronic Care Sustainability Initiative (CSI-RI) has adopted the Joint Principles of the Patient Centered Medical Home as the project’s medical home definition.
 
Recognition
Chronic Care Sustainability Initiative (CSI-RI): CSI-RI uses an approach grounded in the National Committee for Quality Assurance (NCQA) PCMH standards. Practices are expected to achieve NCQA Level 3 recognition and meet additional criteria, including establishing compacts with four high volume specialists (including at least one hospitalist).
 
Connect Care Choice (CCC): The Connect Care Choice (CCC) program requires participating primary care providers to meet state-developed standards that include incorporation of the Chronic Care Model, use of team-based care, adoption of e-prescribing, and links to community supports and behavioral health providers. Additional information may be found on page 11 of this report.
 
ACA Section 2703 Health Homes - CEDARR Family Centers: CEDARR Family Centers are expected to meet state-developed certification standards that are available online. Additional standards specific to serving as a 2703 health home, such as using health information technology (IT) and conducting regular body mass index (BMI) screenings, have also been developed.
ACA Section 2703 Health Homes - Community Mental Health Organizations (CMHOs): Participating CMHOs are required to meet state licensing requirements for behavioral health organizations, as well as comply with health home standards. CMHOs are also required to establish transitional care agreements with hospitals and other inpatient facilities (e.g., psychoatric treatment centers) and long-term care facilities, and to submit a proposal describing their health home care model and regularly report on practice transformation.
South Carolina No known activity at this time.
South Dakota No known activity at this time.
Tennessee No known activity at this time.
Texas No known activity at this time.
Utah Recognition: Practices will be expected to attain National Committee for Quality Assurance (NCQA) medical home recognition.
Vermont
Definition: Act 128 of the 2009-2010 legislative session requires that medical home providers:
  1. Provide comprehensive prevention and disease screening for his or her patients and managing his or her patients’ chronic conditions by coordinating care;
  2. Enable patients to have access to personal health information through a secure medium, such as through the Internet, consistent with federal health information technology standards;
  3. Use a uniform assessment tool provided by the Blueprint in assessing a patient’s health;
  4. Collaborate with the community health teams, including by developing and implementing a comprehensive plan for participating patients;
  5. Ensure access to a patient’s medical records by the community health team members in a manner compliant with federal and state law; and
  6. Meet regularly with the community health team to ensure integration of a participating patient’s care.

Recognition: NCQA PCMH recognition

Virginia
Definition: The Virginia Department of Medical Assistance Services’ (DMAS) contract with Medicaid managed care organizations (MCOs) identifies the following principles as “core” aspects of the medical home model:
  1. Demonstrated leadership;
  2. Team-based approach to care;
  3. Population risk stratification and management;
  4. Practice-integrated care management;
  5. Enhanced access to care;
  6. Behavioral-physical health integration;
  7. Connection to community resources;
  8. Commitment to reducing unnecessary health care spending, reducing waste, and improving cost-effective use of health care services;
  9. Integration of health information technology; and
  10. Inclusion of patients and families in implementation of the patient-centered medical home (PCMH) model.
Washington
Definition: According to Washington State’s 2008 Second Substitute House Bill 2549, a medical home is, “a place where health care is accessible and compassionate. It is built on evidence-based strategies with a team approach. Each patient receives medically necessary acute, chronic, prevention, and wellness services, as well as other medically appropriate dental and behavioral services, and community support services, all which are tailored to the individual needs of the patient.”
 
Recognition: Under Washington State's mutli-payer Patient Centered Medical Home (PCMH) Pilot, practices were not required to maintain formal PCMH recognition. Sites were selected through an application process, and were judged on the basis of their readiness to function as medical homes; practices that had achieved National Committee for Quality Assurance (NCQA) recognition (or otherwise demonstrated their readiness to operate as medical homes) were favored in the selection process.
 
Practices participating in the PCMH Collaborative are not required to obtain formal recognition. Rather, they are assessed using the Medical Home Index to gauge change over time and identify areas for improvement.
West Virginia
Recognition: Practices that participated in the Medical Home Performance Incentive Pilot were expected to apply for NCQA PCMH Recognition within nine months of the project start date.
Wisconsin
Recognition: AIDS Service Organizations participating in Wisconsin’s ACA Section 2703 Health Homes program must integrate medical, behavioral, pharmacy, and oral health care. Wisconsin also expects health homes to either obtain national patient-centered medical home accreditation (e.g., NCQA) or provide written support that they meet the state’s health home standards, which include:
  • Adoption of written standards for patient access and communication;
  • Use electronic charting tools to organize clinical information;
  • Adopting evidence-based guidelines for treating HIV-related conditions;
  • Systematically tracking test results and identify abnormal results;
  • Electronically tracking patient referrals; and
  • Measuring and reporting health care quality, patient safety, and health outcome information.
Wyoming No known activity at this time.

 

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