Missouri – Medical Homes

The Missouri legislature first promoted medical homes with the passage of SB577 of the 2007 Session Laws, known as the Missouri Health Improvement Act, which including a requirement that MOHealthNet (Medicaid) provide all beneficiaries with a health care home (left undefined in the legislation).

The state is also supporting the Missouri Foundation for Health’s (MFH) Patient-Centered Medical Home Collaborative. MOHealthNet is not a participating payer (the program is currently limited to Anthem Blue Cross Blue Shield and United Healthcare), but practices in the MFH medical home program and MOHealthNet health home program will both participate in the same learning collaboratives. MFH describes the two programs as, “separate, but coordinated.” Additional information on the Missouri Medical Home Collaborative can be found in the RFA.

Medical homes for MOHealthNet enrollees with behavioral health conditions and chronic conditions are currently implemented chiefly through ACA Section 2703 Health Homes.

Federal Support: 

  • On October 20, 2011, Missouri became the first state to receive CMS approval for a state plan amendment (SPA) to implement Affordable Care Act Section 2703 Health Homes for enrollees with chronic conditions. Missouri’s first approved SPA targets behavioral health patients served by community mental health centers. On December 22, 2011, CMS approved a second health home SPA focusing on patients with physical health conditions served by Federally Qualified Health Centers, Rural Health Centers and hospital-based primary care clinics. Both SPAs became effective on January 1, 2012. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.

Last updated: April 2014

 

Forming Partnerships SB577 of the 2007 Session Laws created an 18 member MOHealthNet Advisory Committee to oversee the MOHealthNet program. The Advisory Committee includes government, provider (including physicians, non-physicians and dentists), hospital, and consumer representation.The Missouri Department of Mental Health acknowledges the following partners in developing Affordable Care Act Section 2703 Health Homes:

Defining & Recognizing a Medical Home 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.
Aligning Reimbursement & Purchasing ACA Section 2703 Health Homes – Community Mental Health Centers: Health home teams in community mental health centers receive a combined $78.74 per-member per-month payment to fund the services of a nurse care manager, a primary care physician consultant, a health home director, and health home administrative support.ACA Section 2703 Health Homes – Primary Care Health Homes:Primary care health homes receive clinical care management payments totaling $58.87 per-member per-month to fund the services of nurse care managers, behavioral health consultants, and care coordination and administration support staff.

 

 

MOHealthNet will review the payment methodology for both groups of health home providers after 18 months and explore whether tiered payments are appropriate. Payments will be adjusted annually according to the consumer price index. Payments for health home enrollees participating in a managed care plan will be made directly from Medicaid to the health home provider.

Supporting Practices All MOHealthNet providers have access to a web-based HIPAA-compliant electronic medical record program for their Medicaid patients, known as CyberAccess.ACA Section 2703 Health Homes – Community Mental Health Centers and Primary Care Health Homes: Missouri state agencies and health care foundations will join providers in spending over $1.5 million to cover training and technical assistance during practice transformation. 

 

Participating community mental health centers and primary care health homes will participate in a number of statewide learning activities, including learning collaboratives, monthly practice team calls to reinforce learning sessions, practice coaching, and monthly practice reporting (data and narrative) and feedback.

 

Learning activities will focus on teaching practices to coordinate patient- and family-centered, quality-driven, cost-effective, culturally and linguistically appropriate care (including the use of health technology).

Measuring Results ACA Section 2703 Health Homes – Community Mental Health Centers: MOHealthNet will use claims, a disease registry, a web-based electronic medical record, monthly health home reports, and annual status reports to measure success in eight specific goals specified in their first health home state plan amendment:

  1. Improve health outcomes for persons with mental illness
  2. Reduce substance Abuse
  3. Increase patient empowerment and self-management
  4. Improve coordination of care
  5. Improve preventative care
  6. Improve diabetes care
  7. Improve asthma care
  8. Improve cardiovascular care

Missouri will assess quality improvement and clinical outcome measures at both the practice and aggregate levels.

 

ACA Section 2703 Health Homes – Primary Care Health Homes:MOHealthNet will use claims, a disease registry, a web-based electronic medical record, monthly data reports from participating primary care health home practices, and Consumer Assessment of Healthcare Providers and Systems Clinician and Groups (CG-CAHPS) surveys to measure success in eight specific goals specified in their second health home state plan amendment:

  1. Improve health outcomes for persons with chronic conditions
  2. Improve behavioral healthcare
  3. Increase patient empowerment and self-management
  4. Improve coordination of care
  5. Improve preventative care
  6. Improve diabetes care
  7. Improve asthma care
  8. Improve cardiovascular care

Missouri will assess quality improvement and clinical outcome measures at both the practice and aggregate levels.