Questions and Answers

Q & A Topics

General | Billing and Payment | Chronic Illness Demonstration Project (CIDP) | Health Home Design | Health Home Development Funds | Health Home Letter of Intent/Applications/Provider Enrollment/Application Form | Health Home Network | Health Information Technology | Managed Care | Member Forms | Population Assignment/ Eligibility (Patient Tracking System) | Quality Metrics and Evaluation (CMART) | Spend Down | Targeted Case Management (TCM) |

Health Home Letter of Intent/Applications/Provider Enrollment/Application Form

1. Is the State still accepting Health Home applications?

The State is not currently accepting applications for new Health Homes. Providers of care management or other services that are interested in providing care management and related services can become a network partner of an existing lead Health Home. Interested providers can contact Designated Health Homes directly. For contact information for Designated Health Homes click here.

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2. What are the staff qualifications for the Care Managers under this initiative? And what are the qualifications of the supervisory level staff?

Each Health Home will determine the supervisory structure and job qualifications for their care manager positions, including professional discipline (if applicable), along with relevant education, training and experience.

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3. Can a Health Home have contracts with more than one Managed Care Organization?

Yes. Health Homes are encouraged to have contracts (known as Administrative Services Agreements or ASAs) with multiple Managed Care Organizations.

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4. Do Health Home partner networks cover the full range of Health Home services across primary care, behavioral health care (both substance abuse and mental health)?

Yes. All Health Homes were designated based on their attestation that they would provide the full range of services required as outlined in the Health Home Provider Qualification Standards. Click here for more information on Provider Qualification Standards. Health Homes will be evaluated to ensure they have built strong and extensive medical, behavioral health, and social service networks to meet the needs of their Health Home enrollees and that they are achieving positive outcomes.

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5. Are the non–TCM providers being required or encouraged (mandated) to utilize the existing network of effective community based providers who can do the care coordination?

The Department is strongly encouraging Health Home applicants to make full use of community resources. Health Homes were designated based on the extent to which they included these providers in their Health Home networks.

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6. Can Health Homes contract with LHCSAs, waiver providers, and other entities for care management or must this service be provided directly by the Health Home?

Health Homes can subcontract for the provision of Health Home services, including comprehensive care management. However, the Health Home provider remains responsible for all Health Home program requirements, including the services performed by the subcontractor.

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7. Can you give us some help with language for the contracts or other agreements between Health Homes and their network partners.

The Department is not providing specific contract language regarding the relationship between the Health Homes and its network partners. The Health Home is responsible for developing and executing these contracts. At a minimum, the contracts will need to address the terms of participation, minimum time frames for access to services, provision of crisis intervention and responsibility of each provider. Templates for Health Home Administrative Service Agreements (ASAs) are provided for the relationships between Health Homes and Managed Care Plans, these can be found by clicking here.

Contractual agreements between the Health Home applicant and their network partners must be developed and in place prior to the first request for reimbursement when partnerships involve a financial arrangement. A business agreement or MOU is suitable only for partnerships that do not involve a financial arrangement. Note that a Data Exchange Application Agreement or DEAA must be in place in order for the Health Home to share information with its network partners prior to member consent, e.g., when providing lists of potential members to agencies for outreach and engagement. Additional information on DEAAs can be found under Administrative Requirements for Health Homes on the Health Home website by clicking here.

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8. Where do peer advocates fit in to the Health Home model?

Health Homes are encouraged to utilize peers as part of their multidisciplinary team, especially with activities relating to patient and family support and utilization of community and social support services.

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9. Must an individual reside in a county the Health Home has been designated to serve in order to be enrolled in a Health Home?

The member must either reside in the county or receive services in the county.

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