August 26, 2013
SAMHSA-HRSA Center for Integrated Health Solutions
The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) engaged Health Management Associates (HMA) to outline key areas of a recently enacted provision of the Affordable Care Act that permits Medicaid coverage of health homes, a service delivery model supporting care coordination and related supports for individuals with chronic conditions, including those with mental and substance use conditions.
HMA’s team of Managing Principal Jennifer N. Edwards and Principals Katharine V. Lyon, Juan Montanez, and Alicia D. Smith created “Financing and Policy Considerations for Medicaid Health Homes for Individuals with Behavioral Health Conditions: A Discussion of Selected States’ Approaches.”
This report has three purposes:
- To describe the overarching policy considerations for states and potential providers of health home services
- To discuss the roles of quality measurement and health information technology (HIT)
- To explore options and considerations for developing reimbursement methodologies and establishing payment rates.
The report provides an overview of health home service design and Medicaid State Plan Amendment development. It outlines the processes that may be necessary for state governments to work with SAMHSA and CMS in order to receive consultation and obtain approval for Medicaid health home services. HMA authors also offer observations and recommendations for states interested in implementing the benefit.
The report was developed for the SAMHSA-HRSA Center for Integrated Health Solutions with funds under grant number 1UR1SMO60319-01 from SAMHSA-HRSA, U.S. Department of Health and Human Services. The CIHS promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings.