Community Mental Health Center (CMHC) Healthcare Home
Missouri launched the first CMHC Healthcare Home program on January 1, 2012 to provide improved care to Medicaid beneficiaries with behavioral health conditions. The CMHC Healthcare Homes leverage the core Section 2703 Health Home elements such as comprehensive care management, care coordination, health promotion, and community referral services with a focus on delivering integrated physical and mental health.
To be eligible to participate, Medicaid beneficiaries must meet one of three qualifying criteria:
- be an adult with a serious and persistent mental illness (SPMI) or a child with serious emotional disturbance (SED)
- have a mental health condition and a substance use disorder (SUD)
- have a mental health condition or SUD and one other chronic condition or chronic disease risk factor
Qualifying chronic conditions in the CMHC Healthcare Home program include diabetes, asthma/COPD, cardiovascular disease, developmental disabilities, being overweight, or using tobacco.
To serve as a Healthcare Home, CMHCs must effectively co-locate primary care and behavioral health services. This requires CMHCs to embed Primary Care Physician Consultants in their practices that are responsible for establishing disease management priorities and providing chronic disease education and consultation to other CMHC staff such as psychiatrists and care managers. Additional required CMHC Healthcare Home staff include:
- Healthcare Home Director to oversee practice transformation and daily operation
- Nurse Care Manager(s) to provide wellness education and assist with managing patient care
- Administrative support staff
Beyond staffing, CMHC Healthcare Homes are expected to leverage health information technology to deliver comprehensive care management services. CMHCs use specific data analytic tools including CyberAccess, a web-based Medicaid data system that allows providers to view patient histories, and disease management and medication adherence reports.
As of October 2014, 11% of enrollees are children and youth. All enrolled children have a serious emotional disturbance diagnosis and the most common physical conditions for children include asthma, obesity, and developmental disabilities.
Primary Care Health Homes (PCHH)
Missouri’s Primary Care Health Homes (PCHH) also went into effect on January 1, 2012. The targeted Medicaid population for PCHHs are individuals with multiple, chronic physical conditions. Enrollees must have at least two qualifying chronic conditions for the PCHH. Examples of qualifying chronic conditions for the PCHH program are the same as for the CMHC Healthcare Home program.
Currently, children only account for approximately 3% of PCHH enrollees due to the eligibility requirement of having at least two chronic physical conditions and the nature of qualifying conditions. Missouri is considering amending its SPA to enable children with only asthma or obesity to participate in the program.
The core PCHH services are similar to those of the CMHC Healthcare Home and include comprehensive care management, care coordination, health promotion, and referral to community-based services. The PCHH also includes an emphasis on comprehensive transitional care services to ensure smooth patient transitions out of inpatient settings.
PCHH team members are comprised of many of the same staff as CMHC Healthcare Homes including a Health Home Director and Nurse Care Manager. However, instead of a Primary Care Physician Consultant, PCHHs include a Behavioral Health Consultant to assist primary care teams in managing patients with mental health and substance use disorders and a designated care coordinator responsible for tracking referrals, managing data, and assisting patients with appointment and prescription reminders.
PCHH providers must meet additional criteria including:
- serving a minimum percentage of Medicaid/uninsured patients (adults and children)
- using electronic medical records (EMR) for 6 months
- applying for patient-centered medial home recognition through the National Committee for Quality Assurance (NCQA) within 18 months
Current PCHH sites include 18 federally qualified health centers (FQHCs) and 6 hospitals.