Beginning January 1, 2011, creates a Medicaid state plan amendment (SPA) option for states to cover eligible individuals with chronic conditions who select a designated provider, a team of health care professionals operating with such a provider, or a health team as the individual’s health home for purposes of providing the individual with health home services. Eligible individuals include those covered by Medicaid and who have at least: 2 chronic conditions (as defined in the statute); 1 chronic condition and is at risk of having a second chronic condition; or 1 serious and persistent mental health condition.
Provides for a 90% FMAP for states electing this option during the first 8 FY quarters that the option is in effect. Also authorizes HHS to award up to $25 million in planning grants (up to $500,000 per state, according to CMS) pursuant to this provision beginning January 1, 2011 (with mandatory state contributions).
Requires states, as part of electing the option, to include a requirement in its SPA regarding hospital referrals. Also requires states to consult and coordinate with SAMHSA as appropriate in developing such plan and to include in the SPA monitoring-related activities (e.g., relative to tracking hospital readmissions and use of health IT). Further requires states to report on quality measures.
Specifies the mandated services required of health homes, such as comprehensive care management and transitional care. Also defines the team of health care professionals.
Directs HHS to conduct an independent evaluation – which is to examine the impact of the SPA option on such metrics as hospital readmissions, ER visits, and SNF admissions – by January 1, 2017; a related interim report is due by January 1, 2014.