Health Homes Frequently Asked Questions

What is the desired format for Appendix B of the application?
Appendix B should be completed in the framework provided. This can be done in a format that matches the state’s version.
Is there an interactive Adobe application or blank application available?
The application is available on line in PDF format. However, if you want to save and complete it in an electronic format such as Excel, you are welcome to submit it in this format.
Will it be okay to send in the information requested in the application in Excel or Word format that matches the State’s version?
Yes.
Please provide clarification on how a center is deemed “independent, single-site practice” versus a “larger corporate entity.”

A “larger corporate entity” has several sites that are controlled by a “base” site or central office. Each site is enrolled separately with MHD and has its own Medicare certification number and NPI. A hospital with rural health clinics is another example of a larger corporate entity.

An example of an independent, single-site practice would be an independent rural health clinic owned by a physician.

On page 23 of the application, the second column asks “when a patient calls for urgent care, what is availability for an appointment at the Practice Site?” Can you clarify what is means by the term urgent care? The first column says acute visit, and the second column says urgent care. What do you consider acute and what do you consider urgent?
On page 23, the acute visit is in regards to the third next available appointment. The urgent care visit, or a same day acute visit, is a same day appointment to avoid an ED visit.
On page 25 of the application, question 8 says “If the applicant has more than one Practice Site, please list in ranked order the Practice Sites that the applicant wishes to have selected for the learning collaborative, with the applicant’s first choice listed at the top.” If we are only applying for the designation of Health Home Service Provider Status for one site, would we need to list any of our other sites in any part of this application?
The applicant should list the primary care sites it wants to be the Health Home sites to attend a learning collaborative in a ranked order of preference.
On page 21 of the application, it asks for the total number of patients and total payments received for calendar year 2010 – does this include just the listed payer names on the application, or does it include all payers even if less than 5% of practice revenue? In other words, should the columns all add up to the total listed at the bottom, or can our total be higher than the totals listed in the columns because of other sources of revenue?
The applicant needs to list any payer not identified on the list if that payer is responsible for a material amount of patient service revenue. If a primary care practice has payers not already identified on P. 21 that are responsible for an immaterial amount of patient service revenue, such as less than 5%, the practice could just combine those payers in the “Other” line. The sum of the lines on P. 21 should equal the Total line.
What kind of providers are you seeking?
Primary care providers including licensed physicians (internal medicine, pediatric, and family practice) collaborating with other licensed health care professionals including nurse practitioners and physician assistants.
If you have one practice with multiple locations do you have to submit narrative responses ( Questions 8, 10, 11, 12, 15) for each location or just one for the practice?
One application may be submitted per organization with multiple practice sites. The questions would need to be answered for each practice site within that one application.
Can resources used in the core practice team members be shared among the locations or do they all need to be unique individuals?
Resources may be shared between practice sites.
Does the affordable care act pertain to counseling patients in-home?
The Health Home initiative is seeking practice sites comprised of licensed physicians collaborating with other licensed health care professionals that meet the requirements within the application. No one is required to become a health home.
Can Rural Health Clinics participate?
Yes
The rate setting note talks about fee for service payments. Since RHC’s are not paid Fee for Service, how do you plan to pay a RHC?
RHCs are not reimbursed according to a fee schedule, but do receive fee for service payments for patients who are not in MO Health Net managed care.
Would be it be acceptable to designate one clinic on the application, but then work with you to potentially add other clinics on by the time the initiative is formally up and running, or do we have to list every possible clinic in advance? With the short application deadline of July 11th, we’re not even sure we can accumulate all of the information required for every provider in every one of our clinics, though we could certainly gather it during the next month or two as we evaluate physician acceptance of the program and our staffing patterns.
Please include all involved sites at the time of application.
For one clinic in development stage, where we have no historical practice numbers, do we just state that, or list an estimate based on our initial projections?
Please include estimates and projections.
Is the application deadline of July 11, 2011 a firm deadline?
Answer: Yes.
Are both Managed Care and Fee-for-Service patients included in the primary care Health Home?
Yes, both are included. PMPM payments will be made directly to the practice site, not to the MCOs. A shared savings payment method has not been finalized to date.
Are dual Medicare / Medicaid eligibles included?
Yes.
We are already in the process of meeting 2008 level 3 NCQA recognition standards. Is this acceptable in lieu of starting over to meet the 2011 standards?
If you are currently NCQA recognized, we will honor it for the duration of that certification.
Our clinic is accredited through the Joint Commission (JC). Therefore, we would prefer to pursue our Health Home recognition through the JC. Please confirm if this would be acceptable.
We are working on this initiative in collaboration with multiple payers, and the commercial payers have a longer-standing relationship with the NCQA. Because it is the preferred organization and we must be consistent, the NCQA will be the only accepted accreditation authority. Please note that the NCQA is a self-evaluation process and is much less expensive than the JC.
What do you anticipate the patient panel size to be for each care manager?
We do not know of an industry standard, however, you may want to research the following associations: Medical Group Management Association, American Academy of Family Physicians, American Academy of Pediatrics, or others for this information. Please keep in mind that Medicaid patients tend to a higher-need population, so the recommendation is to consider a lower ratio of patients per care manager.
How will patient registries for various plans be resolved if there are discrepancies between patient assignments and their actual / correct Health Home?
Initial assignment will be made by MHD via the patient’s claim data, making assignment to the provider with the highest treatment volume for the most recent 12 months. If/when an assignment is deemed inappropriate by a provider, MHD must be informed accordingly. The MO HealthNet Division (MHD) will monitor patient panel assignments to assure that a patient is assigned to only one Health Home.
Serious mental health conditions: Does this include depression?
Serious mental health conditions are not included among the qualifying conditions for patients in the primary care Health Home group.
Same day urgent care – is this the same as same day acute appointments?
Yes, or at a minimum, treating the patient as soon as possible in your own facility in order to avoid an Emergency Department visit.
Can other sites apply later if a larger site applies first by the deadline?
The larger entity must include all involved sites at the time of application.
Have tracking tools been developed for clinical care managers?
MHD intends to continue developing helpful tools and reports for primary care Health Homes over time. In the meantime, the Learning Collaboratives should provide assistance with internal tracking tools.
Nurse care managers – can this be an LPN or RN?
Care Managers must be an RN or have equivalent education and experience. If the latter, these qualifications will be reviewed on a case by case basis.
Must we currently have an electronic health record (EHR)? We are in the process of establishing EHR and have converted several sites to EHR.
You must have been using a functioning EHR for the past 6 months in order to qualify. MHD has been advised by other experienced states that it would seriously overwhelm a practice to attempt adoption of both an EHR and Health Home status simultaneously.
Regarding # 14 of the Provider Application, is “another clinician” a medical Provider or Nurse?
In addition to the primary care physician or nurse practitioner in a senior leadership role, the second clinician could be a Registered Nurse or higher level clinician.
What is the definition of “uncompensated care?” Are uninsured sliding-scale fee patients considered uncompensated care patients?
Uncompensated care includes any uninsured patient, including sliding-scale fee patients or others paying out-of-pocket for treatment. Uncompensated care does not include Medicare or patients with any other form of third party insurance coverage.
What is the definition of a “proposed core practice team?”
This includes (but is not limited to) the Clinic Director and RN Care Manager, as well as an internal “Champion” – a credible, persuasive clinician to be a leader in making the practice transition.
What is a Learning Collaborative?
These are training opportunities funded by the Missouri Foundation for Health to assist your practice in its transition to a primary care Health Home. Multiple trainings will be regionally located for your area of the state. A detailed curriculum will be available to share in the near future.
What is expected in the Memorandum of Understanding (MOU) with an area hospital?
There is no proscribed language requirement for the MOU. However, it is recommended that the MOU indicate a strong cooperative working relationship between the Health Home and the hospital, including effective communication established between hospital discharge planners and the Health Home. There is a CMS required goal of reducing avoidable emergency department visits and inpatient hospital stays in order to contain healthcare costs. The MOU is important as it relates to potential savings and ongoing sustainability of the project, and the Missouri Hospital Association is very aware of this goal.