Health Homes. The CONTRACTOR shall comply and cooperate with HCA’s Health Home initiative for developing Behavioral Health Homes and Physical Health Homes as authorized under Section 2703 of the PPACA. The CONTRACTOR shall implement Health Homes in accordance with New Mexico’s Medicaid State Plan, the Managed Care Policy Manual, and the CareLink New Mexico Health Homes Policy Manual. The CONTRACTOR shall make best efforts to contract with all Health Home Providers designated by HCA and the CareLink New Mexico Steering Committee. The CONTRACTOR shall refer all eligible Members who meet the CareLink New Mexico Health Home criteria and who are not participating in a Full Delegation of Care Coordination model to one (1) of the CareLink New Mexico Health Homes and document all such referrals. The CONTRACTOR shall also maintain a record of any Member choice to opt in or out of the Health Home or to select a different CareLink New Mexico Provider. The CONTRACTOR shall ensure that Health Home Providers provide Care Coordination functions for Members enrolled with the Health Home. The CONTRACTOR shall maintain administrative responsibility and oversight of Care Coordination and reporting as required by HCA according to this Agreement. The CONTRACTOR shall issue monthly payments to Health Home Provider(s) when the Health Home Provider has submitted Claims to the CONTRACTOR documenting the utilization of Health Home services by a Member per the CareLink New Mexico Provider Policy Manual. The costs associated with Health Homes are included in the CONTRACTOR's Capitation Rate. The payment shall be an amount based on the CONTRACTOR's Turquoise Care membership enrolled in the Health Home and billed by the Health Home Provider for that month using a PMPM set by HCA. The payment shall be made in accordance with Section 4.20 of this Agreement, Claims Management.
Health Homes. The Contractor shall administer and fund the State’s Health Home services within the approved Chronic Condition Health Home and Integrated Health Home State Plan Amendments. The Contractor shall provide oversight that includes but not limited to documentation reviews and provider self-assessment reviews to ensure that Health Home Providers are meeting all of the requirements of the Health Home State Plan Amendments, Health Home Manual and Administrative Rules. The Contractor shall provide guidance to Health Home Providers to ensure the requirements of the Health Home State Plan Amendments, Health Home Manual and Administrative Rules are being met. The Contractor shall be responsible for any identified deficiencies. In accordance with federal requirements, the Contractor shall ensure non-duplication of payment for similar services that are offered through another method, such as 1915(c) HCBS waivers, other forms of community-based case management, or value-based purchasing arrangements.
Health Homes. The Contractor shall develop a network of Integrated Health Homes and Chronic Condition Health Homes. The Contractor shall develop strategies to encourage additional participation, particularly in areas of the State where participation has been low. In developing the Integrated Health Home and Chronic Condition Health Home networks, the Contractor shall ensure all providers meet the minimum requirements for participation as defined in the State Plan and the Agency policy. Refer to Section 3.2.9 for additional detail on all health home requirements.
Health Homes. The Contractor shall subcontract with community entities sufficient in quantity and type to provide the intensive services defined in Section 14 of this contract. The Contractor shall provide health home services as part of a qualified health home, or may enter into subcontractor agreements with Health Homes, qualified by the State to deliver health home services for child and adult enrollees with special health care needs, but must have a network of providers sufficient to provide defined services. Subcontractor agreements shall contain elements defined by the State and which may include:
Health Homes. 9.10.1.5 Interpretation of data from the Quality Improvement program.
Health Homes. If an enrollee meets the requirements as defined in the Medicaid State Plan as qualifying for a chronic condition Health Home the MCO must notify the enrollee of the availability of designated Health Homes for his or her condition. If the enrollee chooses to participate, the MCO shall facilitate a referral to the health home. BMS shall provide monthly Health Home enrollment lists to each MCO so that coordination may occur between the MCO and the Health Home provider. If the enrollee is participating in a chronic care Health Home, the Health Home must be notified of any use of emergency services and be notified of any inpatient admission or discharge of a Health Home member that the MCO learns of through its inpatient admission initial authorization and concurrent review processes within 24 hours.
