Medical Homes. Benefits for services provided by a Patient Centered Medical Home include chronic condition, serious Illness, or complex health care needs when participation in a Patient Centered Medical Home program. Benefits include associated costs for coordination of care, such as: • Liaison services between the Covered Person and the Provider, nurse coordinator, and the care coordination team. • Creation and supervision of a care plan. • Education of the Covered Person and family regarding the disease, treatment compliance, and self-care techniques. • Assistance with coordination of care, including arranging consultations with specialists and obtaining Medically Necessary supplies and services, including community resources.
Medical Homes. The Contractor’s Affiliated Provider network shall include Providers that act as medical homes, with a focus on FQHCs, CMHCs and multi-specialty PCP-centered medical groups and private practice PCP offices. An Enrollee may choose from among the available medical homes. Medical homes shall be patient-centered medical homes that provide and coordinate high quality, planned, family-centered health promotion; Wellness Programs; acute illness care; and Chronic Health Condition management. Medical homes shall provide all PCP services and be supported by Integrated Care Teams and Health Information Technology. The Contractor will support medical homes and the integration of behavioral and physical health care by providing embedded Care Coordinators, as appropriate, onsite at FQHCs, CMHCs and high volume Providers that agree to this approach. The Contractor is required to have a process in place to facilitate medical homes advancing towards NCQA certification and is required to provide financial incentives to Providers that achieve NCQA medical home certification.
