What is a Health Home Program?
The Health Home Program was created by Affordable Care Act (ACA) section 2703. It allows states to provide Health Home services and care coordination to high cost high risk Medicaid and Medicare/Medicaid (duals) eligible clients. Its purpose is to reduce duplication of services and provide smoother transition and more personalized care to help reduce the progression of chronic disease, reduce inappropriate emergency department utilization and preventable hospital readmissions, and improve health and self-management of conditions.
As defined by the Centers for Medicare and Medicaid (CMS), a Health Home provides six specific services beyond the clinical services offered by a typical provider.
- Comprehensive care management
- Care coordination and health promotion
- Comprehensive transitional care and follow-up
- Patient and family support
- Referral to community and social support services
- Use of information technology to link services, if applicable
The Health Care Authority (HCA) and Department of Social and Health Services (DSHS) approve "Lead" Organizations. These Leads include Managed Care Organizations, as well as Community Based Organizations. The Leads contract with Care Coordination Organizations (CCOs) too and may include mental health clinics, area agencies on aging, chemical dependency providers, HIV/AIDs networks, child social service agencies, and community health centers. The CCO's provide Health Home services through a Care Coordinator. Care Coordinators assist clients in coordinating medical care, long-term services and supports, and behavioral health as appropriate. The client and Care Coordinator can meet at a location of the client's choice: a clinic, the patient's home, or other community location. Washington offers the program in all counties except King and Snohomish.
The Centers for Medicare & Medicaid Services Evaluation Reports
Demonstration Year 1 Preliminary Findings from the Washington Managed Fee-for-service demonstration under the Medicare-Medicaid Financial Alignment Initiative. The Washington demonstration leverages Medicaid health homes to test new mechanisms to coordinate services across Medicare and Medicaid for Washington State Medicare-Medicaid enrollees, and allows the State and the Federal governments to share in savings resulting from quality improvements. The preliminary results in this report are based on experience during the first demonstration performance period, from July 2013 – December 2014. Estimates in this report show a reduction of $21.6 million in Medicare spending relative to a comparison group, representing more than 6% savings. The report also includes early quality and utilization results, eligibility and enrollment data, characteristics of the population eligible for the demonstration, beneficiary focus group findings, and a discussion of the initial implementation experience.
Report on Early Implementation of the Demonstrations under the Medicare-Medicaid Financial Alignment Initiative. The report provides an update on the early implementation experience of the seven demonstrations that were operational on or before May 1, 2014. Those demonstrations are in: California, Illinois, Massachusetts, Minnesota, Ohio, Virginia, and Washington. The report describes successes and challenges encountered during the first six months of operation in each state. State-specific, comprehensive annual reports for each demonstration will come in the future, with reports on the demonstrations in Massachusetts, Washington, and Minnesota scheduled for later in 2016.
Care Coordinator Training
- Clinical Eligibility Tool
- Clinical Eligibility Tool Instructions
- Goals Setting Action Plan Worksheet (Revised February 2015)
- Health Action Plan (Revised February 2015)
- Health Action Plan instructions (Revised February 2015)
- Incident Report: Word, PDF
- Information Sharing Consent Form: Word, PDF (Cambodian, Chinese, Korean, Laotian, Russian, Somali, Spanish, Vietnamese)
- Information Sharing Consent Form - Adolescents: Word, PDF (Cambodian, Chinese, Korean, Laotian, Russian, Somali, Spanish, Vietnamese)
- Participation (Opt-Out/Decline Services) Form: Word, PDF (Cambodian, Chinese, Korean, Laotian, Russian, Somali, Spanish, Vietnamese)
- Pediatric Symptoms Checklist (PSC-17): Word, PDF
- Pediatric Symptoms Checklist (PSC-17) Instructions
- Release of Information (ROI) for Substance Use Disorder (SUD) Services
- Health Home Letter
- Health Home Booklet: English, Cambodian, Chinese, Korean, Laotian, Russian, Somali, Spanish, Vietnamese
- Trifold Brochure: English, Cambodian, Chinese, Korean, Laotian, Russian, Somali, Spanish, Vietnamese