Health Homes Implementation Process, Frequently Asked Questions

FAQ Categories

PMPM Questions

What is the anticipated PMPM amount?
The PMPM amount will be $58.87.
If this is a Health Home rather than a Patient Centered Medical Home, will the patient panel size be smaller?
Yes, the patient panels will be smaller since the health home is focusing on the higher cost chronic disease population and not all comers.
What is the Behavioral Health PMPM rate for Patient Centered Medical Homes Initiative?
The Behavioral Health component of the PMPM amount is $7.78.
How much is the Administrative Fee cost to the participating Health Homes from this rate?
The administrative fee cost is a total of $3.47.
Will the PMPM be treated as incentive payment in order to not offset on the cost reports for Federally Qualified Health Clinics and Rural Health Clinics?
Health Home PMPM payments will not be offset from operating costs on FQHC and RHC cost reports. The PMPM is not considered an “incentive payment” but rather a payment for health home services provided for patients.
Does the PMPM available via this project in any way impact the enhanced payments currently available to Rural Health Clinics or is it strictly supplemental?
The PMPM for practice sites is in addition to existing fee-for-service or Managed Care plan payments for direct services as currently received by Rural Health Clinics.
Will the payment come on the same check as claims payments or will separate payment be made for the PMPM? If separate, will it be sent to the clinic/site or the address on claims?
The PMPM payment is currently planned to be with the same payment made for claims. The payment will go to the “pay to” address associated with the provider number on MO HealthNet’s provider file.
Is there a definition of what constitutes a contact for which the site receives payment?
We are currently exploring processes such as the addition of a screen in CyberAccess where a health home would check a box for individuals receiving health home services that month. The health home would need to maintain documentation in its EMR that one of the six health home services (Comprehensive Care Management, Care Coordination, Health Promotion, Comprehensive Transitional Care, Individual and Family Support Services, and Referral to Community and Social Support Services) that constitute a contact occurred in case of audit. After dialoguing with the provider community, we will need to be prescriptive, including how services are to be documented, and how they will be tracked to ensure that providers can weather any CMS audit process. Examples include: logging into CyberAccess, scheduling transportation, scheduling visits to a specialist.
Do we get the PMPM for each month even if we do not see the patient that month?
MHD will do a “look back” to ensure that there has been at least one non-health home medical service claim in the prior 3 months before making each PMPM payment. You should not bill the PMPM payment for a month that you have not documented that a Health Home service occurred.