Integrated Health Homes

What’s new?

  • In August and September 2018, the Department of Healthcare and Family Services (HFS) held webinars on how they would implement Integrated Health Homes (IHH) in Illinois.
  • All updated materials including webinar schedules, slide presentations and frequently asked questions can be found on the HFS Integrated Health Homes website here.  The topics included cover:
    • Provider Requirements, Expectations, and Staffing Ratios
    • Quality Indicators, Incentive Payments, and Reporting
    • Enrollment in IMPACT
    • Attribution, Tiering, and Assignment
    • Billing, Claiming and Payment
  • Providers are supposed to be able to enroll starting in September, 2018 and the first round of Medicaid beneficiaries, from Tiers A, B and C is to be assigned to registered IHHs January 1, 2019.

What’s the issue?

  • A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities.
  • When a state is planning to make a change to its Medicaid program policies or operational approach, the state will send state plan amendments (SPAs) to the federal Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
  • Illinois was granted a SPA for Integrated Health Homes (IHH) to provide a new, fully-integrated form of care coordination for all members of the Illinois Medicaid population.

Why does it matter?

  • Revamping the delivery of behavioral health in Illinois has the potential to create significant savings, while at the same time addressing pressing social problems such as the opioid epidemic.
  • Currently, the 25 percent of Illinois Medicaid beneficiaries with behavioral health issues account for 56 percent of all Medicaid spending.
  • The IHH state plan amendment is a critical component of the 1115 Behavioral Health wavier to provide a single point of care coordination for each Medicaid beneficiary across both their physical and behavioral health needs.
  • In this model, managed care organizations (MCOs) will transition from managing care to monitoring care.  IHHs will be responsible for coordinating the care, not providing every service or treatment to the beneficiaries assigned to them.

What is the Presence Health perspective?

  • Presence Health sees first-hand behavioral health needs. Presence Health is the largest provider of behavioral health services in the state. Our emergency departments have seen an increase in individuals needing behavioral health care as a result of the decreased availability of community mental health services.
  • Physical and mental health care must be coordinated. Treatment of physical and mental health in one setting is important and the current reimbursement structure does not support care delivery in this way. Medicaid beneficiaries who need mental health services can receive them in a community setting rather than a more costly hospital setting.
  • Presence Health wants to be a partner with the state in serving the Medicaid population.  AMITA Health serves 10% of the state’s Medicaid population.  This goal of this effort is to improve patient outcomes so Medicaid beneficiaries get the access they need to be healthier; in turn, saving the Medicaid program unnecessary costs.