Health Homes is an optional Medicaid State Plan benefit that provides an opportunity to build a person-centered system of care that achieves improved outcomes and better services and value for the Oklahoma SoonerCare program for individuals with complex needs. The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) has partnered with OHCA to expand upon the patient-centered medical home model to provide coordinated primary and behavioral health integration.
Oklahoma has two health homes: one for children with serious emotional disturbance (SED) and one for adults with a serious mental illness (SMI)
A health home must provide all six of the following services, based on members’ changing needs, linked as appropriate and feasible by Health Information Technology (HIT):
Comprehensive care management
Care coordination
Health promotion
Comprehensive transitional care from inpatient to other settings, including appropriate follow-up, and transition from pediatric to adult settings
Individual and family support
Referral to community and social support services
The expectation is that behavioral health homes will result in improved quality of care and more cost efficiencies; improved experience with care on the part of members; and reductions in the use of hospitals, emergency departments, and other expensive facility-based care, such as Psychiatric Residential treatment for children.
Reporting Requirements and Supports:
Health homes will be provided with ongoing training and support from the State and will have access to a Health Home patient registry. The registry will aid in enrollment, reporting and tracking, identifying gaps in care and best treatment practices for their members. Health Home providers will receive per member, per month reimbursement contingent upon minimum service delivery and adherence to all requirements.
Additional Oklahoma Health Home Resources:
Oklahoma Health Home State Plan Amendment- Children with Serious Emotional Disturbances (approved 2/10/15)
Oklahoma Health Home State Plan Amendment – Adults with Mental Illness (approved 2/10/15)
Oklahoma will receive a 90% enhanced FMAP (Federal Medical Assistance Percentage) for the specific health home services in Section 2703. The enhanced match does not apply to the underlying Medicaid services also provided to individuals enrolled in a health home.
The 90% enhanced match is good for the first eight quarters in which the program is effective. Oklahoma may receive more than one period of enhanced match, understanding that they will only be allowed to claim the enhanced match for a total of 8 quarters for one beneficiary.
