CareLink NM Health Homes
Program Location:
Santa Fe, NM
Payer Type:
Medicaid
Parent Program:
Payers:
Medicaid
Reported Outcomes
Description:
In April of 2016 the New Mexico Human Services Department (HSD), with CMS approval, initiated the CareLink New Mexico Health Home Program (CLNM HH). The first stage of this statewide program engaged agencies to provide coordinated care in two rural counties. These Health Homes are designed for individuals with chronic conditions in the categories of serious mental illness for adults (SMI), and severe emotional disturbance (SED) for children and adolescents. Based on the positive results in these two counties, HSD is expanding Health Homes in to eight additional counties with seven providers. Within this expansion, HSD will pilot a high delity wraparound model with two providers for our most vulnerable children and adolescents. In addition, one of the providers will be our rst Tribal 638 Health Home.
The Health Home service delivery model, called CareLink NM, provides for enhanced care coordination and integration of primary, acute, behavioral health, long term care services, and social supports. It also includes comprehensive care management, health promotion, disease management, risk prevention, comprehensive transitional care, peer and family supports, and referral for community and social services and supports.
The goals of the program are to:
1) Promote acute and long term health;
2) Prevent risk behaviors;
3) Enhance member engagement and self-ecacy;
4) Improve quality of life for individuals with SMI/SED; and
5) Reduce avoidable utilization of emergency department, inpatient and residential services.
Each goal has a number of process and outcome criteria.
CareLink NM Health Homes Program is an integrated health care service program for Medicaid behavioral health beneficiaries with a primary condition of Serious Mental Illness (SMI) and/or Severe Emotional Disturbance (SED). The CareLink NM Health Homes Program coordinates behavioral & physical health care with community services to improve quality of care.
Payment Model:
FFS PMPM
The PMPM rate will be updated annually based upon results of analyses, including claims experience. HSD reserves the right to update PMPM rates as deemed necessary. The PMPM reimbursement is paid for each CLNM member, regardless of whether the member is enrolled with an MCO or in FFS Medicaid. The provider is responsible for verifying a member’s affirmative agreement to participate and opt-in for CLNM services. In order to be reimbursed, providers must retain a signed opt-in statement in a member’s file.
