Community Mental Health Center (CMHC) Healthcare Home
Missouri launched the first CMHC Healthcare Home program on January
1, 2012 to provide improved care to Medicaid beneficiaries with
behavioral health conditions. The CMHC Healthcare Homes leverage the
core Section 2703 Health Home elements such as comprehensive care
management, care coordination, health promotion, and community referral
services with a focus on delivering integrated physical and mental
To be eligible to participate, Medicaid beneficiaries must meet one of three qualifying criteria:
- be an adult with a serious and persistent mental illness (SPMI) or a child with serious emotional disturbance (SED)
- have a mental health condition and a substance use disorder (SUD)
- have a mental health condition or SUD and one other chronic condition or chronic disease risk factor
Qualifying chronic conditions in the CMHC Healthcare Home program
include diabetes, asthma/COPD, cardiovascular disease, developmental
disabilities, being overweight, or using tobacco.
To serve as a Healthcare Home, CMHCs must effectively co-locate
primary care and behavioral health services. This requires CMHCs to
embed Primary Care Physician Consultants in their practices that are
responsible for establishing disease management priorities and
providing chronic disease education and consultation to other CMHC
staff such as psychiatrists and care managers. Additional required CMHC
Healthcare Home staff include:
- Healthcare Home Director to oversee practice transformation and daily operation
- Nurse Care Manager(s) to provide wellness education and assist with managing patient care
- Administrative support staff
Beyond staffing, CMHC Healthcare Homes are expected to leverage
health information technology to deliver comprehensive care management
services. CMHCs use specific data analytic tools including CyberAccess, a
web-based Medicaid data system that allows providers to view patient
histories, and disease management and medication adherence reports.
As of October 2014, 11% of enrollees are children and youth. All
enrolled children have a serious emotional disturbance diagnosis and the
most common physical conditions for children include asthma, obesity,
and developmental disabilities.
Primary Care Health Homes (PCHH)
Missouri’s Primary Care Health Homes (PCHH) also went into effect on
January 1, 2012. The targeted Medicaid population for PCHHs are
individuals with multiple, chronic physical conditions. Enrollees must
have at least two qualifying chronic conditions for the PCHH. Examples
of qualifying chronic conditions for the PCHH program are the same as
for the CMHC Healthcare Home program.
Currently, children only account for approximately 3% of PCHH
enrollees due to the eligibility requirement of having at least two
chronic physical conditions and the nature of qualifying conditions.
Missouri is considering amending its SPA to enable children with only
asthma or obesity to participate in the program.
The core PCHH services are similar to those of the CMHC Healthcare
Home and include comprehensive care management, care coordination,
health promotion, and referral to community-based services. The PCHH
also includes an emphasis on comprehensive transitional care services
to ensure smooth patient transitions out of inpatient settings.
PCHH team members are comprised of many of the same staff as CMHC
Healthcare Homes including a Health Home Director and Nurse Care
Manager. However, instead of a Primary Care Physician Consultant, PCHHs
include a Behavioral Health Consultant to assist primary care teams in
managing patients with mental health and substance use disorders and a
designated care coordinator responsible for tracking referrals,
managing data, and assisting patients with appointment and prescription
PCHH providers must meet additional criteria including:
- serving a minimum percentage of Medicaid/uninsured patients (adults and children)
- using electronic medical records (EMR) for 6 months
- applying for patient-centered medial home recognition through the
National Committee for Quality Assurance (NCQA) within 18 months
Current PCHH sites include 18 federally qualified health centers (FQHCs) and 6 hospitals.