Frequently Asked Questions (FAQs)
Below are some FAQs about the Health Homes program.
L.A. Care and other managed care plans have been working to provide as much information as possible about the Health Homes Program (HHP) to Los Angeles County providers.
L.A. Care and Health Net, along with our plan partners — Anthem Blue Cross, Blue Shield of California Promise Health Plan, Kaiser Permanente and Molina Healthcare — held town halls in July and September of 2018 to inform stakeholders about this new mandatory Medi-Cal benefit. We also held webinars to provide additional information as the program moves forward.
You'll find a set of Frequently Asked Questions below based on these meetings to further assist you in the process, as well as other resources.
L.A. Care hosted a Health Homes 101 webinar on August 23, 2018 and a Health Homes CB-CME Certification Application Webinar on February 8, 2019. You can view information about the program and its goals and requirements.
Below are some FAQs about the Health Homes program.
To become a CB-CME, organizations must meet the criteria described in the Department of Health Care Services (DHCS) Program Guide, submit a Letter of Intent (LOI), submit an application, and follow L.A. Care's prescribed certification and contracting process.
L.A. Care and all health plans involved in HHP will require the same LOI form and CB-CME application form. While we have committed to a streamlined CB-CME application and contracting process, there is variability in each health plan's certification process as all health plans have their own approach and strategy for certifying CB-CMEs. One health plan may choose to contract with one entity while another health plan may not.
L.A. Care will work closely with CB-CMEs in assessing HHP readiness. The LOI submission process and CB-CME certification process are intended to assess CB-CME readiness for HHP. All interested entities are encouraged to participate in the LOI submission and CB-CME certification process.
Note: Mental health provider organizations do not need to submit an LOI at this time as Serious Mental Illness (SMI) launch in L.A. County is January 1, 2020. Further information will be provided at a later date.
All Health Homes CB-CMEs must be able to provide all six of the required Health Homes services either as direct services or through subcontracting services. The six required services are:
CB-CMEs should indicate specific areas of expertise, such as working with people experiencing homelessness, people with mental health needs, dementia, palliative care, and others. CB-CMEs will need to determine how they can adequately provide all of the required HHP services.
L.A. Care will have oversight, compliance, and monitoring policies and procedures in place. The CB-CME certification process will outline all the requirements, and CB-CMEs will be held responsible for meeting the terms of their contracts.
CB-CMEs can use a variety of staffing models to create a Health Homes program, including subcontracting. CB-CMEs may hire new staff members or leverage existing staffing infrastructure to serve HHP eligible and enrolled members.
If CB-CMEs have existing roles that correspond to the required HHP roles, there is no need to create new positions just for HHP, as long as the staffing model enables the CB-CME to meet the HHP requirements. CB-CMEs must ensure staff serving HHP enrolled members have sufficient time to dedicate to members at the appropriate staffing ratios. DHCS requires at least a minimum 1:60 staffing ratio for HHP enrolled members, but certain subpopulations may require higher or lower staffing to meet their needs.
The L.A. County CB-CME network structure will depend on the interest and readiness of potential CB-CMEs. All entities, permitted by DHCS, that may serve as a CB-CME are listed in the DHCS Program Guide.
The DHCS Program Guide states the aggregate minimum care coordination ratio of Health Homes member to care coordinator, over the course of the two years, is 60:1. However, certain subpopulations may require higher or lower staffing ratios to meet their needs.
Per DHCS, the HHP multidisciplinary team includes a director, clinical consultant, care coordination, community health worker (optional) and a housing navigator (optional). Descriptions of their role and qualifications can be found in the DHCS Program Guide.
Hospitals can choose to serve as CB-CMEs if they desire. Hospitals will be a key place for identifying and engaging HHP eligible members. Given that transitions of care are a required HHP service, hospital discharge planners will be involved.
CB-CME capacity will be monitored by the HHP enrolled member to care coordinator ratio (60:1) outlined by DHCS. CB-CMEs will be required to report to L.A. Care on their HHP capacity.
Cal MediConnect (CMC) members do not qualify to participate in HHP. However, dual eligible members who are in Medi-Cal are eligible to participate in HHP.
HHP referrals will primarily be received by CB-CMEs and submitted to L.A. Care. All CB-CMEs will be subject to specific HHP trainings across their multidisciplinary teams to ensure all individuals involved in the referral process understand the referral pathway, enrollment processes, intake assessment, and the development of the HHP Health Action Plans (HAP), i.e., patient/member/individual care plan.
L.A. Care will provide CB-CMEs a list of individuals that are likely eligible for HHP to begin outreach, engagement, enrollment, and services provision. There will be a referral process in place that will allow CB-CMEs to refer members to HHP that do not appear on their monthly Targeted Engagement List (TEL).
If a member who is enrolled, but then decides to opt out of HHP, the CB-CME will work with L.A. Care to disenroll the member.
The DHCS Program Guide outlines specific exclusionary criteria. HHP enrolled members cannot receive duplicative care coordination services. L.A. Care and other health plans are working with the appropriate L.A. County stakeholders on developing the necessary HHP eligibility and enrollment policies and procedures. More information will be provided at a later time.
L.A. Care will provide CB-CMEs with a monthly Targeted Engagement List (TEL) detailing what members are potentially eligible for Health Homes. We are in process of developing eligibility and enrollment policies and procedures. CB-CMEs will be expected to verify Medi-Cal and HHP eligibility (including screening for any exclusionary criteria) during the enrollment and screening process. More information will be provided at a later time.
CB-CMEs are required to submit monthly data and reporting to L.A. Care. We are developing policies and procedures and there will be one standard reporting template for HHP CB-CMEs participating in L.A. County. More information will be provided at a later time.
L.A. Care and Health Net are working with the Los Angeles County Department of Health Services (including Housing for Health) and the Los Angeles Homeless Services Authority in order to determine how coordination around HHP will be most beneficial for HHP eligible individuals. More information will be provided a later time.
HHP is not the same as home health. HHP is a new DHCS mandated Medi-Cal benefit, authorized under Section 2703 of the Affordable Care Act.
HHP provides comprehensive care management services to help Medi-Cal members with chronic conditions and their physical health, behavioral health and social service needs, including housing. HHP leverages existing care management and care coordination initiatives across L.A. County and expands capacity to serve new populations.
HHP services require intensive engagements with patients, including required frequent, in-person services where the member lives, works or seeks care. HHP does not provide clinical treatment services.