Highlights
- A significant step forward to formalizing quality measures associated with patient values and goals related to healthcare services in home and community settings
- New Medicaid care coordination program for children with complex medical needs
Bottom line: The federal Medicaid program supports many people with serious illnesses and has recently taken steps to enhance care related to people with serious illnesses, many of whom reside in traditionally underserved and under-resourced communities.
Background
The Center for Medicaid and CHIP Services (CMCS), which oversees the federal Medicaid program, recently issued important updates that impact and improve the delivery of care for people with serious illnesses enrolled in Medicaid.
Home and Community Based Services Quality Metrics
In July 2022, CMCS issued the first of two guidance letters on home and community based services (HCBS) quality metrics. This guidance is the first of its kind released by the federal Medicaid program to create a standard national quality framework across HCBS programs. HCBS programs are designed to enable Medicaid beneficiaries to receive services in their own home or community rather than in institutions or other isolated settings. Many individuals with serious illness access such services as an alternative to institutional care. In the proposed measure set outlined in the guidance (see page 16), CMCS has included a number of patient-reported outcome measures and measures intended to assess the extent to which care plans incorporate person-centered goals and reflect individual preferences and choices. C-TAC is pleased that many of the suggested measures align with the C-TAC core principles.
In an upcoming guidance document, CMCS will be outlining how states can use the measure set as part of their HCBS quality measurement, reporting, and improvement activities. C-TAC is working with our partners to submit recommendations to build on these foundational steps taken by CMCS.
New Health Home Option:
Medicaid Health Homes were created under the Affordable Care Act as an optional benefit for state Medicaid agencies to pursue. Health Homes are meant to support care coordination for Medicaid beneficiaries with chronic illnesses; of note, Medicaid Health Homes are different from home health or home care programs, which typically provide an in-home aide to individuals and may not encompass holistic, team-based care coordination across service providers. As of March 2022, there were 20 states, including the District of Columbia, operating such programs.
In August 2022, CMCS issued guidance outlining a new Health Home option for children with medically complex conditions. Under this new option, states can elect to implement a new Health Home benefit for individuals under 21 with a serious, long-term physical, mental, or developmental disability or disease. States that implement the benefit will offer the following types of services: comprehensive care management; care coordination, health promotion, and the provision of access to the full range of pediatric specialty and subspecialty medical services; comprehensive transitional care, including appropriate follow-up, from inpatient to other settings; patient and family support (including authorized representatives); referrals to community and social support services; and use of health information technology to link services.
Participating states will also receive increased federal Medicaid dollars matched to state dollars for the first two fiscal year quarters in which the benefit is in effect; this financial incentive may increase the likelihood of state participation in this optional benefit.
C-TAC commends CMCS for advancing this new option to states that could hold promise for serving a wide array of pediatric populations facing serious illness; C-TAC particularly appreciates the inclusion of coordination and family/caregiver supports in the proposed benefit, consistent with C-TAC core principles, particularly aim 1 and care principle seven. C-TAC will continue to monitor the implementation of this new Medicaid option.
