Iowa Admin. Code r. 441-77.47 - Health home services providers

Current through Register Vol. 44, No. 12, December 15, 2021

Subject to the requirements of this rule, a designated provider may participate in the medical assistance program as a provider of health home services.

(1) Qualifications. A designated provider of health home services must be a Medicaid-enrolled entity or provider that is determined through the provider enrollment process to have the systems and infrastructure in place to provide health home services.
a. Staffing. At a minimum, a qualifying provider must fill the following roles:
(1) Designated practitioner.
(2) Dedicated care coordinator.
(3) Health coach.
(4) Clinic support staff.
b. Data management. A qualifying provider shall ensure that all clinical data related to the member are maintained with the member's medical records through the use of health information technology.
c. Collaboration with case managers. Health homes providing services to members eligible pursuant to 441-subparagraph 78.53(2)"a" (1) or (2) must collaborate, at least quarterly, with targeted case managers, other case managers, or DHS service workers for each member receiving case management services. Strategies to prevent duplication of coordination efforts by the health home and case managers or service workers must be developed by the health home and documented upon request. Documentation may include but is not limited to records of joint staffing meetings where a member's medical needs, current activities, and waiver services needs are reviewed and appropriately updated.
d. Provision of integrated health home services. Health homes providing services to members eligible pursuant to 441-subparagraph 78.53(2)"a" (3) or (4) must be integrated health homes that:
(1) Consist of a team of health care professionals trained in providing health home services to members with a serious mental illness (SMI) and to members with a serious emotional disturbance (SED);
(2) Have a direct agreement with an Iowa Medicaid managed care organization to provide health home services for members with SMI or SED;
(3) Coordinate all community and social support services needs for members enrolled in the health home; and
(4) Follow a system of care model in providing health home services to members with SED, including collaboration with the child welfare, public health, juvenile justice, and education systems.
(2) Report on quality measures. As a condition of participation in the medical assistance program as a provider of health home services and of receiving payment for health home services provided, a designated provider must report to the Iowa Medicaid enterprise on measures for determining the quality of such services. When appropriate and feasible, a designated provider shall use health information technology in providing the Iowa Medicaid enterprise with such information.
(3) Selection. As a condition of payment for health home services provided to a Medicaid member eligible to receive such services pursuant to 441-subrule 78.53(2), a designated provider must be selected by the member as the member's health home, as reported by provider attestation.

This rule is intended to implement Iowa Code section 249A.4 and 2011 Iowa Acts, chapter 129, section 10.

Notes

Iowa Admin. Code r. 441-77.47
ARC 0198C, IAB 7/11/12, effective 7/1/12; ARC 0838C, IAB 7/24/2013, effective 7/1/2013 Amended by IAB January 6, 2016/Volume XXXVIII, Number 14, effective 1/1/2016

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