Health Care Homes (HCH)

Revised: October 10, 2022

· Overview

· Eligible Providers

· Eligible Members

· Care Delivery

· Billing

· Additional Resources

· Legal References

Overview

The Health Care Homes (HCH) program, authorized by the Minnesota Legislature, allows qualified MHCP-enrolled providers to receive HCH reimbursement for the delivery of care coordination services to MHCP members who have complex and chronic medical conditions. For patients enrolled in managed care organizations (MCO), contact the MCO directly.

The development of the HCH initiative is a coordinated effort between the Minnesota Department of Health (MDH) and DHS and is driven by the Institute for Healthcare Improvement’s Triple Aim, an initiative to simultaneously achieve the following goals:

· Improve the individual experience of care

· Improve the health of the population

· Improve affordability by containing the per capita cost of providing care

Eligible Providers

Clinics and clinicians must meet a set of standards and criteria in order to be certified as a health care home in Minnesota. Use the MDH Health Care Homes certification process to become a certified Health Care Homes provider. To receive reimbursement for HCH services, providers must:

· Receive HCH certification from MDH

· Determine eligible HCH members

· Provide HCH services

· Claim HCH reimbursement once a month for each eligible recipient

The Minnesota Department of Health (MDH) will send Health Care Home (HCH) clinics’ and providers’ certifications directly to the Department of Human Services (DHS).

Before billing care coordination services S0281; access MN–ITS and verify the individual provider or clinic is listed on the Health Care Homes list accessible from the Provider Lists link in the left column.  

Eligible Members

Providers can assess the overall complexity of patients by grouping them into complexity tiers based on the number of major chronic condition groups that apply to them. MHCP members with one (1) or more major chronic condition are eligible for HCH. The Care Coordination Tier Assignment Tool has been developed to support complexity assessments. Based on the above methodologies, members with major condition groups are scored as follows:

· Tier 1: 1-3 major condition groups

· Tier 2: 4-6 major condition groups

· Tier 3: 7-9 major condition groups

· Tier 4: 10 or more major condition groups

MHCP increases HCH reimbursement for care coordination when members (including their caregivers): have one of the following supplemental complexity factors:

· Need sign or spoken language interpreter services

· Have a serious and persistent mental illness

See the Care Coordination Tier Assignment Tool for how MHCP defines these factors. There will be a 15% increase for each factor; and a 30% increase when both apply. The corresponding procedure codes and modifiers for member tier level and the presence of supplemental factors are described below.

Care Delivery

· Care Coordination services are a team approach that engages the participant, the personal clinician or local trade area clinician, and other members of the health care home team to enhance the participant’s well-being by organizing timely access to resources and necessary care that results in continuity of care and builds trust

· Members must have at least one evaluation and management (E/M) visit per year with the HCH provider. See billing information below

Patient Care Management Tool

Health Information Request (HIR) – enables clinicians to gather a more complete medical history for MHCP members. Use the automated HIR clinical tool to help improve care coordination, reduce duplication of services, and improve patient safety and quality of care.

Billing

To claim care coordination payment from MHCP for fee-for-service members

1. Document all care coordination services provided and justification for complexity tier assignment in the member’s medical record

2. Use the 837P electronic claim transaction to submit all claims

3. A single date of service represents the entire month. Bill on one claim transaction, enter 1 unit of Initial Care Coordination planning code S0280 for the first month. Enter Maintenance Care Coordination Planning code S0281 for each additional month. Bill the procedure code once a month with:

· Modifier U1: Tier 1

· Modifier TF: Tier 2

· Modifier U2: Tier 3

· Modifier TG: Tier 4

· And, if necessary

· Modifier U3: If primary language is Non-English

· Modifier U4: If Severe and Persistent Mental Illness

Members must have an E/M visit with the care coordination provider within the last 12 months from the care coordination procedure code date of service to be eligible for reimbursement. The appropriate E/M procedure code can occur on a different date of service and be billed separately from the care coordination procedure code. E/M visit procedure codes considered are 99201-99205, 99211-99215, 99324-99328, 99334-99337, 99339, 99340, 99341-99345, 99347-99350, 99381-99387 and 99391-99397.

Reimbursement is the lower of the submitted charge or when the rendering enrolled provider is either a physician or nurse practitioner, per these tiers:

Physician	Nurse practitioner or physician assistant
Tier 1: $ 10.14	Tier 1: $ 9.81
Tier 2: $ 20.27	Tier 2: $ 19.61
Tier 3: $ 40.54	Tier 3: $ 39.22
Tier 4: $ 60.81	Tier 4: $ 58.83

HCH reimbursement is dependent on verification that both the pay-to provider and treating provider are eligible for HCH and that the member is enrolled.

Additional Resources

· Health Information Request (HIR)

· Minnesota Department of Health – Health Care Homes

Legal References

Minnesota Statutes 256B.0625 Subd. 51 (provider-directed care coordination services)