Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.240 - MO HealthNet Primary Care Health Homes

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment adds chronic pain as a
				  stand-alone chronic condition that qualifies MO HealthNet participants as
				  Primary Care Health Home patients. The amendment also clarifies Health Home
				  certification requirements, adds provider requirements for primary care health
				  homes offering services to patients with chronic pain as a qualifying
				  condition, and clarifies which health home patients will generate per-member,
				  per-month (PMPM) payments to health homes.
(1) Definitions.
(A) EMR-Electronic Medical Records, also
				referred to as Electronic Health Records (EHR).
(B) Health Home-A primary care practice or
				site that provides comprehensive primary physical and behavioral health care to
				MHD patients with chronic physical and/or behavioral health conditions, using a
				partnership or team approach between the Health Home practice's/site's health
				care staff and patients in order to achieve improved primary care and to avoid
				preventable hospitalization or emergency department use for conditions
				treatable by the Health Home.
(C)
				Meaningful Use Stage One-The American Recovery and Reinvestment Act (ARRA) of
				2009 created the Electronic Health Records (EHR) incentive payments program to
				provide Medicare or Medicaid incentive payments to eligible professionals in
				primary care practices. Meaningful use means that the eligible professionals or
				providers document that they are using certified EHR technology in ways that
				can be measured significantly in quality and in quantity. Stage one of
				meaningful use means the eligible professionals meet twenty (20) out of
				twenty-five (25) meaningful use objectives as specified by the Centers for
				Medicare and Medicaid Services (CMS).
(D) MHD-MO HealthNet Division, Department of Social
				Services.
(E) NCQA-National
				Committee for Quality Assurance, an entity chosen by MHD to certify that a
				primary care practice has obtained a level of Health Home recognition after the
				practice achieves specified Health Home standards.
(F) Needy Individuals-Patients whose primary care
				services are either reimbursed by MHD or the Children's Health Insurance
				Program (CHIP), or are provided as uncompensated care by the primary care
				practice, or are furnished at no cost or at reduced cost to patients without
				insurance.
(G) Patient Panel-The
				list of patients for whom each provider at the practice site serves as the
				primary care provider.
(H)
				CMS-Centers for Medicare and Medicaid Services.
(I) Chronic Pain-Pain that lasts past the
				time of normal healing and that can lead to other medical conditions such as
				substance use disorder, becoming overweight/obese, anxiety, and depression. For
				the purpose of participant eligibility for Primary Care Health Home, chronic
				pain must be a pre-existing condition for at least twelve (12) consecutive
				months.