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Agency issues guidance on a new
optional Medicaid “health home” benefit that can help connect children with
cerebral palsy and other complex medical conditions to care.
The
U.S. Department of Health and Human Services, through the Centers for
Medicare & Medicaid Services (CMS), today unveiled guidance on a new
Medicaid health home benefit for children with medically complex
conditions. This new optional benefit helps state Medicaid programs provide
Medicaid-eligible children who have medically complex conditions with
person-centered care management, care coordination, and patient and family
support. CMS anticipates that the new benefit will help these children
receive the care they need, including across state lines.
Children
with medically complex conditions — including serious health concerns like
cerebral palsy, cystic fibrosis, blood diseases, and mental health
conditions that can severely impact a child’s ability to function — often
require tremendous care coordination and highly specialized treatment.
Finding needed services often requires traveling well beyond a family’s
home, and often care is only available for these children out-of-state. The
new health home services are expected to give these children and their
families help in coordinating and managing care.
"Every
child deserves the care and support they need to stay healthy and thrive.
This new Medicaid health home benefit will give states new options and
financial incentive to improve care for children with complex medical
conditions. At HHS, we are committed to providing families with access to
appropriate pediatric specialty and subspecialty medical services,
including when those services are needed across state lines," said
Health and Human Services Secretary Xavier Becerra.
“CMS
and our state partners are doing all that we can to provide whole-person
care through Medicaid and the Children’s Health Insurance Program (CHIP),”
said CMS Administrator Chiquita Brooks-LaSure. “This new state plan option
is about ensuring that children and families can get coordinated,
high-quality care — particularly children with complex medical conditions.
CMS is committed to working with states interested in pursuing this option
to ensure they can quickly and efficiently get kids the care they
need.”
As
outlined in today’s letter to state Medicaid directors, states will have
the option to offer the new health home services benefit for children with
medically complex conditions beginning October 1, 2022. The services
provided under the new benefit include providing access to the full range
of pediatric specialty and subspecialty medical services, including
services from out-of-state providers, as medically necessary.
The
guidance issued today provides information to states about the new health
home benefit, including about payment methodologies, provider standards,
provider and state reporting, state monitoring, and state assurance
requirements. States with approved Medicaid state plan amendments (SPAs) to
cover the new health home benefit will receive a 15 percentage point
increase in federal matching for their expenditures on health home services
during the first two fiscal year quarters that the SPA is in effect. CMS
also has committed to offer ongoing technical assistance to states about
implementation of the new benefit.
CMS
has engaged with stakeholders since January 2020 on this opportunity. CMS
issued a Request for Information to obtain feedback from the public,
including advocates, families, and states, on best practices for
coordinating care provided by out-of-state providers to Medicaid-eligible
children with medically complex conditions and, in October 2021, issued a
bulletin on those best practices.
To
learn more about CMS’ latest guidance, consult the state Medicaid director
letter available on https://www.medicaid.gov/federal-policy-guidance/downloads/smd22004.pdf
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