CMS Releases SPA, Implementation Guide for Health Home Services for Children with Medically Complex Conditions
  • States may implement health home programs for Medicaid-eligible children with medically complex conditions beginning October 1.
  • New CMS resources for states include a SPA template and a program implementation guide.
  • Under the health homes program, states can receive an enhanced FMAP for the first two years of their programs.
Today, the Centers for Medicare and Medicaid Services (CMS) released the state plan amendment (SPA) template and implementation guide for the Medicaid state plan option to cover health home services for Medicaid-eligible children with medically complex conditions. Additional technical assistance for state Medicaid programs can be found through MACPro. These new resources represent the latest update to CMS’ amalgamation of guidance documents and resources related to health homes’ coordination of beneficiaries’ medical, behavioral health, and long-term services and supports (LTSS) needs.

  • Background. The Medicaid Health Home State Plan Option was first authorized as part of the Affordable Care Act (ACA) in 2010. Enacted as part of the Medicaid Services Investment and Accountability Act (MSIA) of 2019, section 1945A(e)(2) of the Social Security Act (SSA) directs the Department of Health and Human Services (HHS) to issue a Request for information (RFI) related to coordinating care for children with medically complex conditions furnished by out-of-state providers. Most recently, CMS issued guidance to states on August 1, 2022, pertaining to health homes for children with medically complex needs.
 
The Medicaid Health Home State Plan Option allows states to design health home models that focus on Medicaid beneficiaries with chronic conditions. Under these programs, states receive an enhanced Federal Medical Assistance Percentage (FMAP) for the first eight quarters of an approved model. While states can choose to home in on a range of medical conditions in their health home plans, today’s updated guidance from CMS specifically pertains to services for Medicaid-eligible children with complex conditions. As a means to provide states with technical assistance in crafting a health homes policy, states can request one-on-one assistance from CMS and share best practices from existing state programs, as well as receive assistance with health home proposals and drafting SPAs.
 
  • What’s Next? Beginning October 1, 2022, HHS can award planning grants to states developing SPAs for Medicaid-eligible children with medically complex conditions.
 
Through the Health Home Information Resource Center, CMS has provided guidance related to the following:
 
General Resources
  • Substance Abuse and Mental Health Services Administration (SAMHSA) Health Home Resources;
  • State Medicare-Medicaid Data Guidance;
  • The MACPro portal, through which states can submit a SPA via an online template;
  • Guidance for states focusing on substance use disorder (SUD) health homes;
  • Map of state health home activity;
  • Overview of approved health homes SPAs;
  • Comparison chart for approved health home SPAs; and
  • Health homes fact sheet.
 
Coordinating Care from Out-of-State Providers for Children with Medically-Complex Conditions
  • The 2020 RFI on coordinating care from out-of-state providers for Medicaid-eligible children with medically complex conditions;
  • A fact sheet on the RFI;
  • Guidance resulting from this RFI; and
  • The SSA 1945A SPA Template and IG Reference Materials (zip file).

The resource center provides additional information specific to: