Your health home is not a building or a place of residence. It's an approach to care that provides you with a team of professionals working together to meet all your healthcare needs. This is an opportunity for you to play a big role in your healthcare and achieve healthier results related to chronic medical conditions. There are two types of Health Homes. A member can only be enrolled in one at a time.
WHO DOES A HEALTH HOME COVER?
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Exceptions considered through a prior authorization process when the behavioral health condition is chronic and the Global Assessment Functioning (GAF) score is 50 or less (A lower score indicates lower functionality).
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Includes members enrolled in full Medicaid benefits, Medicaid-Medicare members (Duals), adults, children
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Chronic Condition Health Home
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Member must have at least two chronic conditions from the below list, or
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One chronic condition and at risk of a second condition from the list below:
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Hypertension
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Overweight
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Heart Disease
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Diabetes
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Asthma
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Substance Abuse
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Mental Health
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Integrated Health Home
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Members with Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED) are eligible. SMI is defined as:
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Psychotic Disorders
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Schizophrenia
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Schizoaffective Disorder
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Major Depression
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Bipolar Disorder
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Delusional Disorder
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Obsessive-Compulsive Disorder
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SED is a diagnosable mental, behavioral or emotional disorder of sufficient duration to meet diagnostic criteria specified within the most current Diagnostic and Statistical Manual of mental disorders published by the American Psychiatric Association or its most recent International Classification of Diseases equivalent that result in functional impairment. SED may co-occur with substance use disorders, learning disorders, or intellectual disorders that may be a focus of clinical attention. Functional Impairment (FI) is:
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Difficulties that substantially interfere with or limit the achievement of or maintaining one or more developmentally appropriate social, behavioral, cognitive, communicative or adaptive skills and substantially interfere with or limits functioning in family, school or community activities
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Difficulties of episodic, recurrent and continuous duration.
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Does not include difficulties resulting from temporary and expected responses to stressful events in a person’s environment.
For children 3 yrs. or younger, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised (DC: 0-3R) may be used as the diagnostic tool. For children 4 yrs. and older, the Diagnostic Interview Schedule for Children (DISC) may be used as an alternative to the most current DSM. FI will be determined through an assessment provided by the integrated health home that serves children.
WHAT SERVICES ARE COVERED BY A HEALTH HOME?
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A primary care practitioner that manages all your health care
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A nurse available to help you identify and achieve your health and wellness goals
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Access to support services to remove barriers to achieving better health
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Access to health education and promotion to address smoking, nutrition and physical activity
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Assistance with transitional care and discharge planning after hospitalization or rehab
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Assistance in finding community resources and support services
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Assistance with managing your medication and medical treatments
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One plan of care that you participate in
HOW DO I APPLY OR GET INTO A HEALTH HOME?
It is your choice to become part of a health home. This is a voluntary program, through the engagement of your provider.
WHERE CAN I RECEIVE SERVICES?
- Chronic Condition Health Home Brochure
- Iowa Medicaid Chronic Condition Health Home Provider List
- Provider MAP (to come)
- Integrated Health Home Provider List
- Provider MAP (to come)