View From Washington

How Will Health Reform Promote Medical Homes?

By Brent Ewig, MHS
Director of Public Policy & Government Affairs, AMCHP    

Greetings again from our nation’s capital. I will address this issue’s main topic of medical homes in a moment but first wanted to provide a quick re-cap of some policy related highlights from AMCHP’s recent Annual Conference. We are thrilled to report that over 60 members, families, and friends made visits to Capitol Hill while in town to advocate for increased funding for the Title V Maternal and Child Health Services Block Grant!                                        


Youth leader Mallory Cyr shares AMCHP’s Title V Advocacy materials and gets great feedback from U.S. Senator Susan Collins (R-MEWe are so appreciative of all whom helped raise the profile of state MCH programs and made the case for increased funding with elected officials and their staff. An archive of all the materials developed to support this advocacy is available here. While health reform will continue to dominate attention, we are not losing sight of the need to keep pressing on for an increase to Title V MCH Services Block Grant funding and will continue to advocate on your behalf as this year’s appropriations process continues. 





On Tuesday March 9 we capped off our annual conference with a spectacular reception on Capitol Hill where we presented our 2010 AMCHP Legislative Champion for MCH Awards. We were joined by Rep. Jesse Jackson, Jr. (D-IL) who accepted an award in honor of his work addressing health disparities, promoting MCH and specifically for championing funding for the Title V MCH Services Block Grant. He provided some poignant remarks about the wisdom he gained from his mother. He also highlighted how our request for an increase to Title V is a heavy lift in this fiscal environment, but committed to continuing to champion our cause.  

 AMCHP President-Elect Stephanie Birch (AK) presents an AMCHP Legislative Champion for MCH Award to Rep. Jesse Jackson, Jr. (D-IL

We were also joined at the reception by Rep. Lois Capps (D-CA) who as a former school nurse has been a consistent champion for MCH issues in Congress. She spoke eloquently of the leadership Congress is providing for mothers, children and families, and highlighted her intention to soon introduce legislation to address maternal mortality within the United States.  

 Rep. Lois Capps (D-CA) addresses AMCHP members on Capitol Hill.

Finally, on March 10 a small AMCHP delegation joined Sen. Max Baucus (D-MT) to present him with an AMCHP Legislative Champion Award. While acknowledging his overall work on reauthorizing CHIP and leading health reform efforts in the U.S Senate, we specifically celebrated his leadership to place the new Maternal, Infant, and Early Childhood Home Visiting State Grant Program with Title V in the Patient Protection and Affordable Care Act.

AMCHP leaders present a Legislative Champion for MCH Award to Sen. Max Baucus (D-MT) and Senate Finance Committee staff  

Overall, the AMCHP annual conference provided a great opportunity to raise the profile of State Title V MCH programs in our nation’s capital, celebrate the progress we are making, and continue our advocacy efforts on behalf of the women, children, and families we serve. We look forward to building on this momentum next year! 

Now, back on to the topic at hand – Medical Home. I first want to extend a word of appreciation to our colleagues at the American Academy of Pediatrics who have been consistent and effective advocates for promoting medical homes. We have been working in partnership for several years now on a shared vision to provide all children with care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. We are appreciative of the strong collaboration between AMCHP and AAP staff members in both DC and Illinois. 

Together with AAP and many other partners, AMCHP advocated for many important provisions for MCH populations in health reform. Following are highlights included in the Patient Protection and Accountable Care Act (PPACA) which present the best opportunities to support the expansion of medical homes: 

Health Homes in Medicaid: Section 2703 of the PPACA creates a state option to provide health homes for Medicaid enrollees with chronic conditions. The Secretary may award $25 million in planning grants to states to develop a state plan amendment to provide health homes. Health homes are to be provided by a designated provider (physician, clinical group practice, rural clinic, community health center, community mental health center, pediatricians, gynecologists, obstetricians) or team (including physicians and other professionals such as nurse care coordinator, social worker, behavioral health) and must provide comprehensive case management, care coordination and health promotion, transitional care, patient and family support, referral to community services, and the use of Health Information Technology as appropriate. 

Pediatric Accountable Care Organization Demonstration Project: Section 2706 authorizes participating states to recognize pediatric medical providers as an accountable care organization (ACO) for purposes of receiving incentive payments (states and the Secretary will establish an annual minimum savings level to be achieved by the ACO for services covered under Medicaid or CHIP in order to receive savings). Demonstration project established with the ACO should last three years. 

CMS Center for Medicare and Medicaid Innovation: Section 3021 establishes a new Center for Medicare and Medicaid Innovation within CMS to test innovative payment and service delivery models for Medicare, Medicaid, and CHIP programs. Models should promote payment and practice reform in primary care, including patient-centered medical home models for high-need individuals and medical homes that address women’s unique health care needs. Additional factors for consideration include whether the model places the individual, including family members and other informal caregivers, at the center of the care team and provides for the maintenance of a close relationship between care coordinators, primary care, specialists, and community-based organizations. The law provides an initial mandatory appropriation of $5 million for planning in FY 2010 and then a mandatory appropriation of $10 billion over the next ten years for implementation. 

State Grants to Promote Community Health Teams that support the Patient-Centered Medical Home: Section 3502 authorizes grants for community-based interdisciplinary teams which will provide support services to primary care practices, including OBGYN practices. The team may include specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral/mental health providers, and physicians’assistants. Health teams should collaborate with local primary care and health providers; coordinate disease prevention and management, coordinate transition between health care providers and settings; provide case management for patients, including children; incorporate patients and caregivers in program design and oversight; provide quality-driven, cost-effective, culturally appropriate, and patient- and family-centered health care; establish a coordinated system of early identification and referral for children at risk for developmental or behavioral problems; and should provide support for transitional health care needs from adolescence to adulthood. 

Community Health Centers: Finally, to dramatically expand community based primary care capacity, section 10503 creates a Community Health Center Fund that provides $11 billion in mandatory funding (over five years) for the Community Health Center program, the National Health Service Corps, and construction and renovation of community health centers. Additionally, section 4101 provides $50 million over four years for a new grant program to establish school-based health clinics that provide health services to children and adolescents. 

Taken together, these provisions offer substantial resources and opportunities to generate further expansion of medical homes. AMCHP will continue to work with key partners to provide additional information on these opportunities, with a particular focus on the potential roles for state Title V MCH and CYSHCN programs.