On August 23, 2018, the Centers for Medicare and Medicaid Innovation (CMMI), housed within CMS, introduced the Integrated Care for Kids (InCK) Model. The InCK Model will support states and local providers with conducting early identification and treatment of children with health- and behavioral health-related needs across settings. This Model may present an opportunity for HealthySteps sites to collaborate with their community (defined by CMMI as “geographically-defined regions”) and State Medicaid Agency to better integrate care for children while creating sustainable funding mechanisms to support HealthySteps. CMMI will award grant funding to a maximum of eight states to support these goals. The National Office is available to address questions from sites interested in exploring the opportunity further.
This initiative is particularly exciting because it is the first pediatric model developed at CMMI and reflects the growing understanding that children are not “mini-adults” and that special considerations must be taken when redesigning systems of care that more effectively serve children and their families. In part, the InCK Model draws from comments CMMI received after releasing a Request for Information (RFI) on alternative payment models (APMs) for children in the Fall of 2017. (See ZERO TO THREE and HealthySteps’ comment .)
The stated goals of the InCK Model are: 1) improving child health outcomes; 2) reducing avoidable inpatient stays and out-of-home placements; and 3) creating sustainable APMs. In addition to these enumerated goals, CMMI, through its introductory webinars, is messaging that the overall purpose of the model is to more broadly focus on early identification of behavioral health challenges, integrate physical and behavioral health with other key services, and provide child- and family-centered care – all of which are central to the HealthySteps model.
The InCK Model will promote and leverage a risk-stratified and tiered service delivery approach to integrate services for Medicaid and CHIP populations according to levels of need. Within the eight geographically defined regions selected, there will be three Service Integration Levels (SILs). The SIL 1 category will provide care coordination and case management to all children covered by Medicaid and CHIP. The SIL 2 and 3 categories will include children with multi-sector needs, functional impairments, or those at-risk or currently placed outside of their home. These children will receive integrated care coordination and case management services ranging in intensity based on individual needs. The HealthySteps three-tier model naturally aligns with the InCK Model’s goals and approach for ensuring that resources are available to serve children and families based on their unique needs and circumstances.
The InCK Model is funded and structured over a two-year pre-implementation period, followed by a five-year Model performance period, with funding available for all seven years.
Key Application Requirements:
HealthySteps sites, particularly those affiliated with a larger system, are well-positioned to apply for this opportunity as a Lead Organization. Lead Organizations must be HIPAA-covered entities and are responsible for coordinating the following core child services within their geographically defined region:
- Clinical care including physical and behavioral health;
- Early care and education;
- Food banks, including WIC;
- Housing support;
- Title V Agencies;
- Child welfare; and
- Mobile crisis response services.
HealthySteps Specialists (HS Specialists) actively coordinate referrals and follow-ups for these types of services at the child and family level. Pursuing funding under the InCK Model provides an opportunity to partner with these organizations in your community in a more systematic way. The Lead Organization must also formally partner with the State Medicaid Agency to apply, which offers a valuable opportunity to increase the visibility of your HealthySteps program within your state and to cultivate and nurture relationships at the state level. If your HealthySteps site or health system is unable to serve as the Lead Organization, there are still opportunities to engage as a partner by contacting your State Medicaid Agency to identify other potential entities within your community that may be interested in applying as the Lead Organization.
Lead Organizations must also develop an APM to support care coordination, case management, and mobile crisis response and stabilization services. This APM can serve to support HealthySteps long-term sustainability. Awardees will work actively with CMS to develop APMs under existing Medicaid and CHIP state authorities. ZERO TO THREE’s RFI comments may help inform discussions with your State Medicaid Agency on how to formulate an APM.
Key Dates and Next Steps:
CMS intends to release the Notice of Funding Opportunity (NOFO) in the Fall of 2018 and to award cooperative agreements as early as Summer 2019. Cooperative agreements may be issued to as many as eight states for up to $16 million for seven years.The National Office Policy and Finance Team will release additional information and guidance once CMS releases the NOFO.
For additional information, visit: https://innovation.cms.gov/initiatives/integrated-care-for-kids-model/ or contact Johanna Lister, Director of Policy for HealthySteps, at [email protected] for more information.