Vermont Hub and Spokes Health Homes

Program Location: 
Montpelier, VT
Payer Type: 
Medicaid
Payers: 
Medicaid
Description: 

Vermont has an approved state plan amendment for a 2703 Medicaid Health Home program. The Hub and Spokes Health Homes program creates a coordinated, systemic response to the complex issues of opioid addiction among Vermont's Medicaid population, focusing specifically on medication assisted therapy (MAT) for individuals with opioid dependence. The Hub and Spoke approach builds on the statewide expansion of Advanced Primary Care Practices (APCP) also known as Patient Centered Medical Homes, supported by core Blueprint for Health Community Health Teams (CHT) and CHT extenders. This model has allowed Vermont to establish a novel foundation for high quality primary care with embedded multidisciplinary support services, better coordination and transitions of care, and more seamless linkage among the multitude of partners from many disciplines.

As a public-private partnership, the Blueprint has existing CHTs comprised of nurse coordinators, clinician case managers, social workers and other professionals who extend the capacity of primary care practices to assess patients' needs, coordinate communitybased support services, and provide multidisciplinary care. Effective teams are the basis for all of the quality improvements in the Blueprint, supported by payment reforms that provide patients and practices with unhindered access to CHTs, CHT extenders and Self-Management opportunities.

  • Hub: Registered nurse and master’s level licensed clinician case manager, and program director employed by the Hub
  • Spoke: Registered nurse and clinician case manager employed by Blueprint Community Health Team
Payment Model: 

There will be two payment streams: one for Hubs and one for Spokes. Both the Hubs and Spokes will combine services currently reimbursed in Vermont’s State Medicaid Plan with the new Health Home services. Under the terms of the 2703 State Plan Amendment, Vermont will seek 90-10 matching funds only for the percentage of the Hub and Spoke costs directly linked to providing the Health Home services. The remaining percentage will be matched at the current state match rate.

Hub Payment

The Hub payment is a monthly, bundled rate per patient. The Hub provider initiates a claim for the monthly rate, using an existing procedure code and a modifier for the Health Home Services. 

  • Monthly bundled rate per member of $493.37. Note: only 30% of the rate is health-home specific, thus only 30% of the Hub payment is matched at 90% of the federal financial participation rate, or approximately $148 PMPM.

Spoke payment

Spoke payments are based on the average monthly number of unique patients in each Health Services Area (HSA) for whom Medicaid paid a buprenorphine pharmacy claim during the most recent three-month period in increments of 25 patients. Spoke physicians will continue to bill fee-for-service for all typical treatment services currently reimbused by the Department of Vermonth Health Access (DVHA). The Nurse & Clinician Case Manager receives capacity payments to the Blueprint administrative entity, based on number of unique Medicaid beneficiaries receiving buprenorphine.

  •  $163.75 PMPM payment

Last updated December 2015
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