Wisconsin – Medical Homes

Federal Support: On January 29, 2013, the Centers for Medicare & Medicaid Services (CMS) approved Wisconsin’s state plan amendment (SPA) to implement Section 2703 of the Affordable Care Act, creating health homes for Medicaid enrollees with an HIV diagnosis and at least one other diagnosed condition or a risk of developing a second condition. AIDS Service Organizations in four counties are eligible to serve as health homes under this SPA, serving large urban areas including Green Bay, Madison, and Milwaukee. The SPA became effective on October 1, 2012. Wisconsin was a recipient of a planning grant from CMS to develop its state plan amendment. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.

Wisconsin has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”

Last updated: April 2014

Defining & Recognizing a Medical Home
Recognition: AIDS Service Organizations participating in Wisconsin’s ACA Section 2703 Health Homes program must integrate medical, behavioral, pharmacy, and oral health care. Wisconsin also expects health homes to either obtain national patient-centered medical home accreditation (e.g., NCQA) or provide written support that they meet the state’s health home standards, which include:
  • Adoption of written standards for patient access and communication;
  • Use electronic charting tools to organize clinical information;
  • Adopting evidence-based guidelines for treating HIV-related conditions;
  • Systematically tracking test results and identify abnormal results;
  • Electronically tracking patient referrals; and
  • Measuring and reporting health care quality, patient safety, and health outcome information.
Aligning Reimbursement & Purchasing
Wisconsin pays AIDS Service Organizations participating in the state’s ACA Section 2703 Health Homes program a monthly case rate for care management activity and an annual fee for completing an assessment and developing or updating a care plan.
Measuring Results
Wisconsin has identified two specific goals for its ACA Section 2703 Health Homes program:
  1. Reduce the risk of complicating opportunistic infections and improve health outcomes;
  2. Ensure the integration of oral health care and medical health care for HIV patients.
Wisconsin will use public health surveillance data, claims data from the state’s Medicaid Management Information System, and enrollees’ medical records to track the state’s performance on these goals.
The state’s Medicaid agency and the Wisconsin Division of Public Health (DPH) will collaboratively assess program implementation.
Costs savings will be calculated using a pre/post analysis of Medicaid claims data for health home enrollees, as well as comparing the costs for Medicaid enrollees with HIV that are not participating in the health home program.