Community Care of Wake and Johnston Counties/ Community Care Physician Network (CCPN) Meeting November 1st, Michelle Bucknor, MD, MBA, FAAP

Size: px
Start display at page:

Download "Community Care of Wake and Johnston Counties/ Community Care Physician Network (CCPN) Meeting November 1st, Michelle Bucknor, MD, MBA, FAAP"

Transcription

1 Community Care of Wake and Johnston Counties/ Community Care Physician Network (CCPN) Meeting November 1st, 2018 Michelle Bucknor, MD, MBA, FAAP

2 Agenda Welcome Dr. Michelle Bucknor, CCNC Chief Medical Officer & CCWJC Medical Director DHHS & Medicaid Updates Dr. Michelle Bucknor, CCNC & CCWJC Medical Director CCPN Support of Future Business Solutions Atha Gurganus, Director of QI/Practice Support Virtual Health: Provider Portal Update Patty Myrick, Director of Clinical Operations Atha Gurganus, Director of QI/Practice Support 2

3 UPDATE 3

4 Opioid SPARC Safety Prevention Awareness Raising Confidence Project ECHO is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases workforce capacity to provide bestpractice specialty care and reduce health disparities. Academic Detailing is a peer to peer educational outreach approach that is a hybrid of pharm detailing and evidence based practice improvments goals of academic groups. 4

5 ADHD Resource guide AAP Guidelines from 2011 and current (2018) update; new AAP mental health textbook; AAP text on psychopharmacology for pediatrics Algorithm aligns general AAP Primary Care Approach to Mental Health Care Algorithm, with application of specific ADHD algorithm steps Focuses on multimodal intervention Resource guide includes guidance for rating scales, pharmacology, communication with the school (forms based on Guilford model)

6 NC Department of Health and Human Services released the draft statewide Early Childhood Action Plan Shares a bold vision for improving the health, safety and well-being, and developmental and academic readiness for all young children in NC Includes 10 data-informed goals focusing on child-level outcomes Provides a framework to galvanize coordinated action across public and private stakeholders throughout the state Was drafted with the support of over 350 stakeholders from across North Carolina, including the Early Childhood Advisory Council (ECAC). Click here to view the draft Early Childhood Action Plan. all feedback on this draft plan to ECAP@dhhs.nc.gov by November 30 th,

7 Medicaid Transition 7

8 Transition Timeline NC General Assembly enacted Session Law ,directing the transition of Medicaid and NC Health Choice from predominantly fee-for-service to managed care.

9 Section 1115 Waivers: An Overview Federal Medicaid law requires that waivers: o o o Waiver Requirements Further the objectives of the Medicaid program Be authorized for a demonstration purpose, subject to evaluation Affect a section of the federal Medicaid law subject to waiver (e.g., federal match rate is not waivable) By longstanding practice, waivers must be budget neutral to the federal government Public comment periods for new waivers and renewals are required at the state and federal levels; public input requirements more limited for amendments Common Waiver Uses Expand coverage: New populations and new services Delivery System Reform Waivers: Often involve substantial federal investment; 12 states have DSRIPtype waivers Uncompensated Care Pool Waivers: Payments typically for hospitals to reimburse for uncompensated care; 9 states have UCC waivers Expansion-Related Coverage Waivers: Allows states to modify features of Medicaid coverage (e.g., premiums, higher copayments) Source: Social Security Act (SSA) 1115; See SSA 1916(f) for cost sharing waiver limitations. *States may only waive the previsions in SSA 1902.

10 Waiver Approved!

11 Demonstration Waiver The North Carolina demonstration allows the state and CMS to test innovative new approaches to address a broader range of issues that can have a direct impact on an individual s health. North Carolina will implement a groundbreaking program in select regions to pilot evidence-based interventions addressing social determinant issues like housing instability, transportation insecurity, food security, and interpersonal violence and toxic stress.

12 Leverage Managed Care to Drive New Programs State s Vision for Managed Care Transition All beneficiaries screened for unmet social resource needs Population Health Approach to select conditions Mild-Moderate behavioral health carved in In Lieu of Services Test the Advanced Medical Home Model Value based contracts Funding follows the patient to the practice Care management occurs at practice level 12

13 Demonstration Waiver DHHS goals: Deliver whole-person care through coordinated physical health, behavioral health, intellectual/developmental disability and pharmacy products, and care models Address the full set of factors that impact health, uniting communities and health care systems Perform localized care management at the site of care, in the home or community Maintain broad provider participation by mitigating provider administrative burden

14 Medicaid Waiver Approved Move to managed care plans for 1.6 million on Medicaid. Targeted plans for high-needs behavioral health patients, intellectual or developmental disability patients Pilot programs to address housing, transportation, food access, family violence and toxic stress issues that undermine health outcomes Foster care children under specialized plan, including coverage up to age 26 for those who age out of system Funding for opioid and substance abuse treatment in short-term facilities Not approved Behavioral health crisis services for those in nonhospital, inpatient settings Assessment and incentives to address gaps in state s healthcare workforce Endorsement of Carolina Cares, a Medicaid expansion proposal with work requirement that for yet to clear the N.C. legislature Funding for telemedicine initiatives Money to cover uninsured patients treated by the Eastern Band of Cherokee Indians medical system Source: Oct. 19 Letter from CMS to DHHS 14

15 DHHS FY2019 FY2020 7/18 1/19 7/19 1/20 Waiver Waiver Approved Enrollment begins (7/19) 1-2 regions go live (11/19) All regions go live (12/19) PHPs RFP Release (8/18) RFP Response Due (10/18) MCO contracts awarded (2/19) Implementation (3/19-11/19) 15

16 Managed Care Transition Behavioral Health Integration and Tailored Plans Integrated physical, behavioral and pharmacy benefits Allows seamless access to coordinated care Opioid Strategy increase access to inpatient and residential substance use disorder treatment by beginning to reimburse for substance use disorder services provided in institutions of mental disease Healthy Opportunities Pilots

17 North Carolina will implement within its Medicaid managed care program a groundbreaking pilot program in two to four regions of North Carolina to improve health and reduce health care costs. Healthy Opportunities Pilots Working with managed care plans, these pilots will identify cost-effective, evidence-based strategies focused on addressing Medicaid enrollees needs in five priority areas that drive health outcomes and costs: housing, food, transportation, employment and interpersonal safety. The State will increasingly link pilot payments to improvements in health outcomes and efficiency. North Carolina will use a rigorous rapid-cycle assessment strategy to evaluate pilot performance and tailor service offerings to those with demonstrated efficacy.

18 Prepaid Health Plans (PHP)

19 DHHS Levers for Improvement in Managed Care Provider Incentive Programs PHP Withholds Value-based Payment Quality Improvement PHP Performance Improvement Plans 19

20 How Does Care Management Work? Each beneficiary receives a Care Needs Screening Housing, Transportation, Interpersonal Violence, Food Population Health Approach 7 Priority Populations (Infant mortality, low birth weight) Telephonic care management Care gap closure 20

21 How Does CCWJC Provider Support Work? Data Will need to ingest and operationalize data from multiple sources Value-Based Reimbursement Using CMS LAN framework Advanced Medical Home Attestation for Tier 3 starts October 1st 21

22 Provider Services and Practice Support 22

23 Care Management and Care Coordination 23

24 FAQs 24

25 Question Under Medicaid Managed Care four health plans will offer statewide coverage. There will also be one to two regional contracts awarded. Does that mean I must sign up to take four or more different Medicaid insurance products? Answer No, there is no requirement to sign up with all offered Medicaid plans. You may sign up with one plan or all plans, depending upon what you think is reasonable. A key consideration is that if your current patients sign up with plans that you don t contract with, they will no longer be able to see you. As a CCPN member you will have access to multiple, favorable contracts with health plans, increasing expand your chances that you will be able to continue seeing your current patients. 25

26 Question How hard will it be to sign up with participating health plans? Answer It won t be hard. There will be a single, staterun credentialing process. And, you only need to get credentialed once. All health plans will have access to your credentialing information. CCPN provider relations staff will bring contracts to CCPN members as soon as winning plans are selected. 26

27 Question Why should I become a member of CCPN? It s Time to Think Big Answer CCPN is a physician-led, clinically integrated network of primary care clinicians and supported by CCNC resources. We have negotiated very favorable contracts with almost all health plans hoping to offer a Medicaid managed care program in North Carolina. That means CCPN members won t have to negotiate rates and terms with each plan on their own. 27

28 Question What if I already contract with some managed care companies that win the state s Medicaid bid? Answer United Healthcare, Aetna, BCBS and other health plans, for example, already offer commercial and Medicare Advantage plans in North Carolina. If you are in one of these networks, they will still need to have you to sign a contract amendment to cover Medicaid. As a CCPN member you will already have contracts for Medicaid with many of these plans. You may want to compare their contract terms and rates with CCPN contract terms and rates. Their contract terms and rates for commercial or Medicare Advantage plans will be very different than Medicaid terms and rates. 28

29 Question The state is offering practices an opportunity to attest as a Tier 3 Advanced Medical Home. If I attest to being a Tier 3 AMH, I can contract directly with health plans and get paid a permember/per-month care management fee on top of my fee-for-service payments. In a DHHS meeting I recently attended, speakers said there was $10.86 per-member/permonth available for Tier 3 AMH participants. Should I do this? It seems like a lot of money. Answer That is certainly an option for any practice that is willing and able to provide the associated Tier 3 AMH required services. These include: hiring a care manager, aggregating quality and clinical data, doing risk stratification, identifying specific patients for health screenings, documenting a comprehensive care plan and communicating the details of that plan back to the health plan, and quality reporting including metrics tied to value-based care metrics. The $10.86 per-member/per-month amount is what the state will provide to health plans for all care management functions. A portion of the $10.86 amount would be used to offset a health plan s costs associated with care management and to pay for their costs of managing some high-risk and complex patients. You will want to carefully evaluate the cost of providing or developing these required services in your practice and then compare those costs with what plans are offering you for Tier 3 AMH participation. The state will not dictate the amount of care management payments paid by plans and it is still not known what health plans may be willing to pay. CCPN has negotiated very favorable contracts with almost all health plans hoping to offer a Medicaid managed care program in North Carolina. That means CCPN members won t have to negotiate rates and terms with each plan on their own. 29

30 Question The state says if I am a currently participating in CCNC, I will automatically become a Tier 2 AMH in the new system. Does this approach have any advantages? Answer Yes, as a Tier 2 AMH, you will continue to get your current fee-for-service payments and the $2.50 or $5.00 per-member/per-month for enrolled patients from all Medicaid health plans. You will be glad to know that CCPN has negotiated contract terms with five of the six health plans bidding on the new Medicaid plan. These terms meet and or exceed your current fee-for-service and per-member/ permonth payments. In addition, the CCPN/health plan agreements include your CCNC care manager, analytics and reporting support, and a generous guaranteed bonus pool for providers meeting quality targets. Most plans have also offered CCPN a significant shared saving bonus pool. If you are a member of CCPN, there is no additional contract negotiation needed on your part to participate in these arrangements. 30

31 So what are the next steps in Medicaid Transformation? 31

32 DHHS FY2019 FY2020 7/18 1/19 7/19 1/20 Waiver Waiver Approved Enrollment begins (7/19) 1-2 regions go live (11/19) All regions go live (12/19) PHPs RFP Release (8/18) RFP Response Due (10/18) MCO contracts awarded (2/19) Implementation (3/19-11/19) 32

33 Next steps in Medicaid Transformation First, look for a visit from our CCWJC practice liaisons. They will meet with you to walk through all the contracts CCPN has negotiated, summarize current and future CCPN offerings, and let you know about important changes coming in the next six months as the state implements commercial managed care. Second, look for regional CCPN meetings we will hold across the state after the health plan contracts are awarded in February of We want to get your feedback and provide more details on CCPN s quality reporting tools, care management process and contract monitoring procedures. 33

34 Next steps in Medicaid Transformation Third, we will distribute to CCPN members all the contracts we have negotiated after the health plan awards are announced. You will have a 30-day period to review contact terms and decide to participate. We think you will like what CCPN has negotiated, and won t need to do anything else, because you will be enrolled in each plan through CCPN s single-signature contract. A final point to keep in mind is that many of the Medicaid health plans with other business lines beyond Medicaid have offered contracts to CCPN for commercial business and other populations. So, the system that works for you for Medicaid may soon offer additional benefits with other populations. We expect to see much more expansion of your options in the future. 34

35 Questions or Comments? 35

Medicaid Transformation

Medicaid Transformation Medicaid Transformation Debra Farrington Senior Program Manager August 18, 2017 Medicaid Managed Care Already Exists in NC What North Carolina Has Now PRIMARY CARE CASE MANAGEMENT (CCNC) Primary care provider-based

More information

Medicaid Transformation Overview & Update: Focus on Population Health & Diabetes

Medicaid Transformation Overview & Update: Focus on Population Health & Diabetes Medicaid Transformation Overview & Update: Focus on Population Health & Diabetes Kelly Crosbie, MSW, LCSW Senior Program Manager, Health Transformation June 1, 2018 2 NC MANAGED CARE OVERVIEW 3 Medicaid

More information

Medicaid Transformation Overview & Update. Kelly Crosbie, MSW, LCSW Project Lead Quality & Population Health Division of Health Benefits

Medicaid Transformation Overview & Update. Kelly Crosbie, MSW, LCSW Project Lead Quality & Population Health Division of Health Benefits Medicaid Transformation Overview & Update Kelly Crosbie, MSW, LCSW Project Lead Quality & Population Health Division of Health Benefits IOM Policy Fellows: February 26, 2018 North Carolina s Vision for

More information

EMBARGOED UNTIL AUGUST 8, 2017, 10:30 A.M. North Carolina s Proposed Program Design for Medicaid Managed Care. August 2017

EMBARGOED UNTIL AUGUST 8, 2017, 10:30 A.M. North Carolina s Proposed Program Design for Medicaid Managed Care. August 2017 EMBARGOED UNTIL AUGUST 8, 2017, 10:30 A.M. North Carolina s Proposed Program Design for Medicaid Managed Care August 2017 North Carolina s Proposed Program Design for Medicaid Managed Care August 2017

More information

Social Services Regional Supervision and Collaboration Working Group

Social Services Regional Supervision and Collaboration Working Group Social Services Regional Supervision and Collaboration Working Group Agenda Convene Child Welfare Reform in Oklahoma Sen. A.J. Griffin, OK State Legislature Child Fatality Review System Sara DePasquale,

More information

North Carolina Medicaid Managed Care Update

North Carolina Medicaid Managed Care Update North Carolina Medicaid Managed Care Update Dave Richard Deputy Secretary NC Medicaid August 24, 2018 What we ll cover today DHHS Silent Period Managed Care Vision and Goals Medicaid Managed Care Status

More information

North Carolina Medicaid and NC Health Choice Transformation Request for Public Input

North Carolina Medicaid and NC Health Choice Transformation Request for Public Input North Carolina Medicaid and NC Health Choice Transformation Request for Public Input The Department of Health and Human Services is requesting public input from April 25 to 11:59 p.m. on May 25 on Medicaid

More information

Legislative Report TRANSFORMATION AND REORGANIZATION OF NORTH CAROLINA MEDICAID AND NC HEALTH CHOICE PROGRAMS SESSION LAW

Legislative Report TRANSFORMATION AND REORGANIZATION OF NORTH CAROLINA MEDICAID AND NC HEALTH CHOICE PROGRAMS SESSION LAW Legislative Report TRANSFORMATION AND REORGANIZATION OF NORTH CAROLINA MEDICAID AND NC HEALTH CHOICE PROGRAMS SESSION LAW 2016-121 State of North Carolina Department of Health and Human Services Division

More information

North Carolina s Transformation to Managed Care

North Carolina s Transformation to Managed Care North Carolina s Transformation to Managed Care Jay Ludlam, Assistant Secretary Department of Health and Human Services December 2017 My background Only 10+ years of experience in Medicaid Assistant Attorney

More information

Medicaid Transformation

Medicaid Transformation JOINT LEGISLATIVE COMMITTEE ON MEDICAID AND NC HEALTH CHOICE Medicaid Transformation Dr. Mandy Cohen, Dave Richard, Jay Ludlam Department of Health and Human Services Nov. 14, 2017 Recap: Where We Are

More information

NC TIDE 2016 Fall Conference November 14, Department of Health and Human Services NC Medicaid Reform Update

NC TIDE 2016 Fall Conference November 14, Department of Health and Human Services NC Medicaid Reform Update NC TIDE 2016 Fall Conference November 14, 2016 Department of Health and Human Services NC Medicaid Reform Update Agenda National Medicaid Landscape Medicaid Transformation in NC 1115 Waiver Process NC

More information

Maryland Department of Health and Mental Hygiene FY 2012 Memorandum of Understanding Annual Report of Activities and Accomplishments Highlights

Maryland Department of Health and Mental Hygiene FY 2012 Memorandum of Understanding Annual Report of Activities and Accomplishments Highlights Maryland Department of Health and Mental Hygiene FY 2012 Memorandum of Understanding Annual Report of Activities and Accomplishments Highlights A Nationally Recognized Partnership Hilltop was founded on

More information

Alaska Mental Health Trust Authority. Medicaid

Alaska Mental Health Trust Authority. Medicaid Alaska Mental Health Trust Authority Medicaid November 20, 2014 Background Why focus on Medicaid? Trust result desired in working on Medicaid policy issues and in implementing several of our focus area

More information

LEGISLATIVE REPORT NORTH CAROLINA HEALTH TRANSFORMATION CENTER (TRANSFORMATION INNOVATIONS CENTER) PROGRAM DESIGN AND BUDGET PROPOSAL

LEGISLATIVE REPORT NORTH CAROLINA HEALTH TRANSFORMATION CENTER (TRANSFORMATION INNOVATIONS CENTER) PROGRAM DESIGN AND BUDGET PROPOSAL LEGISLATIVE REPORT NORTH CAROLINA HEALTH TRANSFORMATION CENTER (TRANSFORMATION INNOVATIONS CENTER) PROGRAM DESIGN AND BUDGET PROPOSAL SESSION LAW 2015-245, SECTION 8 FINAL REPORT State of North Carolina

More information

Medicaid and CHIP Payment and Access Commission (MACPAC) February 2013 Meeting Summary

Medicaid and CHIP Payment and Access Commission (MACPAC) February 2013 Meeting Summary Medicaid and CHIP Payment and Access Commission (MACPAC) February 2013 Meeting Summary The Medicaid and CHIP Payment and Access Commission (MACPAC) was established in the Children's Health Insurance Program

More information

Texas Health Care Transformation and Quality Improvement Program - FAQ

Texas Health Care Transformation and Quality Improvement Program - FAQ Texas Health Care Transformation and Quality Improvement Program - FAQ http://www.hhsc.state.tx.us/1115-faq.shtml 1115 Waiver Approval and Effective Date Why is HHSC seeking an 1115 waiver under the Social

More information

Working Together for a Healthier Washington

Working Together for a Healthier Washington Working Together for a Healthier Washington Laura Kate Zaichkin, Administrator, Office of Health Innovation & Reform Health Care Authority April 29, 2015 Why do we need health system transformation? Because

More information

Medicaid and the. Bus Pass Problem

Medicaid and the. Bus Pass Problem Medicaid and the Bus Pass Problem PRESENTED BY: Cardinal Innovations Healthcare Richard F. Topping, Chief Executive Officer Leesa Bain, Vice President, Care Coordination & Quality Management September

More information

NC TIDE SPRING CONFERENCE April 26, NC Department of Health and Human Services Medicaid Transformation and the 1115 Waiver

NC TIDE SPRING CONFERENCE April 26, NC Department of Health and Human Services Medicaid Transformation and the 1115 Waiver NC TIDE SPRING CONFERENCE April 26, 2017 NC Department of Health and Human Services Medicaid Transformation and the 1115 Waiver Agenda Medicaid Landscape NC Medicaid Transformation Supporting Legislation

More information

Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act

Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act October 2018 Issue Brief Federal Legislation to Address the Opioid Crisis: Medicaid Provisions in the SUPPORT Act MaryBeth Musumeci and Jennifer Tolbert On October 3, 2018, the Senate overwhelmingly passed

More information

1115 Waiver Renewal Tribal Consultation June 23, New Mexico Human Services Department

1115 Waiver Renewal Tribal Consultation June 23, New Mexico Human Services Department 1115 Waiver Renewal Tribal Consultation June 23, 2017 New Mexico Human Services Department 1 Centennial Care 2.0 Concepts Public Comments Wrap Up Provide information about Centennial Care: overview, goals,

More information

Accelerating Medicaid Innovation

Accelerating Medicaid Innovation Accelerating Medicaid Innovation Colorado Summit on Pediatric Home Asthma Interventions August 28, 2014 Mark A. Levine, MD Chief Medical Officer, Denver CMS Medicaid and CHIP The Center for Medicaid and

More information

UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS

UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS November 18, 2013 NYS OMH Behavioral Health Transition 2 Key MRT initiative to move fee-for-service populations and services into managed

More information

Estimated Decrease in Expenditure by Service Category

Estimated Decrease in Expenditure by Service Category Public Notice for June 2009 Release PUBLIC NOTICE COLORADO MEDICAID Department of Health Care Policy and Financing Fee-for-Service Provider Payments Effective July 1, 2009, in an effort to reduce expenditures

More information

Accountable Health Communities

Accountable Health Communities Accountable Health Communities Preventive & Population Health Models Group The Innovation Center at CMS January 2016 CMS Aims Better Care: We have an opportunity to realign the practice of medicine with

More information

Performance Measurement Work Group Meeting 10/18/2017

Performance Measurement Work Group Meeting 10/18/2017 Performance Measurement Work Group Meeting 10/18/2017 Welcome to New Members QBR RY 2020 DRAFT QBR Policy Components QBR Program RY 2020 Snapshot QBR Consists of 3 Domains: Person and Community Engagement

More information

I. Overview of Managed Care I. A. Key Goals and Objectives for Transformation Efforts

I. Overview of Managed Care I. A. Key Goals and Objectives for Transformation Efforts I. Overview of Managed Care I. A. Key Goals and Objectives for Transformation Efforts The North Carolina Community Health Center Association is encouraged by the NC Department of Health and Human Services

More information

Executive Summary 1. Better Health. Better Care. Lower Cost

Executive Summary 1. Better Health. Better Care. Lower Cost Executive Summary 1 To build a stronger Michigan, we must build a healthier Michigan. My vision is for Michiganders to be healthy, productive individuals, living in communities that support health and

More information

Behavioral Health Redesign. 1. Progress toward transformation 2. Readiness to go live January 1, Contingency plan for provider payment

Behavioral Health Redesign. 1. Progress toward transformation 2. Readiness to go live January 1, Contingency plan for provider payment Behavioral Health Redesign 1. Progress toward transformation 2. Readiness to go live January 1, 2017 3. Contingency plan for provider payment Behavioral Health Redesign The goal is to integrate physical

More information

Template Language for Memorandum of Understanding between Duals Demonstration Health Plans and County Behavioral Health Department(s)

Template Language for Memorandum of Understanding between Duals Demonstration Health Plans and County Behavioral Health Department(s) Template Language for Memorandum of Understanding between Duals Demonstration Health Plans and County Behavioral Health Department(s) Updated Draft February 14, 2013 In the duals demonstration, participating

More information

approved Nevada s State Innovation Model (SIM) Round October 2015 Division of Health Care Financing and Policy Introduction to SIM

approved Nevada s State Innovation Model (SIM) Round October 2015 Division of Health Care Financing and Policy Introduction to SIM Nevada State Innovation Model (SIM) October 2015 1 Introduction to SIM The Center for Medicare and Medicaid Services (CMS) approved Nevada s State Innovation Model (SIM) Round Two application to improve

More information

I. Coordinating Quality Strategies Across Managed Care Plans

I. Coordinating Quality Strategies Across Managed Care Plans Jennifer Kent Director California Department of Health Care Services 1501 Capitol Avenue Sacramento, CA 95814 SUBJECT: California Department of Health Care Services Medi-Cal Managed Care Quality Strategy

More information

Medicaid and CHIP Managed Care Final Rule MLTSS

Medicaid and CHIP Managed Care Final Rule MLTSS Medicaid and CHIP Managed Care Final Rule MLTSS John Giles, Technical Director Division of Quality and Health Outcomes Children and Adult Health Programs Group Debbie Anderson, Deputy Director Division

More information

Status of Implementing Legislation Regarding the Eastern Band of Cherokee Indians

Status of Implementing Legislation Regarding the Eastern Band of Cherokee Indians Status of Implementing Legislation Regarding the Eastern Band of Cherokee Indians Session Law 2015 241, Section 12C.10.(h) Report to The Joint Legislative Oversight Committee on Health and Human Services

More information

Working Together for a Healthier Washington

Working Together for a Healthier Washington Working Together for a Healthier Washington Dorothy Teeter, HCA Director Nathan Johnson, HCA Chief Policy Officer All Alliance Meeting June 9, 2015 By 2019, we will have a Healthier Washington. Here s

More information

HEALTH CARE TEAM SACRAMENTO S MENTAL HEALTH CRISIS

HEALTH CARE TEAM SACRAMENTO S MENTAL HEALTH CRISIS Team Leader/Issue Contact: HEALTH CARE TEAM Laura Niznik Williams, UC Davis Health System, (916) 276-9078, ljniznik@ucdavis.edu SACRAMENTO S MENTAL HEALTH CRISIS Requested Action: Evaluate the Institutions

More information

The Quality Payment Program Overview Fact Sheet

The Quality Payment Program Overview Fact Sheet Quality Payment Program The Quality Payment Program Overview Background On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the

More information

Population Health: Care Management

Population Health: Care Management Population Health under Managed Care: Care Management & The Advanced Medical Home (AMH) Program Kelly Crosbie, MSW, LCSW Project Lead, Quality & Population Health Division of Health Benefits Population

More information

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint

More information

Oregon s Health System Transformation: The Coordinated Care Model. March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority

Oregon s Health System Transformation: The Coordinated Care Model. March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority Oregon s Health System Transformation: The Coordinated Care Model March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority The Challenges Oregon Faced Rising healthcare costs outpacing

More information

Transforming Louisiana s Long Term Care Supports and Services System. Initial Program Concept

Transforming Louisiana s Long Term Care Supports and Services System. Initial Program Concept Transforming Louisiana s Long Term Care Supports and Services System Initial Program Concept August 30, 2013 Transforming Louisiana s Long Term Care Supports and Services System Our Vision Introduction

More information

SUMMARY OF THE STATE GRANT OPPORTUNITIES IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: H.R (May 24, 2010)

SUMMARY OF THE STATE GRANT OPPORTUNITIES IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: H.R (May 24, 2010) National Conference of State Legislatures 444 North Capitol Street, N.W., Suite 515 Washington, D.C. 20001 SUMMARY OF THE STATE GRANT OPPORTUNITIES IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: H.R.

More information

NC INNOVATIONS WAIVER HANDBOOK

NC INNOVATIONS WAIVER HANDBOOK A Managed Care Organization of the NC Department of Health & Human Services NC INNOVATIONS WAIVER HANDBOOK Revised April 01, 2013 Sandhills Center provides access to services for mental health, intellectual

More information

OHPB DRAFT Coordinated Care Organization (CCO) Proposal OMA Summary and Analysis

OHPB DRAFT Coordinated Care Organization (CCO) Proposal OMA Summary and Analysis OHPB DRAFT Coordinated Care Organization (CCO) Proposal OMA Summary and Analysis December 15, 2011 Bryan Boehringer Courtni Dresser OMA Government Relations Overview CCOs established and implemented to

More information

Medicaid Funded Services Plan

Medicaid Funded Services Plan Clinical Communication Bulletin 007 To: From: All Enrollees, Stakeholders, and Providers Cham Trowell, UM Director Date: May 10, 2016 Subject: Medicaid Funded Services Plan benefit changes, State Funded

More information

Public Notice Document 03/21/ /19/2018

Public Notice Document 03/21/ /19/2018 Florida Managed Medical Assistance Waiver 1115 Research and Demonstration Waiver Project Number 11-W-00206/4 Public Notice Document 03/21/2018 04/19/2018 Agency for Health Care Administration This page

More information

Maryland Medicaid s Partnership in Improving Behavioral Health Services. Susan Tucker Executive Director, Office of Health Services September 8, 2014

Maryland Medicaid s Partnership in Improving Behavioral Health Services. Susan Tucker Executive Director, Office of Health Services September 8, 2014 Maryland Medicaid s Partnership in Improving Behavioral Health Services Susan Tucker Executive Director, Office of Health Services September 8, 2014 Began in 1966 Maryland Medicaid By FY 14, we provided

More information

Testing a New Terminology System for Health and Social Services Integration

Testing a New Terminology System for Health and Social Services Integration Strategies to Achieve Alignment, Collaboration, and Synergy across Delivery and Financing Systems Testing a New Terminology System for Health and Social Services Integration Research-in-Progress Webinar

More information

Minnesota s Plan for the Prevention, Treatment and Recovery of Addiction

Minnesota s Plan for the Prevention, Treatment and Recovery of Addiction Minnesota s Plan for the Prevention, Treatment and Recovery of Addiction Background Beginning in June 2016, the Alcohol and Drug Abuse Division (ADAD) of the Minnesota Department of Human Services convened

More information

Illinois' Behavioral Health 1115 Waiver Application - Comments

Illinois' Behavioral Health 1115 Waiver Application - Comments As a non-profit organization experienced in Illinois maternal and child health program and advocacy efforts for over 27 years, EverThrive Illinois works to improve the health of Illinois women, children,

More information

Draft Children s Managed Care Transition MCO Requirements

Draft Children s Managed Care Transition MCO Requirements Draft Children s Managed Care Transition MCO Requirements OVERVIEW On February 1 st, New York State released for stakeholder feedback a draft version of the Medicaid Managed Care Organization (MCO) Children

More information

Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees

Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees TECHNICAL ASSISTANCE BRIEF J UNE 2 0 1 2 Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees I ndividuals eligible for both Medicare and Medicaid (Medicare-Medicaid

More information

Overview of Medicaid. and the 1115 Medicaid Transformation Waiver. Opportunities for Supportive Housing Providers and Tenants August 2, 2016

Overview of Medicaid. and the 1115 Medicaid Transformation Waiver. Opportunities for Supportive Housing Providers and Tenants August 2, 2016 Overview of Medicaid and the 1115 Medicaid Transformation Waiver Opportunities for Supportive Housing Providers and Tenants August 2, 2016 Speaker Carol Wilkins, MPP Consultant carol.wilkins.ca@gmail.com

More information

CMS Quality Payment Program: Performance and Reporting Requirements

CMS Quality Payment Program: Performance and Reporting Requirements CMS Quality Payment Program: Performance and Reporting Requirements Session #QU1, February 19, 2017 Kristine Martin Anderson, Executive Vice President, Booz Allen Hamilton Colleen Bruce, Lead Associate,

More information

Value-Based Payments 101: Moving from Volume to Value in Behavioral Health Care

Value-Based Payments 101: Moving from Volume to Value in Behavioral Health Care Value-Based Payments 101: Moving from Volume to Value in Behavioral Health Care Nina Marshall, MSW Senior Director, Policy and Practice Improvement NinaM@TheNationalCouncil.org Bill Hudock Senior Public

More information

North Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011

North Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011 North Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011 1. What is working well in the current system of services and supports

More information

5/30/2012

5/30/2012 The Affordable Care Act Background Coverage Long-term Care Home and Community Based Services Payment Delivery Care Transitions Assuring Quality Supreme Court 5/30/2012 www.nasuad.org BACKGROUND Health

More information

Integrating Public Health and Social Services with Delivery System Reform

Integrating Public Health and Social Services with Delivery System Reform Integrating Public Health and Social Services with Delivery System Reform New York State Department of Health Office of Health Insurance Programs Greg, Policy Director October 2015 1 Agenda 1. DSRIP &

More information

HEALTH CARE REFORM IN THE U.S.

HEALTH CARE REFORM IN THE U.S. HEALTH CARE REFORM IN THE U.S. A LOOK AT THE PAST, PRESENT AND FUTURE Carolyn Belk January 11, 2016 0 HEALTH CARE REFORM BIRTH OF THE AFFORDABLE CARE ACT Health care reform in the U.S. has been an ongoing

More information

Public Health Law Series Webinar. Medicaid 1115 Waivers: How are they Transforming the Health System?

Public Health Law Series Webinar. Medicaid 1115 Waivers: How are they Transforming the Health System? Public Health Law Series Webinar Medicaid 1115 Waivers: How are they Transforming the Health System? How to Use Webex Audio: If you can hear us through your computer, you do not need to use your phone.

More information

Implementing Medicaid Behavioral Health Reform in New York

Implementing Medicaid Behavioral Health Reform in New York Redesign Medicaid in New York State Implementing Medicaid Behavioral Health Reform in New York HIV Health and Human Services Planning Council of New York March 19, 2014 Agenda Goals Timeline BH Benefit

More information

The MetroHealth System

The MetroHealth System The MetroHealth System June 16, 2016 Presentation to Ohio Joint Medicaid Oversight Committee Dr. James Misak, Vice Chair of Community and Population Health, Department of Family Medicine Susan Mego, Executive

More information

Using Medicaid Accountable Care Initiatives to Improve Care for People with Serious Behavioral Health Conditions

Using Medicaid Accountable Care Initiatives to Improve Care for People with Serious Behavioral Health Conditions Using Medicaid Accountable Care Initiatives to Improve Care for People with Serious Behavioral Health Conditions Prepared by Wendy Holt and Richard Dougherty of DMA Health Strategies and Chuck Ingoglia

More information

Executive, Legislative & Regulatory 2018 AGENDA. unitypoint.org/govaffairs

Executive, Legislative & Regulatory 2018 AGENDA. unitypoint.org/govaffairs Executive, Legislative & Regulatory 2018 AGENDA unitypoint.org/govaffairs Dear Policy Makers and Community Stakeholders, In the midst of tumultuous times, we bring you our 2018 State Legislative Agenda.

More information

Implementing Medicaid Behavioral Health Reform in New York

Implementing Medicaid Behavioral Health Reform in New York Redesign Medicaid in New York State Implementing Medicaid Behavioral Health Reform in New York Conference of Local Mental Hygiene Directors November 19, 2013 Agenda Goals Timeline BH Benefit Design Overview

More information

Primary Care 101: A Glossary for Prevention Practitioners

Primary Care 101: A Glossary for Prevention Practitioners PREVENTION COLLABORATION IN ACTION Engaging the Right Partners Primary Care 101: A Glossary for Prevention Practitioners As the U.S. healthcare landscape continues to change under the Affordable Care Act

More information

Chad Shearer, JD, MHA, Vice President for Policy, Medicaid Institute Director Misha Sharp, Research Analyst February 28, 2018

Chad Shearer, JD, MHA, Vice President for Policy, Medicaid Institute Director Misha Sharp, Research Analyst February 28, 2018 Testimony of the United Hospital Fund to the Council of the City of New York, Committee on Hospitals: Oversight Examining the Status of One New York: Health Care for Our Neighborhoods : What Progress Has

More information

Bulletin. DHS Provides Policy for Certified Community Behavioral Health Clinics TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE

Bulletin. DHS Provides Policy for Certified Community Behavioral Health Clinics TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE Bulletin NUMBER 17-51-01 DATE February 27, 2017 OF INTEREST TO County Directors Social Services Supervisors and Staff Case Managers and Care Coordinators Managed Care Organizations Mental Health Providers

More information

The benefits of the Affordable Care Act for persons with Developmental Disabilities

The benefits of the Affordable Care Act for persons with Developmental Disabilities Tuesday, 2:30 2:00, B5 The benefits of the Affordable Care Act for persons with Developmental Disabilities Objectives: Notes: Audrey E. Smith, MPH 33-402-9608 Asmith2@waynecounty.com. Identify effective

More information

Trends in State Medicaid Programs: Emerging Models and Innovations

Trends in State Medicaid Programs: Emerging Models and Innovations Trends in State Medicaid Programs: Emerging Models and Innovations Speakers: Barbara Edwards, Principal, Steve Fitton, Principal, Tina Edlund, Managing Principal, Moderator: Annie Melia, Information Services

More information

medicaid commission on a n d t h e uninsured May 2009 Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid SUMMARY

medicaid commission on a n d t h e uninsured May 2009 Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid SUMMARY kaiser commission on medicaid SUMMARY a n d t h e uninsured Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid Why is Community Care of North Carolina (CCNC) of Interest?

More information

AmeriHealth Michigan Provider Overview. April, 2014

AmeriHealth Michigan Provider Overview. April, 2014 AmeriHealth Michigan Provider Overview April, 2014 Who We Are Our Mission Dual Demonstration of Michigan AmeriHealth VIP Care Plus Agenda Our Record of Success Integrated Care Management Provider Partnerships

More information

Sunflower Health Plan

Sunflower Health Plan Key Components for Successful LTSS Integration: Case Studies of Ten Exemplar Programs Sunflower Health Plan Jennifer Windh September 2016 Long- term services and supports (LTSS) integration is the integration

More information

Introduction for New Mexico Providers. Corporate Provider Network Management

Introduction for New Mexico Providers. Corporate Provider Network Management Introduction for New Mexico Providers Corporate Provider Network Management Overview New Mexico snapshot. Who we are. Why Medicaid managed care? Why AmeriHealth Caritas? Why partner with us? Medical Management

More information

Patient-Centered Medical Homes in Rural and Underserved Areas: A Webinar and Peer Discussion for Primary Care Offices

Patient-Centered Medical Homes in Rural and Underserved Areas: A Webinar and Peer Discussion for Primary Care Offices Patient-Centered Medical Homes in Rural and Underserved Areas: A Webinar and Peer Discussion for Primary Care Offices Association of State and Territorial Health Officials (ASTHO) August 17, 2016 Dial-In

More information

kaiser medicaid and the uninsured commission on O L I C Y

kaiser medicaid and the uninsured commission on O L I C Y P O L I C Y B R I E F kaiser commission on medicaid and the uninsured 1330 G S T R E E T NW, W A S H I N G T O N, DC 20005 P H O N E: (202) 347-5270, F A X: ( 202) 347-5274 W E B S I T E: W W W. K F F.

More information

The TBI Waiver: the North Carolina Brain Injury Advisory Council Recommendations to the Legislative Oversight Committee on Health and Human Services

The TBI Waiver: the North Carolina Brain Injury Advisory Council Recommendations to the Legislative Oversight Committee on Health and Human Services The TBI Waiver: the North Carolina Brain Injury Advisory Council Recommendations to the Legislative Oversight Committee on Health and Human Services On behalf of the North Carolina Brain Injury Advisory

More information

Introduction to and Overview of Delivery System Reform Incentive Payment or DSRIP Programs

Introduction to and Overview of Delivery System Reform Incentive Payment or DSRIP Programs Introduction to and Overview of Delivery System Reform Incentive Payment or DSRIP Programs The Antitrust in Health Care Program Co-Sponsored by the American Health Lawyers Association, the ABA Section

More information

Q1: What is changing and why?

Q1: What is changing and why? Q1: What is changing and why? A1: Over the past few years, the Centers for Medicare & Medicaid (CMS) and the State of Tennessee (State) have increased efforts to coordinate the care of people that are

More information

MEDICAID RE-DESIGN IN NORTH CAROLINA: THE FUTURE IS NOW

MEDICAID RE-DESIGN IN NORTH CAROLINA: THE FUTURE IS NOW MEDICAID RE-DESIGN IN NORTH CAROLINA: THE FUTURE IS NOW 1 LANIER CANSLER, PRESIDENT TARA LARSON, SENIOR HEALTHCARE POLICY SPECIALIST Cansler Collaborative Resources, Inc. Session Agenda 2 Identify strategies

More information

MassHealth Restructuring Overview

MassHealth Restructuring Overview 1 MassHealth Restructuring Overview State of the State, Assuring Access, Equity and Integrated Care Massachusetts League of Community Health Centers Marylou Sudders, Secretary Executive Office of Health

More information

State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013

State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013 State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013 The National Association of Medicaid Directors (NAMD) is engaging states in shared learning on how Medicaid

More information

ILLINOIS 1115 WAIVER BRIEF

ILLINOIS 1115 WAIVER BRIEF ILLINOIS 1115 WAIVER BRIEF STATE TESTING FOR THE FOLLOWING ACHIEVED RESULTS: 1. Increased rates of identification, initiation, and engagement in treatment 2. Increased adherence to and retention in treatment

More information

The Money Follows the Person Demonstration in Massachusetts

The Money Follows the Person Demonstration in Massachusetts The Money Follows the Person Demonstration in Massachusetts Use of Concurrent 1915(b)(c) Waivers to Serve Elders and Adults with Disabilities Transitioning from Long-Stay Facilities HCBS Conference Arlington,

More information

Medicaid Expansion + Reform: Impact for Trust Beneficiaries. March 8, 2018

Medicaid Expansion + Reform: Impact for Trust Beneficiaries. March 8, 2018 Medicaid Expansion + Reform: Impact for Trust Beneficiaries March 8, 2018 Contents 1. Introduction... 3 Medicaid Expansion... 3 Medicaid Redesign... 6 Trust s Role in Medicaid Expansion and Redesign...

More information

Financing the Integration of Behavioral Health: Three Cases Studies: Texas, Oklahoma and Georgia

Financing the Integration of Behavioral Health: Three Cases Studies: Texas, Oklahoma and Georgia National Association of State Mental Health Program Directors 66 Canal Center Plaza, Suite 302 Alexandria, Virginia 22314 Assessment #8 Financing the Integration of Behavioral Health: Three Cases Studies:

More information

MMW Webinar Medicare & Medicaid Updates. August 30, 2017

MMW Webinar Medicare & Medicaid Updates. August 30, 2017 MMW Webinar Medicare & Medicaid Updates Webinar Logistics: Audio: Listen through your computer speakers or call in using a telephone. To get call-in information, click telephone under audio. Because there

More information

What is a Pathways HUB?

What is a Pathways HUB? What is a Pathways HUB? Q: What is a Community Pathways HUB? A: The Pathways HUB model is an evidence-based community care coordination approach that uses 20 standardized care plans (Pathways) as tools

More information

The New York State Value-Based Payment (VBP) Roadmap. Primary Care Providers March 27, 2018

The New York State Value-Based Payment (VBP) Roadmap. Primary Care Providers March 27, 2018 The New York State Value-Based Payment (VBP) Roadmap Primary Care Providers March 27, 2018 1 Housekeeping All lines have been muted To ask a question at any time, use the Chat feature in WebEx We will

More information

Mental Health Liaison Group

Mental Health Liaison Group Mental Health Liaison Group The Honorable Nancy Pelosi The Honorable Harry Reid Speaker Majority Leader United States House of Representatives United States Senate Washington, DC 20515 Washington, DC 20510

More information

2019 Quality Improvement Program Description Overview

2019 Quality Improvement Program Description Overview 2019 Quality Improvement Program Description Overview Introduction Eon/Clear Spring s Quality Improvement (QI) program guides the company s activities to improve care and treatment for the member s we

More information

10 State Strategies for Improving Medicaid: Quality, Outcomes and The Bottom Line JUNE 2018

10 State Strategies for Improving Medicaid: Quality, Outcomes and The Bottom Line JUNE 2018 10 State Strategies for Improving Medicaid: Quality, Outcomes and The Bottom Line JUNE 2018 10 State Strategies for Improving Medicaid: Quality, Outcomes and The Bottom Line By Kristine B. Goodwin The

More information

Alabama Medicaid Preparing the State for Reform through Regional Care Organizations. January 23, 2015

Alabama Medicaid Preparing the State for Reform through Regional Care Organizations. January 23, 2015 Alabama Medicaid Preparing the State for Reform through Regional Care Organizations January 23, 2015 Restarting the Conversation 2 Agenda Alabama s Healthcare Landscape I. RCO Rationale II. DSRIP Design

More information

STATE POLICY UPDATE. MNACHC Annual Conference October 30,

STATE POLICY UPDATE. MNACHC Annual Conference October 30, STATE MNACHC Annual Conference October 30, 2008 POLICY UPDATE 1 Goals & Objectives 1. Review 2008 Minnesota legislative session. 2. Health Care Reform 3. Preview 2009 session. 4. MNACHC 2009 Legislative

More information

Medicaid Fundamentals. John O Brien Senior Advisor SAMHSA

Medicaid Fundamentals. John O Brien Senior Advisor SAMHSA Medicaid Fundamentals John O Brien Senior Advisor SAMHSA Medicaid Fundamentals Provides medical benefits to groups of low-income people with no medical insurance or inadequate medical insurance. Federally

More information

Bridging to Preventive Care: The Roadmap to Medicaid Coverage of Community Based Chronic Disease Prevention & Management Programs. September 20, 2017

Bridging to Preventive Care: The Roadmap to Medicaid Coverage of Community Based Chronic Disease Prevention & Management Programs. September 20, 2017 Bridging to Preventive Care: The Roadmap to Medicaid Coverage of Community Based Chronic Disease Prevention & Management Programs September 20, 2017 Introductions & Agenda Introduce Panelists Overview

More information

ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017

ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 1 DISCLAIMER The enclosed materials are highly sensitive, proprietary and confidential.

More information

North Carolina Medicaid Reform

North Carolina Medicaid Reform North Carolina Medicaid Reform Sandy Terrell Director, Clinical Policy Health and Human Services NC Health Care History c.1952 Good Health Act 1965 Medicare & Medicaid c.1972 Office of Rural Health 1877

More information

Draft Covered California Delivery Reform Contract Provisions Comments Welcome and Encouraged

Draft Covered California Delivery Reform Contract Provisions Comments Welcome and Encouraged TO: FROM: RE: State Based Marketplaces State Medicaid Directors Delivery Reform/Value Promoting Colleagues Peter V. Lee, Executive Director Draft Covered California Delivery Reform Contract Provisions

More information

New York State s Ambitious DSRIP Program

New York State s Ambitious DSRIP Program New York State s Ambitious DSRIP Program A Case Study Speaker: Denise Soffel, Ph.D., Principal May 28, 2015 Information Services Webinar HealthManagement.com HealthManagement.com HealthManagement.com HealthManagement.com

More information