Cost Containment Strategies: RI Global Consumer Choice Compact 1115 Waiver Demonstration
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1 Cost Containment Strategies: RI Global Consumer Choice Compact 1115 Waiver Demonstration Gary Alexander, Secretary RI Executive Office Of Health and Human Services
2 RI Global Waiver Goals Re-balance Medicaid-funded long-term care system Manage and coordinate primary and acute care Implement procurement strategies that result in high quality, cost-effective care
3 RI State Budget From The Economist April 30, 2009: Rhode Island has a budget gap of $372m for the year that ends on June 30th. This is about 11.4% of the state s total budget. According to the Council of State Governments, it is among the highest in the country. The future looks bleaker. Revenue collections are down by $13.8m. The Rhode Island Public Expenditure Council, an independent research group, says the state faces long-term deficits over the next decade. The 2011 fiscal year will probably show a $156m deficit. The gap will continue to widen to a potentially crippling $482m in 2014.
4 Opportunities in Global Waiver Budget Cap on Federal contribution Facilitates administrative processes Requires collaboration with all state agencies providing Medicaid-funded services
5 Re-Balancing Long-term Care Voluntarily transition current nursing home residents to the community Divert potential institutionalization Increase access to and scope of home and community-based services
6 Re-Balancing Long-term Care: Cost- Containment Increase payments to communitybased providers adult day services; homemaker services Change nursing home per diem costbased payments to acuity-based rates Expand spousal impoverishment rules to apply to couples in the community Increase self-direction opportunities
7 Re-Balancing Long-term Care: Cost- Containment Next Steps: Work with the RI Department of Mental Health, Retardation, and Hospitals to address costs in the system for individuals with developmental disabilities
8 Manage and coordinate primary and acute care Mandatorily enroll the elderly and adults with disabilities into either a Medicaid managed care organization (Rhody Health Partners) or a primary care case management program
9 Manage and coordinate primary and acute care Maintain existing RIte Care and RIte Share program; Mandatorily enroll children with special health care needs in RIte Care
10 Manage and coordinate primary and acute care: Cost-containment Decrease administrative portion of capitation rates and of PCCM fee Implement a high cost case review that involves multiple state agencies.
11 Manage and coordinate primary and acute care: Cost-containment Next Steps: Find ways to control the costs associated with dual-eligible beneficiaries that result in cost-savings to Medicaid
12 Procurement Strategies Selective Contracting for new services, such as shared living, and for existing services, such as durable medical equipment Acuity-based rates for institutions and community-based providers Change to a hospital reimbursement system based on DRGs
13 Procurement Strategies Increase collections and improve TPL efforts Decrease number of services dental benefit eliminated for adults in RIte Care
14 Impact of ARRA Stimulus Helps but really limits ability to contain costs Under the Global Waiver, no changes anticipated in cost-sharing or eligibility
15 External Task Force Cost containment efforts can often be hampered by external agencies who are trying to protect their constituencies Large External Task Force has been formed to address the sustainability of the Medicaid Program
16 External Task Force The Medicaid program consumes such a large percentage of the State Budget we all need to be working together to ensure it is cost-effective Task Force will be looking at Employment, Housing, Long-term Care Insurance Partnership Program; the Katie Beckett Program; Dual-Eligibles, and Medicaid Benefit Re-Design
17 Cost Containment Strategies: RI Global Consumer Choice Compact 1115 Waiver Demonstration Questions?
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