Public Health Law Series Webinar. Medicaid 1115 Waivers: How are they Transforming the Health System?
|
|
- Bridget Gilbert
- 5 years ago
- Views:
Transcription
1 Public Health Law Series Webinar Medicaid 1115 Waivers: How are they Transforming the Health System?
2 How to Use Webex Audio: If you can hear us through your computer, you do not need to use your phone. Just adjust your computer speakers as needed. Support: If you need technical assistance, call Webex Technical Support at Submitting Questions: All participants are muted. Type a question into the Q & A panel for our panelists to answer. Submit your questions at any time during webinar. Recording: This webinar is being recorded. If you arrive late, miss details or would like to share it, we will send you a link to this recording after the session has ended. Public Health Law Series Webinar: Medicaid 1115 Waivers 2
3 Public Health Law Series Webinar A series focused on providing substantive knowledge on important issues in public health law o May qualify for CLE credits, details will be sent after the webinar Webinar series partners include: o American Society of Law, Medicine & Ethics o Network for Public Health Law o Public Health Law Research Program Public Health Law Series Webinar: Medicaid 1115 Waivers 3
4 Intersection of Law, Policy and Prevention October 16 & 17 Atlanta, GA Attend to learn how law can be used to address some of today s most critical public health issues. Get more info and register at: phlc2014.org Public Health Law Series Webinar: 4
5 Public Health Law Series Webinar Medicaid 1115 Waivers: How are they Transforming the Health System?
6 Moderator Introduction Akshara Menon, J.D., M.P.H. Senior Legal Analyst/ORISE Fellow, Public Health Law Program, Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention J.D. from Emory University School of Law, M.P.H. in Health Policy and Administration from Yale School of Public Health Research interests/areas of expertise: Prescription Drug Overdose, Anti-Viral Distribution, Electronic Health Information and Health System Transformation Public Health Law Series Webinar: Medicaid 1115 Waivers 6
7 Panel Introduction Sarah Somers, J.D., M.P.H., Managing Attorney, Network for Public Health Law Southeastern Region, National Health Law Program J.D. from University of Michigan, M.P.H. from University of North Carolina School of Health Policy and Management, B.A. from Wellesley College Research interests/areas of expertise: Issues related to Patient Protection and Affordable Care Act; Medicaid; the Americans with Disabilities Act; and other publicly-funded health care programs Specializes in litigation and litigation support, expertise in Medicaid and disability issues Public Health Law Series Webinar: Medicaid 1115 Waivers 7
8 Panel Introduction Ardas Khalsa, M.S.W. Director of Healthcare Transformation Waiver Operations with the Medicaid CHIP Division, Texas Health and Human Service Commission M.S.W., University of Texas at Austin, B.S., Berry College Research interests/areas of expertise: Implements the Delivery System Reform Incentive Payment Program Extensive experience at the local level, focusing on behavioral health systems of care, literacy education, and social services Public Health Law Series Webinar: Medicaid 1115 Waivers 8
9 Panel Introduction Suzanne Bierman, J.D., M.P.H., Director, Continuity of Care and Coordination of Coverage Division of Medical Services Arkansas Medicaid J.D., from the University of Arkansas Little Rock School of Law, M.P.H., from University of Arkansas Medical Science Fay W. Boozman College of Public Health, B.A. from Hendrix College Research interests/areas of expertise: Coordinating DMS efforts in the implementation of the Health Care Independence Program and promoting coordination of coverage for Medicaid recipients Policy analysis, public health Public Health Law Series Webinar: Medicaid 1115 Waivers 9
10 Public Health Law Series Webinar Medicaid 1115 Waivers: How are they Transforming the Health System? Medicaid 1115 Demonstrations: The Basic Rules Sarah Somers, Managing Attorney Network for Public Health Law Southeastern Region National Health Law Program June 19, 2014
11 Medicaid Basics States are required to have an approved state Medicaid plan Must meet specific statutory requirements Eligibility and coverage of services Statewideness Choice of willing provider Limits on cost sharing 42 U.S.C. 1396a (Section 1902) A state plan for medical assistance must... provide Public Health Law Series Webinar: Medicaid 1115 Waivers 11
12 Section 1115 Research and Demonstration Projects Experimental, pilot, or demonstration Likely to assist in promoting the objectives of the Medicaid Act States may waive compliance with section 1902 Public Health Law Series Webinar: Medicaid 1115 Waivers 12
13 Examples of 1115 Demonstrations Delivering services through mandatory managed care (AZ, HI, TN) Extending coverage to childless adults (e.g. AZ, DE, ME, OR, VT) Imposing enhanced cost sharing (AZ, OR) Topics/Waivers/Waivers.html?filterBy=1115#waivers Public Health Law Series Webinar: Medicaid 1115 Waivers 13
14 Medicaid Expansion ACA added option requiring states to cover childless adults through Medicaid, with 100% federal match Supreme Court ruling means that expansion is optional ALTERNATIVE: 1115 Expansion Demonstrations Public Health Law Series Webinar: Medicaid 1115 Waivers 14
15 Medicaid Expansion Demonstrations Receives full federal match Assistance to pay premiums for private insurance (some demonstrations) Full Medicaid protections/wraparound Approved plans in AR, IA, MI Pending/Under development in PA, IN, NH Public Health Law Series Webinar: Medicaid 1115 Waivers 15
16 What is affected by waiver? E.g. Limits on premiums and cost sharing Requirement to cover non-emergent transportation Benefit packages Public Health Law Series Webinar: Medicaid 1115 Waivers 16
17 Limits on authority per HHS No partial expansion Full Medicaid protections (particularly for lowest income) Must provide choice of two plans Time limited Public Health Law Series Webinar: Medicaid 1115 Waivers 17
18 Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver Ardas Khalsa Director, Healthcare Transformation Waiver June 19, 2014
19 Transformation Waiver Overview Five-Year Medicaid 1115 Demonstration Waiver ( ) Allows expansion of managed care while protecting hospital supplemental payments under a new methodology Incentivize delivery system improvements and improve access and system coordination Establishes Regional Healthcare Partnerships (RHPs) anchored by public hospitals or another public entity in coordination with local stakeholders. 19
20 UC and DSRIP Under the waiver, historic Upper Payment Limit (UPL) funds and new funds are distributed to hospitals and other providers through two pools Uncompensated Care (UC) Pool ($17.6 billion) Replaces UPL Costs for care provided to individuals who have no third party coverage for hospital and other services Delivery System Reform Incentive Payments (DSRIP) Pool ($11.4 billion) New program to support coordinated care and quality improvements through RHPs Transform delivery systems to improve care for individuals (including access, quality, and health outcomes), improve health for the population, and lower costs through efficiencies and improvements DSRIP providers include hospitals, physician groups, community mental health centers, and local health departments. 20
21 UC and DSRIP UC & DSRIP Pool Funding Distribution (All Funds) Page 21
22 Regional Healthcare Partnerships Beginning October 1, 2012, to participate in DSRIP and UC, hospitals and other providers must participate in a Regional Healthcare Partnership (RHP). In May 2012, HHSC established 20 RHPs: Each RHP is anchored by a public hospital or other public entity. Each RHP submitted an RHP Plan by December 31, 2012, that outlined priority community needs and DSRIP projects to improve regional health care delivery. 22
23 20 RHPs 23
24 How Texas DSRIP is Different from other States The RHP concept is unique to Texas. Intergovernmental transfers (IGT) from governmental entities largely local public hospital districts are the non-federal share for DSRIP payments (at the FMAP rate about 40 percent non-federal share), including for private hospitals. There are 300 DSRIP performing providers 224 hospitals (public and private), 18 physician groups, 38 community mental health centers, and 20 local health departments. 24
25 RHP Plans: Two Key DSRIP Protocols Along with the approved waiver, two protocols serve as the basis for RHP Plan development and DSRIP funding. Program Funding and Mechanics (PFM) Protocol Initially approved by CMS on August 31, 2012 Amended four times, most recently in May 2014 Includes project, funding allocation and reporting requirements for projects. RHP Planning Protocol (DSRIP Menu) Initially approved by CMS in September 2012 Amended in May 2014 for technical clean up and to update the outcomes measures so there are measures appropriate for all projects and provider types. 25
26 RHP Plans: RHP Planning Protocol The RHP Planning protocol outlines the menu of projects eligible for DSRIP funds. RHPs were able to select their projects from the menu as long as they met minimum requirements and the projects address priority community needs. Category 1 Infrastructure Development - Lays the foundation for the delivery system through investments in people, places, processes and technology. Pay for performance. Category 2 Program Innovation and Redesign - Pilots, tests and replicates innovative care models. Pay for performance. Category 3 Quality Improvements - Healthcare delivery outcomes improvement targets tied to Category 1 and 2 projects. Pay for outcomes. Category 4 Population-Based Improvements - Requires hospitals in all RHPs to report on the same measures. Pay for reporting. 26
27 DSRIP Proposed Projects As of May 1, 2014, there were 1,277 approved and active 4-year DSRIP projects. More than 200 additional proposed 3-year projects received initial federal approval in May Common project types: Expand access to primary care Expand access to specialty care Behavioral health interventions to prevent unnecessary use of services in certain settings (e.g. emergency department, jail) Programs to help targeted patients navigate the healthcare system 27
28 DSRIP Projects and Public Health DSRIP Menu project options: Evidence-based Health Promotion Programs examples include Chronic Disease Prevention and Education (such as diabetes) Prenatal and Postnatal programs to improve birth and postnatal outcomes Interdisciplinary teams to promote preventive health and health literacy Fall prevention and safety for low income older adults. Evidence-based Disease Prevention Programs examples include Obesity prevention in children through nutrition and physical activity Screening programs and awareness education for colorectal cancer, mammography Expand HIV and STD screenings focused on high risk populations Promote and provide preventive immunizations to low-income adults. 28
29 DSRIP Timeline Most 4-year projects received approval by September Demonstration Years (DYs) 2-3 (October 2012-September 2014) - Start-up activities, including developing project infrastructure Project planning Hiring and training of providers and other staff Expansion of space, hours DY 3 - This year, all projects must select outcomes and submit outcome baseline data. Many projects will begin to report on the number of additional patients served due to the project. For local health departments, outcomes measurement can also include activities such as regional exchange of public health surveillance data DY 4-5 (October 2014-September 2016) Projects will earn funds by serving additional patients, showing improvements in outcomes, and continuous quality improvement. 29
30 How DSRIP Funds are Earned DSRIP funds must be earned based on achievement of projectspecific metrics each year. Payments are at the Medicaid matching rate - about 60% federal funds and 40% non-federal funds (intergovernmental transfers, largely from local public entities). As of January 2014, DSRIP participants had earned over $2.1 billion all funds for achievement through September For demonstration years 3-5 (October 2013-September 2016), providers have two opportunities to report achievement each year (April and October) to earn DSRIP funds. For April 2014 reporting, payments will be made in July
31 DSRIP Projects Measuring Success Most DSRIP projects have completed their start-up phase, and have successfully reported achievement of initial project activities. Projects have begun reporting their direct patient impact and establish benchmarks for project outcomes. Providers report twice a year on project metrics and milestones completed to earn DSRIP payments. In the final two years of the waiver, providers will report improvement in outcome measures related to each project. HHSC will conduct a mid-point assessment this year to evaluate the progress of the projects so far, and to determine if they require any modifications or technical assistance to be successful. This assessment will include a review each project s impact on those served and particularly Medicaid and uninsured individuals, and how the project could be strengthened. 31
32 DSRIP Projects Measuring Success Groups of providers and other DSRIP participants are meeting across the state to work collaboratively to identify best practices, share ways to improve projects, and promote continuous quality improvement. These learning collaboratives are underway in many regions, and a statewide learning collaborative summit for all RHPs will be held September 9-10, Common topics for the regional learning collaboratives: Behavioral healthcare, including integrated behavioral/primary healthcare Care transitions and patient navigation Chronic care and disease management Reducing unnecessary emergency room use, potentially preventable readmissions Primary care/access 32
33 Summary DSRIP provides a major opportunity to improve how health care is delivered in Texas, especially for Medicaid and low-income uninsured patients. The RHP structure provides a new avenue for increased regional cooperation and learning. Many DSRIP projects are underway and HHSC expects a significant amount of DSRIP funds will be paid in July to further DSRIP progress. DSRIP success will help contribute to waiver extension beyond September 30,
34 Waiver Website Find background materials and updates: 34
35 Public Health Law Series Webinar Medicaid 1115 Waivers: How are they Transforming the Health System? Arkansas Health Care Independence Program (Private Option) Suzanne Bierman Director, Coordination of Coverage & Continuity of Care Division of Medical Services, Arkansas Department of Human Services
36 Background on Section 1115 Waivers States have the flexibility to design programs to test policy innovations, including testing innovative delivery systems Section 1115 of the Social Security Act permits the Department of Health and Human Services to waive requirements of the federal Medicaid law Demonstration projects under Section 1115 must be budget neutral, i.e. the Demonstration may not cost more than the Medicaid program would without the Demonstration Waivers are generally approved for 3-5 years States must provide public process for notice and comment on proposed waiver application Public Health Law Series Webinar: Medicaid 1115 Waivers 36
37 Arkansas Private Option Waiver Approval Timeline Feb. 22 Mar. 13 Apr. 1 Apr. 17 Apr. 23 June 24 July 2, 8, 9 Aug. 6 Aug. 8 Sept. 27 Oct. 1 Jan. 1, 2014 Governor Beebe meets with Secretary Sebelius Secretary Sebelius expresses support for Arkansas framework Governor Beebe signs Private Option authorizing legislation Statewide public hearings on Waiver CMS notifies Arkansas submission is complete and releases for public comment Open Enrollment began Arkansas releases Private Option framework General Assembly passes Private Option authorizing legislation Arkansas releases draft of Private Option Waiver for public comment Private Option Waiver submitted to CMS CMS approves Private Option Waiver Up to an estimated 250,000 Arkansans became eligible for coverage under Private Option
38 Arkansas Health Care Independence Program The Health Care Independence Act of 2013 calls on the Arkansas Department of Human Services to reform the Medicaid Program to: Maximize the available service options; Promote accountability, personal responsibility, and transparency; Encourage and reward healthy outcomes and responsible choices; and Promote efficiencies that will deliver value to the taxpayers
39 The Private Option Offers Significant Benefits 39 Individuals may remain with the same plan and providers as their income shifts More than 35 percent of adults with incomes below 200% FPL will experience a change in eligibility within six months The size of the Marketplace will double, with the addition of 200,000 + Private Option enrollees Enrollees will be fully integrated into the Marketplace The enrollment of Private Option enrollees into Qualified Health Plans (QHPs) will facilitate payment and delivery system reform
40 Private Option Eligible Individuals in Childless adults between ages with incomes at or below 138% FPL Parents ages with incomes between 17% and 138% FPL Who are not on Medicare Who are not disabled Who have not been determined to be more effectively covered under the standard Medicaid program, such as an individual who is medically frail or other individuals for whom coverage through the Health Insurance Marketplace is determined to be impractical, overly complex or would undermine continuity or effectiveness of care FEDERAL MEDICALLY FRAIL DEFINITION IS THE STARTING POINT A disabling mental disorder Serious and complex medical conditions Physical, intellectual or developmental disability that significantly impairs their ability to perform one or more activities of daily living A disability determination
41 Private Option Benefits 41 QHP benefit package, including 10 Essential Health Benefits (EHBs) Additional Medicaid-specific benefits through fee-for-service Medicaid, not QHPs: Non-emergency transportation Dental and vision services for 19 & 20 year olds Private Option enrollees will access all benefits through one insurance card Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services Laboratory services Preventive and wellness services, and chronic disease management Pediatric services, including oral and vision care
42 Cost Sharing in the Private Option in 2014: 42 Private Option eligible individuals are permitted to shop among and enroll in QHPs offered at the Silver metal level in the Marketplace Arkansas designed a standardized cost sharing structure for all high-value Silver plans in the Marketplace, regardless of whether the individual is eligible for the Private Option or tax credits (above 138% FPL to 150% FPL) Individuals with incomes below 100% FPL are exempt from cost sharing (and enroll in the 100% AV QHP) Individuals with incomes above 100% FPL are subject to cost sharing and enroll in the high-value Silver QHP with standardized cost sharing All cost sharing is consistent with both Medicaid and Marketplace requirements.
43 Private Option Today 43 As of May 31, 187,123 Arkansans had been determined eligible for coverage in the Private Option This represents approximately 75% of expected Private Option enrollees. Four issuers are offering QHPs in the Arkansas Marketplace. Ambetter of Arkansas Arkansas Blue Cross Blue Shield Blue Cross Blue Shield, a multi-state plan QualChoice Health Insurance of Arkansas Private Option coverage became effective on January 1, 2014.
44 Private Option 2015 Initiatives 44
45 Private Option Initiatives for The Arkansas Division of Medical Services will submit and seek federal approval for the following revisions to the Private Option: Designing a limited state-designed non-emergency transportation program Implementing cost-sharing for Private Option adults with incomes above 50% of FPL Developing a model for Private Option enrollees to utilize flexible Independence Accounts
46 Q&A Please type your questions in the Q&A panel. Public Health Law Series Webinar: Expanding Medical Marijuana Laws 46
47 Upcoming Webinars Thank you for attending. Please join us for our upcoming webinar: Taking on Tobacco Regulation: An Overview of New York City s Tobacco Control Laws Presented by the Network for Public Health Law and New York State Bar Association Public Health Committee Friday, June 27 at 3 p.m. (ET) networkforphl.org/webinars Public Health Law Series Webinar: 47
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 informationNEW YORK STATE MEDICAID REDESIGN TEAM AND THE AFFORDABLE CARE ACT (MRT & ACA)
NEW YORK STATE MEDICAID REDESIGN TEAM AND THE AFFORDABLE CARE ACT (MRT & ACA) The Affordable Care Act (ACA) The Affordable Care Act 3 Officially called the Patient Protection and Affordable Care Act (PPACA)
More informationA Tale of Three Regions: Texas 1115 Waiver Journey Regional Healthcare Partnership 3 Shannon Evans, MBA, LSSGB Regional Healthcare Partnership 6
A Tale of Three Regions: Texas 1115 Waiver Journey Regional Healthcare Partnership 3 Shannon Evans, MBA, LSSGB Regional Healthcare Partnership 6 Carol Huber, MBA Regional Healthcare Partnership 1 Daniel
More informationHEALTH 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 informationTexas 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 informationIntroduction 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 informationMedicaid Payments to Incentivize Delivery System Reform Webinar Dec. 17, :00 3:00 pm ET
Medicaid Payments to Incentivize Delivery System Reform Webinar Dec. 17, 2013 2:00 3:00 pm ET TODAY S SPEAKERS: Beth Feldpush, DrPH Senior Vice President for Policy and Advocacy, America s Essential Hospitals
More informationMedicaid and the Free Care Rule
Public Health Law Series Webinar Medicaid and the Free Care Rule January 21, 2016 How to Use Webex Audio: If you can hear us through your computer, you do not need to use your phone. Just adjust your computer
More informationTrends 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 informationAlaska 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 informationThe Affordable Care Act and Its Potential to Reduce Health Disparities Cara V. James, Ph.D.
The Affordable Care Act and Its Potential to Reduce Health Disparities Cara V. James, Ph.D. Director, Office of Minority Health Centers for Medicare & Medicaid Services April 22, 2013 The Affordable Care
More informationOregon s Health System Transformation: Coordinated Care Model. November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer
Oregon s Health System Transformation: Coordinated Care Model November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer The Challenges Oregon Faced Rising healthcare costs outpacing state budget in
More informationHealth Care Reform 1
Health Care Reform 1 Health Care Reform Covered California (Health Benefit Exchange) Medi-Cal Expansion Bridge Plan Proposal Gold Coast Readiness Outreach to the Eligible 2 Health Care Reform: What is
More informationFEDERAL FUNDS ARE FLOWING: WHO'S GETTING WHAT, WHERE AND WHY?
Not Peer Reviewed FEDERAL FUNDS ARE FLOWING: WHO'S GETTING WHAT, WHERE AND WHY? Dianne Heffron Principal 1050 Connecticut Ave., NW Suite 700 Washington, DC National Governor s Association Learning From
More informationTexas Section 1115 Uncompensated Care Waiver Update. Texas Critical Access Hospital Conference June 21, 2018
Texas Section 1115 Uncompensated Care Waiver Update Texas Critical Access Hospital Conference June 21, 2018 Texas Section 1115 Uncompensated Care Waiver Update Waiver allows for Managed Care DSRIP UC Additional
More informationCoastal Bend Regional Health Partnership (RHP) 4
Coastal Bend Regional Health Partnership (RHP) 4 Waiver Updates April 5, 2018 Linda Wertz Dianne Longley HealthManagement.com RHP 4 Agenda Topics Summary Draft RHP 4 Plan Update Learning Collaborative
More informationJ. Brandon Durbin th Street Lubbock, Texas Plano, Texas Fax
J. Brandon Durbin 2950-50th Street 909-18 th St. Lubbock, Texas 79413 Plano, Texas 806-791-1591 469-361-0120 Fax 806-791-3974 brandon@dhcg.com brandon@durbinco.com Changed with the Waiver Mostly Managed
More informationHHSC Value-Based Purchasing Roadmap Texas Policy Summit
HHSC Value-Based Purchasing Roadmap Texas Policy Summit Andy Vasquez, Deputy Associate Commissioner MCS, Quality & Program Improvement Section October 19, 2017 1 HHSC Value-Based Purchasing Roadmap Topics
More informationMetrics, Money, and the Ethics of Behavioral Health Care. Joan L. Erney, JD Chief Executive Officer Community Behavioral Health December 2, 2013
Metrics, Money, and the Ethics of Behavioral Health Care Joan L. Erney, JD Chief Executive Officer Community Behavioral Health December 2, 2013 Today s Conversation DBHIDS-Community Behavioral Health Current
More informationMedicaid & Global Commitment
Medicaid & Global Commitment Nolan Langweil, Joint Fiscal Office, Lindsay Parker, Vermont Agency of Human Services Updated January 13, 2017 1 PART ONE Medicaid Background 2 What is Medicaid? Created in
More informationPartnering with Managed Care Entities A Path to Coordination and Collaboration
Partnering with Managed Care Entities A Path to Coordination and Collaboration Presented by: Caroline Carney Doebbeling, MD, MSc Chief Medical Officer, MDwise May 9, 2013 Agenda Are new care models on
More informationFY 2018 PROPOSED BUDGET
FY 2018 PROPOSED BUDGET Letter from CEO It is my pleasure to present the proposed fiscal year 2018 budget for Central Health. Since my start just a few months ago, I have been awed by the work of Central
More informationLong-Term Care Improvements under the Affordable Care Act (ACA)
Long-Term Care Improvements under the Affordable Care Act (ACA) South Carolina Health Care Implementation Coalition September 17, 2010 JoAnn Lamphere, DrPH Director, State Government Relations Health &
More informationSUMMARY 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 informationNC 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 informationOhio Medicaid Overview
Ohio Medicaid Overview May 2014 John McCarthy Ohio Medicaid Director Medicaid Overview Medicaid is Ohio s largest health payer 83,000 active providers, hospitals, nursing homes and other providers care
More informationLegalNotes. Disparities Reduction and Minority Health Improvement under the ACA. Introduction. Highlights. Volume3 Issue1
Volume3 Issue1 is a regular online Aligning Forces for Quality (AF4Q) publication that provides readers with short, readable summaries of developments in the law that collectively shape the broader legal
More informationTEXAS HEALTHCARE TRANSFORMATION & QUALITY IMPROVEMENT PROGRAM. Bluebonnet Trails Community Services
TEXAS HEALTHCARE TRANSFORMATION & QUALITY IMPROVEMENT PROGRAM Regional Healthcare Partnership Region 4 Bluebonnet Trails Community Services Delivery System Reform Incentive Payment (DSRIP) Projects Category
More informationNC 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 informationHealth Coverage for San Franciscans
Health Coverage for San Franciscans SF FES Council Affordable Care Act Alejandro Salinas LaShenna Sirles July 16, 2014 The following presentation is not for consumer use and is for informational purposes
More informationPatient Protection and Affordable Care Act Selected Prevention Provisions 11/19
Patient Protection and Affordable Care Act Selected Prevention Provisions 11/19 Coverage of Preventive Health Services (Sec. 2708) Stipulates that a group health plan and a health insurance issuer offering
More informationNew 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 informationUnderstanding Medicaid: A Primer for State Legislators
Understanding Medicaid: A Primer for State Legislators Introduction This booklet summarizes key elements of the Medicaid program, including basic answers to questions about the design and cost of the
More informationOregon 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 informationSTATEMENT OF POLICY. Foundational Public Health Services
12-18 STATEMENT OF POLICY Foundational Public Health Services Policy The National Association of County and City Health Officials (NACCHO) recognizes the importance of an evidence- and experience-based
More informationMedicaid: Current Challenges and Future Prospects
Medicaid: Current Challenges and Future Prospects Diane Rowland, Sc.D. Executive Vice President, Henry J. Kaiser Family Foundation Executive Director, Kaiser Commission on Medicaid and the Uninsured The
More informationMedicaid 101: The Basics for Homeless Advocates
Medicaid 101: The Basics for Homeless Advocates July 29, 2014 The Source for Housing Solutions Peggy Bailey CSH Senior Policy Advisor Getting Started Things to Remember: Medicaid Agency 1. Medicaid is
More informationMEDI-CAL PROGRAM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC SOCIAL SERVICES - DPSS
MEDI-CAL PROGRAM LOS ANGELES COUNTY DEPARTMENT OF PUBLIC SOCIAL SERVICES - DPSS W O R K F O R C E D E V E L O P M E N T B O A R D A J C C P A R T N E R S MEDI-CAL PRESENTATION Medi-Cal Overview Health
More informationAn Introduction to MPCA and Federally Qualified Health Centers~ Partners for Quality Care
An Introduction to MPCA and Federally Qualified Health Centers~ Partners for Quality Care AIM Partnership Forum June 5, 2014 Lynda C. Meade, MPA Director of Clinical Services Michigan Primary Care Association
More informationMedicaid 201: Home and Community Based Services
Medicaid 201: Home and Community Based Services Kathy Poisal Division of Long Term Services and Supports Disabled and Elderly Health Programs Group Center for Medicaid and CHIP Services Centers for Medicare
More informationImproving the Continuum of Care: Progress on Selected Provisions of the Affordable Care Act One Year Post-Passage
Improving the Continuum of Care: Progress on Selected Provisions of the Affordable Care Act One Year Post-Passage March 23, 2011 marks the oneyear anniversary of the signing of the Patient Protection and
More informationMedicaid 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 informationLegislative 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 informationThe 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 informationHealth Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10
Health Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10 On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March
More informationHealthcare Service Delivery and Purchasing Reform in Connecticut
Healthcare Service Delivery and Purchasing Reform in Connecticut Presentation to National Association of Medicaid Directors November 9, 2011 Mark Schaefer Director, Medical Care Administration Health Purchasing
More informationThere are over 2 million Michigan Medicaid and CHIP Beneficiaries, more than ½ are children
April, 2015 There are over 2 million Michigan Medicaid and CHIP Beneficiaries, more than ½ are children (January, 2015). www.medicaid.gov/medicaid-chip-program- Information/By-State/michigan.html Signed
More informationMedicaid Payment Reform at Scale: The New York State Roadmap
Medicaid Payment Reform at Scale: The New York State Roadmap ASTHO Technical Assistance Call June 22 nd 2015 Greg Allen Policy Director New York State Medicaid Overview Background and Brief History Delivery
More informationMedi-Cal and the Safety Net California Association of Health Plans Seminar Series Medi-Cal at its Core
Medi-Cal and the Safety Net California Association of Health Plans Seminar Series Medi-Cal at its Core August 3, 2017 Deborah Kelch Executive Director Insure the Uninsured Project 1 Safety-Net Definitions
More informationMedicaid 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 informationTEXAS HEALTHCARE TRANSFORMATION & QUALITY IMPROVEMENT PROGRAM. Jackson Healthcare Center
TEXAS HEALTHCARE TRANSFORMATION & QUALITY IMPROVEMENT PROGRAM Regional Healthcare Partnership Region 4 Jackson Healthcare Center Delivery System Reform Incentive Payment (DSRIP) Projects Category 1 DSRIP
More informationStrengthening Long Term Services and Supports (LTSS): Reform Strategies for States
Advancing innovations in health care delivery for low-income Americans Strengthening Long Term Services and Supports (LTSS): Reform Strategies for States March 6, 2018 Michelle Herman Soper and Alexandra
More informationFIDA. Care Management for ALL
Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative
More informationArkansas. Medicaid Primer
Arkansas Medicaid Primer Updated January 2012 Arkansas Medicaid Primer Table of Contents 1 What is Medicaid? 3 What services are covered by Medicaid? 4 Who does Medicaid cover? 7 How much does Arkansas
More informationProvider Town Hall Presentation
Provider Town Hall Presentation Topics HAP & Health Care Reform Overview Healthy Engagement Reminder Healthy Michigan Plan HAP Midwest Health Plan Overview ICD-10 & HAP Provider Newsroom Updates 2 HAP
More informationI. 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 informationHealth Literacy Implications of the Affordable Care Act (ACA)
Health Literacy Implications of the Affordable Care Act (ACA) Presentation to the Institute of Medicine s Roundtable on Health Literacy Stephen Somers Roopa Mahadevan Center for Health Care Strategies
More informationMaryland 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 informationATTACHMENT A Delivery System Reform Incentive Payment (DSRIP) Program Renewal Request
Background ATTACHMENT A The New Jersey Department of Health (DOH) operates the Delivery System Reform Incentive Payment (DSRIP) program as required by Section 93(e) of the Special Terms and Conditions
More informationShana Scott, JD, MPH, Health Systems Team Lead Tuesday, October 3, 2017
Health Systems Transformation & Health System Interventions: Innovative Public Health Approaches to Improve Quality of Care for Georgians with Chronic Conditions Presentation at 2017 Southern Obesity Summit
More informationThe Patient Protection and Affordable Care Act Summary of Key Maternal and Child Health Related Highlights with Updates on Status of Implementation
NOVEMBER 29, 2011 The Patient Protection and Affordable Care Act Summary of Key Maternal and Child Health Related Highlights with Updates on Status of Implementation The Patient Protection and Affordable
More informationMedicaid 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 information8/11/16. Disclosures. What is an 1115 Medicaid Waiver? Objectives. What is an 1115 Medicaid Waiver? What is an 1115 Medicaid Waiver?
Disclosures Nothing to disclose. Nurse Practitioners Bridging the Gap: The Im pact of a Nurs e Practitioner Managed Trans itional Care Chronic D is ease Management Cl inic on Low Incom e and Uninsured
More informationkaiser 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 informationState 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 informationNYS Value Based Payments (VBP):
NYS Value Based Payments (VBP): Provider Associations, Community Based Organizations, and Consumer Advocates Town Hall Meeting Jason Helgerson NYS Medicaid Director December 16, 2016 2 Today s Agenda Agenda
More informationDSRIP Programs: Delivery System Reform Incentive Payment The Current Situation
DSRIP Programs: Delivery System Reform Incentive Payment The Current Situation Claudia Gourdon 203-580-5408 cgourdon@hfgusa.com DSRIP What it Is and Isn t Drivers Behind DSRIP State Programs Commonalities
More informationMedicaid 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 informationSummary of Legislation Relating to Sunset Commission Recommendations 84 th Legislature
Bill Number and Caption SB 200 (Nelson/Price) HHSC continuation and functions for the Health and Human Services Commission and the provision of health and human services in this state. Selected Bill Provisions
More informationDraft 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 informationNewly Elected County Judge & Commissioners Seminar January 14, 2015
Newly Elected County Judge & Commissioners Seminar January 14, 2015 1/14/2015 1 } County Indigent Health Care Program } Role of the County Health Authority } Accessing Financial support & other resources
More informationFinancing of Community Health Workers: Issues and Options for State Health Departments
Financing of Community Health Workers: Issues and Options for State Health Departments ASTHO Technical Assistance Presentation Terry Mason, PhD Carl Rush, MRP Geoff Wilkinson, MSW This webinar is supported
More informationRegional Healthcare Partnership 18 Texas 1115 Medicaid Waiver Plan Update Summary for Demonstration Years 7 and & 2019 Final Draft for Public
Regional Healthcare Partnership 18 Texas 1115 Medicaid Waiver Plan Update Summary for Demonstration Years 7 and 8 2018 & 2019 Final Draft for Public Comment April 10, 2018 Table of Contents THE WAIVER
More informationEarly and Periodic Screening, Diagnosis and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) EPSDT and Bright Futures: Alaska ALASKA (AK) Medicaid s EPSDT benefit provides comprehensive health care services to children under age 21,
More informationPublic 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 informationOverview of Six Texas Demonstrations
Texas Case Study: Document 2 Overview of Six Texas Demonstrations The chart below provides an overview of six Texas demonstrations. Where possible, the chart indicates the purpose of the demonstration,
More informationPlanning a Course to Population Health Management
Planning a Course to Population Health Management A Complimentary Webinar From healthsystemcio.com Your Line Will Be Silent Until Our Event Begins at 12:00 ET Thank You! Slide Deck: http://goo.gl/1w119j
More informationThe Opportunities and Challenges of Health Reform
Assessing Federal, State and Market Changes in the Next Decade Medicaid in Alaska Executive Summary, April 2011 Medicaid is a jointly managed federal-state program providing health insurance to low-income
More informationCommunity Health Workers: ACA and Redesign Funding Opportunities
Community Health Workers: ACA and Redesign Funding Opportunities What are the Goals of the Affordable Care Act and Redesign? Increased Coverage Better Population Health Higher Quality, More-Patient Centered
More information2014 Chapter Leadership Workshop
2014 Chapter Leadership Workshop Saturday, July 26, 2014 2:30 PM 3:00 PM Trust, But Verify: Oncology Nurses Impact on Public Policy Speaker: Alec Stone, MA, MPA Health Policy Director Oncology Nursing
More informationImplementing 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 informationWorking 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 informationWelcome Providers. Thursday, November 11, Page 1
Welcome Providers Thursday, November 11, 2010 Page 1 What is a 3 Share Plan? The 3 Share Plan is an affordable health plan for small businesses. Cost is shared among employers, their employees, and one
More informationDriving Quality Improvement in Managed Care. Toby Douglas, Director California Department of Health Care Services
1 Driving Quality Improvement in Managed Care Toby Douglas, Director 2 Presentation Overview 1. Background on California s Medicaid Program (Medi-Cal) 2. California s Quality Improvement Focuses 3. Challenges
More informationMedicaid 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 informationHealth Homes (Section 2703) Frequently Asked Questions
Health Homes (Section 2703) Frequently Asked Questions Following are Frequently Asked Questions regarding opportunities made possible through Section 2703 of the Affordable Care Act to develop health home
More informationLong-Term Services and Supports (LTSS): Medicaid s Role and Options for States
Long-Term Services and Supports (LTSS): Medicaid s Role and Options for States Erica L. Reaves, Policy Analyst State Variation in Long-Term Services and Supports: Location, Location, Location National
More informationThe Long and Winding Road-map: From Waiver Services to VBP and Other Stops Along the Way
The Long and Winding Road-map: From Waiver Services to VBP and Other Stops Along the Way Mental Health Association in New York State, Inc. Annual Meeting Gregory Allen, MSW Director Division of Program
More informationapproved 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 informationExploring Public Health Barriers and Opportunities in Eye Care: Role of Community Health Clinics
Exploring Public Health Barriers and Opportunities in Eye Care: Role of Community Health Clinics Susan A. Primo, O.D., M.P.H., F.A.A.O. Director, Vision and Optical Services Emory Eye Center Professor
More informationMedicaid Efficiency and Cost-Containment Strategies
Medicaid Efficiency and Cost-Containment Strategies Medicaid provides comprehensive health services to approximately 2 million Ohioans, including low-income children and their parents, as well as frail
More informationIowa Medicaid: Innovations & Initiatives
Iowa Medicaid: Innovations & Initiatives ICD-10 ACA Expansion Presumptive Eligibility Health Information Technology PERM DHS Initiatives Adult Quality Measures SIM CDAC Topics 2 ICD-10 3 1 ICD-10 Background
More informationNew Opportunities in Long Term Services and Supports
Profiles of State Innovation: Long -Term Supports and Services CHCS Webinar November 22, 1010 New Opportunities in Long Term Services and Supports Mary Sowers Director, Division of Community and Institutional
More informationKentucky Rural Health Summit June 8, 2018
Kentucky Rural Health Summit June 8, 2018 Kentucky Health Program Overview Kentucky HEALTH is the Commonwealth s new program for certain low-income adults and their families. The program gets its name
More informationFriday Health Plans of Colorado
QUALITY OVERVIEW Health Plans of Colorado (formerly Colorado Choice Health Plans) Serving Colorado for over 4 years, Health Plans utilizes a community-focused model. We work hand in hand with local providers
More informationColorado s Health Care Safety Net
PRIMER Colorado s Health Care Safety Net The same is true for Colorado s health care safety net, the network of clinics and providers that care for the most vulnerable residents. The state s safety net
More informationMaking the ACA Work for Clients & Communities
+ Making the ACA Work for Clients & Communities September 18, 2013 Barbara DiPietro Director of Policy National HCH Council + Agenda for the Day Part 1: Outreach & Enrollment National Goals & Issues Barbara
More informationACA Preventive Services & Associated Coding and Billing
ACA Preventive Services & Associated Coding and Billing A Resource manual CBA CENTER High-Impact HIV Prevention Capacity Building Assistance for Healthcare Organizations A Center of Excellence TABLE OF
More informationIssue Brief February 2015 Affordable Care Act Funding:
CENTER FOR HEALTHCARE RESEARCH & TRANSFORMATION Issue Brief February 2015 Affordable Care Act Funding: An Analysis of Grant Programs under Health Care Reform FY2010- The Patient Protection and Affordable
More informationEstimated 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