Section 1115 Waiver Renewal Stakeholder Workgroup Update - California
Section 1115Waiver RenewalStakeholder WorkgroupUpdateMari Cantwell, Chief Deputy Director, Health Care ProgramsWendy Soe, Senior Advisor for Policy DevelopmentDepartment of Health Care ServicesDecember 03, 2014
Workgroups Update2
Workgroups Update Five separate workgroups assembled to develop concepts on:–––––1) Medicaid-funded Shelter/Housing2) Provider/Managed Care Plan incentive programs3) a Delivery System Reform Incentive Program (DSRIP)4) Workforce Development5) Safety Net Reform – Disproportionate Share Hospitals (DSH)/Safety NetCare Pool (SNCP) bundled payments 3-5 sessions on each topic between November 2014 –February 2015 A one-day session with a broad stakeholder distribution is planned in lateJanuary for the Department to solicit input on a financing strategy forfederal-state shared savings under the 1115 Waiver. Two other concepts potentially linked to waiver: redesign of the CaliforniaChildren's Services (CCS) Program and Federally Qualified Health Centers(FQHC) payment reform will continue on separate stakeholder/conceptdevelopment efforts already underway.3
WorkgroupsDSH/SNCP SafetyNet Financing Next (First) Meeting: Dec. 9 3 TotalWorkforceDevelopment Next Meeting: Dec. 11 3 TotalPlan/ProviderIncentives Next Meeting: Dec. 15 3 TotalMedicaid-fundingHousing/Shelter Next Meeting: Dec. 16 4 TotalDSRIP 2.0 Next Meeting: Dec. 19 5 Total4
Early Areas of InterestAlignment of metrics acrossproviders/plans/deliverysystemsDeveloping sharedsavings/accountable carearrangements betweenentities towards betterquality, cost effective careBehavioral health integrationstrategies within each of theworkgroup concept areasExpanding workforce capacityand access to beneficiaries byincenting new providers toserve Medi-Cal and forexisting providers to serveadditional Medi-Cal patientsStrategies to maximize federalfinancial investment underthe authority of section 1115waiversEvaluation design for deliverysystem transformation5
Highlights from First MeetingsMedicaid-funded Housing/Shelter (Nov. 4, 2014) DHCS Long-Term Care Division and Corporation for SupportiveHousing (CSH) provided information on 1115 Wavier renewalprocess, initial concepts, with a focus on defining housing andhousing-based servicesPlan/Provider Incentives (Nov. 12, 2014) Framed discussion around potential incentive constructs: DHCS to Medi-Cal Managed Care plans (MCPs); MCPs tocontracted entities/providers; MCPs to county behavioral health Potential pay-for-performance structures, sharedsavings/accountable care arrangements6
Highlights from First Meetings(continued)DSRIP 2.0 (Nov. 13, 2014) Framed discussion around: successes of the current DSRIP, thelogistics of non-federal share in CA, looking forward at DSRIP 2.0 asthe first 5-yr DSRIP up for renewalWorkforce Development (Nov. 20, 2014) Framed discussion around three goals, for a wide range of providertypes: Increase the number of new health workers to serve in medicallyunderserved areas or to serve more Medi-Cal beneficiaries Develop innovative ways to address whole person care to addressphysical and mental health and substance use disorder care needs Create financial and other incentives to encourage greatercommitment to serve the Medi-Cal population7
Workgroups Update (cont.) DHCS will be engaging CMS throughout theconcept development and stakeholder process Workgroup meeting summaries posted onDHCS Waiver Renewal webpage Comments can continue to be submitted tothe Waiver Renewal inbox Public summary of stakeholder input as wellas letters to the Department made availableon website8
Federally Qualified HealthCenters (FQHCs) PaymentReform&CA Children’s Services (CCS)Program Redesign Update9
FQHC Update: Payment ReformObjectivesTransform how careis provided atFQHCs Increased accessand capacity Allow for additionalflexibilities in caredeliveryBuild upon thestate’s existingorganized deliverysystemImprove patienthealth outcomes Align incentives forpatient-centeredcare Strengthen MCPFQHC relationshipsEnhanceTest a value-basedAlternativePaymentMethodology (APM)and bend the costcurvedata quality Data sharingbetween MCPs,FQHC and the state Reporting andtracking measuresfor evaluation andratesetting10
FQHC Update:Current and Upcoming EffortsTo date, DHCS has provided technical assistance to FQHCs and Managed Care Plans(MCPs) in convening workgroups to develop a viable Alternative PaymentMethodology (APM) pilot.Workgroups on key components: data analysis of payment and claims dataalternative methods of care deliverytriggers for reconciliationevaluation metrics: What does successful practice transformation look like?Capitation rate developmentLegislation and Federal approval11
Path to SuccessConsensusbetween plans,health centers, andthe Administrationon pilot designEvaluation ofpracticetransformationLegislative andfederalauthorityViableratesettingmethodology12
CCS UpdateDHCS has assembled a CCS Redesign Stakeholder Advisory Board (RSAB)composed of individuals from various organizations and backgrounds withexpertise in both the CCS program and care for children and youth with specialhealth care needs.Meetings begin in December 2014 and run through approximately July 2015.This process will also include topic-specific technical workgroups composed ofexperts in key issues.The fundamental goals of the redesign process are to: 1) improve care andoutcomes for children and youth with special health care needs by ensuring thatthey receive coordinated care and 2) identify indicators that will measure qualityin order to improve care for these children and their families.The DHCS has no predetermined preference for health care delivery changesor improvements and is looking to the stakeholder process to provide viablerecommendations that would best benefit the CCS population.13
Technical ConsultantsGenerally providing assistance to DHCS in: Researching national and state issues related to the initial set of Waiver concepts Presenting/ facilitating discussion at stakeholder workgroup meetings Contributing content for Waiver Renewal submissionDHCS looking to bring on additional consultants with familiarity on1115 Waivers and Medicaid financing to help with STC and BudgetNeutrality developmentDHCS also working with departments under CA HHS Agencyaround specific concepts areas through the stakeholderworkgroups14
SAC Meetings in 2015Will continue through the current WaiverAnticipate 4 meetings in 2015Tentative dates set Feb 2015 - Oct 2015Will continue discussion on progress of current BTR Waiver programs andhealth care reform implementationWill routinely provide update on status of Waiver Renewal efforts at SACmeetings15
Foundation SupportCA foundations (Blue Shield of CA Foundation, CaliforniaHealthCare Foundation, The California Endowment)continue to be supportive of DHCS initiatives that seek toimprove the health of our beneficiaries. Among the manyinitiatives they help support are:1115 WaiverRenewalSACFQHC PaymentReform16
Questions/CommentsWaiverRenewal@dhcs.ca.govNews and aiverRenewal.aspx17
Highlights from First Meetings (continued) DSRIP 2.0 (Nov. 13, 2014) Framed discussion around: successes of the current DSRIP, the logistics of non-federal share in CA, looking forward at DSRIP 2.0 as the first 5-yr DSRIP up for renewal. Workforce Development (Nov. 20, 2014) Framed discussion around three goals, for a wide range of .
Waiver 1. Request Information The State of Illinois requests approval for an amendment to the following Medicaid home and community-based services waiver approved under authority of §1915(c) of the Social Security Act. A. Program Title: HCBS Waiver for Adults with Developmental Disabilities B. Waiver Number: IL.0350 Original Base Waiver Number .
In the Custom Reports from College Board, how will I know which file contains the fee waiver codes? The fee waiver code file will be in an Excel file that uses the following naming convention: [school year] SAT Fee Waiver Codes [Your AI Code], e.g., 2021 SAT Fee Waiver Codes 123456.xlsx . How will I know that the fee waiver code file is available?
care, improve population health, and reduce the cost of health care without compromising quality. CMS approved the waiver on December 12, 2011. The Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver, commonly called the 1115 Transformation Waiver . DSRIP enabled groundbreaking work, including increased regional .
Waiver Number: MD.0353.R02.00 Draft ID: MD.09.02.00 Renewal Number: D. Type of Waiver (select only one): E. Proposed Effective Date: (mm/dd/yy) There are no significant changes to this renewal application. 0353 04/01/01 02 Regular Waiver 07/01/09 Application for 1915(c) HCBS Waiver: MD.0353.R02.00 - Jul 01, 2009Page 1 of 140
Florida MEDS-AD Waiver Q1 of DY10 Report 1 I. Introduction This report includes programmatic and financial activities for the period July 1, 2015 through September 30, 2015. By implementing Florida's 1115 MEDS-AD waiver (MEDS-AD waiver), the Agency for Health Care Administration (Agency) seeks to demonstrate that the total cost of
Based Services Waiver PURPOSE OF THE HCBS WAIVER PROGRAM The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security . §1915(b)(3) (employ cost savings to furnish additional services) G. Application for 1915(c) HCBS Waiver: FL.40166.R06.00 - Jul 01, 2020 Page 2 of 118 06/24/2020
same course by taking the waiver exam if one is offered. You have only one attempt at each waiver exam and are eligible to take them only in the summer preceding your first year. If you are unable to waive a core course by credential and cannot take the waiver exam at the scheduled time, you must take the course. There are no make-up waiver exams.
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