Medicaid Advisory Committee September 27, 2017 9:00-12:00 Oregon - PowerPoint PPT Presentation

Medicaid Advisory Committee September 27, 2017 9:00-12:00 Oregon State Library Salem, Oregon

Welcome & Introductions

Meeting objectives • Regular business (e.g. approve minutes) • Approve committee work plan for social determinants of health in Oregon’s CCOs • Receive agency Medicaid update • Understand State Plan Amendments (SPA) and receive update on upcoming/in progress SPAs • Understand the role of OHA’s Office of Equity & Inclusion (OEI) and OEI’s perspective on social determinants of health • Agree on a shared definition of social determinants of health for Oregon CCOs • Receive update on the Oregon Health Policy Board’s Action Plan for Health 3

Webinar Housekeeping • Join audio using computer mic/speakers or telephone • Public line is muted • Send questions using the “Questions” box in the control pane • Q&A and public comment near the end • Meeting/webinar is being recorded and will be posted online 4

Agenda Welcome and Introductions 9:00 Co Chairs Adopt minutes Social Determinants of Health (SDoH) in Oregon’s CCOs 9:15 Amanda Peden, MAC • OHA SDoH initiatives staff • Review and approve committee work plan 9:30 Agency Medicaid update David Simnitt/ Jeremy Vandehey/Anna Lansky 9:45 State Plan Amendments Jesse Anderson • Background and Q&A • SPA Dashboard Office of Equity & Inclusion (OEI) overview and social Leann Johnson 10:00 determinants of health Break 10:30 Defining social determinants of health of Oregon CCOs Committee 10:40 11:25 Public Comment All Oregon Health Policy Board update – Action Plan for Steph Jarem 11:10 Health 11:55 Closing Co-Chairs

Social Determinants of Health Work Plan

MAC SDoH Work Plan: Needed action steps • Approve SDoH work plan • Approve extended November meeting for additional SDoH presentations • Designate SDoH workgroup members (MAC member subcommittee) — sign up during break 7

OHA’s Social Determinants of Health Initiatives • Statewide Supportive Housing • Health Equity Subcommittee of Strategy Workgroup Oregon Health Policy Board • Opioid STR Grant – housing services • Regional Health Equity Coalitions • Health in All Policies (RHECs) support & Technical • Health Impact Assessments Assistance • Healthy Redevelopment Initiative/ • Traditional Health Worker (THW) Brownfield Initiative Commission • Climate and Health Resilience State • HIV Care & Treatment Program Plan (services related to SDOH) • Public Health Division, Maternal & • DHS Long Term Services & Supports K Child Health - various SDOH Population Plan (Home & Community Based Equity efforts Services Health OHA staff workgroups on SDOH, equity, and trauma-informed care Health System Data and Transformation technology • Health-related services rules • OPIP/Pediatric Health Complexity – and guidance integrate social complexity score for SDOH • OHPB CCO 2.0 recommendations & • Health Information Exchange SDOH implementation integration (future efforts) • Transformation Center TA • Environmental public health tracking o Learning collaboratives, equity • Health Impact Modeling (e.g. reduction Black – general/all SDOH consultations, early learning of greenhouse gas emissions based on Purple – Housing transportation plan scenarios) • FQHC Alternative Payment & Green – Built environment/ Care Model (APCM) environmental • MAC Framework Orange – Child health/early learning

Social Determinants of Health – MAC committee role • MAC is the main state advisory body for the Medicaid program • Recommend framework and guidance for leveraging aspects of Medicaid to address SDoH through CCOs • Support CCO efforts to continue and expand social determinants of health work and establish coordinated and strategic initiatives 9

MAC SDoH Scope of Work Framework for addressing Social Determinants of Health in Oregon CCOs Phase 1  Shared definition of social determinants of health June – Dec  Role of CCOs in addressing SDoH: recommend the role and key strategies 2017 CCOs should continue to use or should adopt to address SDoH in their communities Phase Recommendations for using Health-related Services to address 2 SDoH Jan – Apr  Create guide(s) for CCOs to address social determinants of health using 2018 health-related services. Framework for social determinants of Health in Oregon (committee memo) Products Health-related services and social determinants of health guide(s)

Proposed committee work plan Date (2017/2018 Task Description Deliverable May – July 2017 Develop work plan, introductory presentations on Draft work plan (Staff) SDoH (OPCA) and Health-related services (HRS) Sept 27 In-person Approve work plan; designate MAC SDoH workgroup Final work plan, agree on definition of SDoH for CCOs definition, WG Oct/Nov Develop & field stakeholder survey Stakeholder survey (Staff & WG) Nov 3 In-person – Presentations & discussion – role of CCOs in 3.5 hours (extended) addressing SDOH Dec 6 In Person Review survey results & select priority areas for health- 1-2 priority areas related services guide(s); Review & discuss draft for HRS guide(s) framework for SDoH in CCOs Jan 24 Webinar Presentations on measuring impact of SDoH on health in priority areas Feb-April Develop HRS guides (compile evidence on and key Framework on (Staff & WG) strategies to address priority areas); consult CCOs on SDoH for CCOs MAC draft framework (memo) March 28 In-person Identify example interventions for HRS guide(s) in priority area(s) April 25 In-person Approve final SDoH framework and HRS guides Final framework, guides and memo 11

Agency Medicaid Update Jeremy Vandehey, Interim Director of Health Policy & Analytics, OHA David Simnitt, OHA Medicaid Director Anna Lansky, Deputy Director of ODDS, DHS

Agency Medicaid Update: OHA • Welcome to Jeremy Vandehey and update on OHA leadership • Eligibility update: OHA has completed Medicaid eligibility renewals for all members whose renewals were put on hold following the Cover Oregon failure • Federal policy update: – Congress has until Sept 30 to reauthorize funding for CHIP before it expires; use current budget reconciliation resolution for ACA – CHIP Reauthorization – Sens. Wyden & Hatch reached agreement for 5-year reauthorization, no further action in senate or house is scheduled – ACA-related reforms – Graham-Cassidy bill vote pulled, but could resurface after other priorities (i.e. tax reform)  MAC Guiding Principles for Oregon Medicaid shared with OHPB & Oregon legislature by OHPB board chair 13

Agency Medicaid Update: DHS

Oregon’s State Plan Jesse Anderson, State Plan Manager, OHA

Medicaid State Plan • Every state that participates in a Medicaid or a CHIP program must file a document called the State Plan. – It is essentially our contract with the Centers for Medicare and Medicaid Services (CMS) that allows us to draw down federal match for the programs. • All State Medicaid agency’s must comply with some basic requirements: – Serve certain mandatory populations. – Provide certain mandatory services. – Provide services that are “sufficient in amount, duration, and scope and provided statewide.

What initiates a State Plan Amendment (SPA) • There are various reasons an amendment would be filed. These include: – A change in federal law – Change in state law – Legislative discussions, budget notes, budget reductions – Reimbursement changes

SPA timelines • Once a state plan amendment is submitted, CMS has 90 days to review and approve or deny the SPA. • If during the initial 90 day period, CMS needs more time to review, they will issue a Request for Additional Information (RAI). – This will start a new 90 day period in which the state can respond to the questions. – Once the state has responded, CMS begins a new 90 days in which to review and approve or deny the SPA.

SPA notice requirements • Tribal consultation- 30 days prior to submission of a state plan. – CMS allows an expedited review when necessary. • Public notice- required if changes to reimbursement or reimbursement methodologies, a public notice is required prior to the SPA’s effective date. – Public notice must describe the proposed change; estimate the increase or decrease in expenditures; give contact person, address for written comments to be received. – Comments received during the comment period are reviewed and acted upon if warranted.

Difference between Waiver and State Plan • The State Plan adheres strictly to the federal Medicaid requirements as outlined in the Code of Federal Regulations (CFR). • Waivers are time limited, the state plan is not. • Waivers specify ways that the state Medicaid program will operate differently from what is outlined in the CFR. – OHP operates under the 1115 Demonstration Waiver, however there are several other types of waivers (1915(b)(4), 1915(c),(i),(j)).