Medicaid Reform Updates Melisa Byrd Senior Deputy - - PowerPoint PPT Presentation

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Medicaid Reform Updates Melisa Byrd Senior Deputy - - PowerPoint PPT Presentation

Medicaid Reform Updates Melisa Byrd Senior Deputy Director/Medicaid Director Medical Care Advisory Committee December 18, 2019 Department of Health Care Finance 12/18/19 1 Presentation Overview Rev eview N w Next S t Step teps f


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SLIDE 1

Department of Health Care Finance

Melisa Byrd Senior Deputy Director/Medicaid Director Medical Care Advisory Committee December 18, 2019

Medicaid Reform Updates

12/18/19 1

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SLIDE 2

Presentation Overview

  • Rev

eview N w Next S t Step teps f from October er M MCAC Mee eeti ting

  • Fee-for-Service Transition Updates
  • Long Term Care Reform Updates
  • Next Steps

2 12/18/19

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Building on Reform Efforts to Improve Health Outcomes: The Next Five Years

The Goal: Improve health outcomes so that District residents can live their best lives The Path to Improve Outcomes:

  • More value over volume: increase expectations for value-based purchasing through managed care
  • Increased access to care: require universal contracting for key providers (acute care hospitals and

FQHCs)

  • More coordinated care: transition FFS Medicaid population to managed care

Managed Care as the Vehicle:

  • Access to care coordination and case management:
  • Increased program flexibility promotes innovation
  • Utilize plan (Medicaid and Medicare) expertise
  • Strengthen program oversight

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Next Steps from October MCAC Meeting

  • Behavioral Health Transformation
  • Anticipate waiver approval; plan for implementation
  • Stakeholder Engagement
  • Establish avenues for communication:
  • Standing Update at MCAC Meetings
  • DHCF website: create Medicaid Reform page
  • Establish Medicaid Reform listserv and email (DCMedicaidReform@dc.gov)
  • Outreach to / meetings with key stakeholder groups
  • Managed Care Procurement
  • Issue a Request for Proposals (RFP)

4 12/18/19

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Next Steps from October MCAC Meeting

  • Behavioral Health Transformation

Anticipate waiver approval Plan for implementation

  • Stakeholder Engagement

Establish avenues for communication:

 Standing Update at MCAC Meetings  Create Medicaid Reform page: https://dhcf.dc.gov/page/medicaid-reform  Establish Medicaid Reform listserv and email (DCMedicaidReform@dc.gov)

Outreach to / meetings with key stakeholder groups

  • Managed Care Procurement
  • Issue a Request for Proposals (RFP)

5 12/18/19

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Presentation Overview

  • Review Next Steps from October MCAC

Meeting

  • Fe

Fee-fo for-Servic ice T Tran ansit ition ion Up Updates

  • Long Term Care Reform Updates
  • Next Steps

6 12/18/19

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SLIDE 7

Fee-for-Service Transition

12/17/19 7

  • Managed Care Contract Timeline
  • Issue RFP in early 2020
  • Council approval Summer 2020
  • Contracts effective October 1, 2020
  • Submit a 1932(a) State Plan Amendment
  • Allows states to make managed care mandatory for certain populations
  • Submission to CMS in early Summer 2020
  • Year 1 transition populations
  • SSI Adults (~15,000 individuals)
  • Non-disabled adults currently opting out of managed care (~9,000 individuals)
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Fee-for-Service Transition

12/17/19 8

  • Contract Changes
  • Value Based Purchasing
  • MCOs shall incorporate value-based purchasing initiatives with their network providers
  • Align financial incentives and accountability with the total cost of care and overall health
  • utcome
  • Recognition and rewards for quality gains; VBP model aligns payment more directly to the

quality and efficiency of care

  • 25% of the total medical expenditures linked to alternative payment methods (APM) by the

end of Option Year 1; 50% by the end Option Year 3

  • Universal Contracting: ensuring program-wide access of critical providers
  • Managed care plans will be required to contract with all tertiary hospitals and for the

provision of primary care services, dental services, preventive care services and/or specialty/referral services with FQHCs or FQHC look-alikes.

  • Hospitals (and hospital affiliated physician groups) will be required to contract with all

Medicaid plans and FFS Medicaid to participate in the Medicaid program

  • Effectuated through Medicaid Provider Agreement
  • Anticipate outreach to hospitals in May 2020
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SLIDE 9

Presentation Overview

  • Review Next Steps from October MCAC

Meeting

  • Fee-for-Service Transition Updates
  • Long T

Term C m Care R Reform U m Updat ates

  • Next Steps

9 12/18/19

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Dual Eligible Special Needs Plan (D-SNP) Timeline

  • Highly Integrated Dual-Eligible Special Needs Plan (HIDE-SNP) Request for Information (RFI) issued

October 2019

  • Highly Integrated Dual-Eligible Special Needs Plan (HIDE-SNP) RFI responses due

November 2019

  • Public program design call based on feedback from RFI
  • Develop State Medicaid Agency Contract (SMAC) to comply with new CMS requirements

January 2020

  • Draft State Medicaid Agency Contract (SMAC) available to potential partners
  • Medicaid capitated rates developed

February 2020

  • Finalize SMAC with plans

Spring 2020

  • Plans must submit benefit package and signed SMAC to CMS for approval

June 2020

  • CMS sends approved D-SNP approval letters

September 2020

  • Effective date for approved D-SNPs

January 1, 2021

12/17/19 10

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Program of All-Inclusive Care for the Elderly (PACE) Timeline

  • Submit PACE SPA to CMS

October 2019

  • Publish proposed PACE rule
  • Receive CMS Approval

January 2020

  • Issue PACE RFP

February 2020

  • Select provider
  • Provider secures CMS approval
  • Publish final PACE rule

Summer/Fall 2020

  • DHCF readiness review process
  • Program launch and beneficiary enrollment

Fall/Winter 2020

12/17/19 11

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SLIDE 12

Presentation Overview

  • Review Next Steps from October MCAC

Meeting

  • Fee-for-Service Transition Updates
  • Long Term Care Reform Updates
  • Ne

Next xt St Steps

12 12/18/19

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Next Steps

  • Behavioral Health Transformation
  • Implement January 1, 2020
  • Continued stakeholder engagement
  • Managed Care Procurement
  • Issue a Request for Proposals (RFP)
  • Long Term Care Reform
  • Phone call to discuss Dual Eligible Special Needs Plan program design
  • PACE RFP

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