Section 1115 Waiver Renewal Assembly Bill 6, Fourth Extraordinary - PDF document

Section 1115 Waiver Renewal

Assembly Bill 6, Fourth Extraordinary Session (ABx4 6)  Approved by the Governor July 28, 2009  Requires the submittal of an application for a waiver to CMS.  Requires the Department to convene a stakeholder committee to advise on the implementation of the waiver  Specifies the key goals for the waiver Service –Accountability- Innovation

Comprehensive Waiver Goals  Strengthen California’s health care safety net  Maximize opportunities to reduce the number of uninsured  Optimize opportunities to increase FFP and maximize financial resources to address uncompensated care  Promote long-term, efficient, and effective use of state and local funds  Improve health care quality and outcomes  Promote home-and community-based care Service –Accountability- Innovation

Waiver Concept  In October 2009 a draft concept paper was released for review and comment  Met with stakeholders and the health committees from both houses of the Legislature convened hearings  The draft concept paper was revised and incorporated much of the comments and input received  In December 2009 this concept paper was submitted to CMS Service –Accountability- Innovation

Centers for Medicare and Medicaid Services  Ongoing discussion and guidance  Based on input from CMS and technical workgroups some of the concepts have been adjusted Service –Accountability- Innovation

Formation of Technical Workgroups  California Children’s Services (CCS)  Seniors and Persons with Disabilities (SPD)  Behavioral Health Integration (BHI)  Health Care Coverage Initiative (HCCI)  Dual Eligibles Service –Accountability- Innovation

Workgroup Objective Provide technical support to the Department regarding the development of the section 1115 comprehensive waiver implementation plan Service –Accountability- Innovation

Select Workgroup Activities  SPD – discussing mandatory enrollment in managed care and alternative systems where managed care is not appropriate  BHI - looking at strategies for integrated delivery of service for people with behavioral health and medical needs and possible pilot models  HCCI – discussing how CI might facilitate the transition to health reform http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal Service –Accountability- Innovation

Possible CI Considerations  Benefit package  Enrollment system  Eligibility  Provider network Service –Accountability- Innovation

Waiver & Health Care Reform  Bridge to Health Care Reform  Opportunity to increase federal funds Service –Accountability- Innovation

CI & Health Care Reform  CI may be the key to bridge health reform  Possible enrollment gateway to transition to federal Health Care Reform Service –Accountability- Innovation

Next Steps in Waiver Renewal Process  Early summer, submit to CMS: • Final concept paper • Draft implementation plan • “Interim Evaluation of California’s CI” by UCLA Service –Accountability- Innovation

Continued Steps in Waiver Renewal Process  Receive CMS approval  Negotiate with CMS and finalize Special Terms and Conditions  September 2010 begin implementation of the new waiver Service –Accountability- Innovation

New Waiver – September 2010  State is committed to meeting this date  CMS is working closely with the State and is committed to helping us meet this date Service –Accountability- Innovation