Multi-Payor Purchasing Power
The ACA increases states’ already significant purchasing power and provides new tools for delivery system improvements, thereby increasing states’ ability to purchase with an eye toward quality and efficiency.
*Milestone details:
*Full name: Use federal funding opportunities and the state’s purchasing power in Medicaid, CHIP, public employee insurance plans, and the exchange to promote quality and efficiency.
*Relevance to the ACA:
Medicaid expansions and opportunities to align and develop public and private insurance programs within the Exchange will expand states’ already large roles in the health care market. The ACA provides several funding streams. States, as health care purchasers, may seek to foster higher quality and more efficient care.
Funding for Medicaid demonstrations projects:
§2403 - Extends the Medicaid Money Follows the Person long-term care demonstration.
§2601 - Extends the Medicaid waiver demonstration projects for dual eligibles.
§2704 - Establishes a demonstration program to evaluate the use of bundled payments for integrated care of Medicaid beneficiaries.
§2707 - Creates a Medicaid demonstration project to provide payments to institution of mental disease for treatment of adult enrollees who require emergency stabilization.
Grants available to states to encourage health system reforms:
§2951 - Awards grants to states to create and improve upon benchmarks in maternal in child health.
§3504 - Awards grants to states or groups of states to support pilot projects that design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care and trauma systems.
§4201 - Grants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention.
§6703 - Provides grants to states agencies to bolster coordination within and to monitor and act on issues regarding abuse neglect and exploitation in long term care facilities and among the elderly.
less
comment, ask a question or post a document
Login or Register to participate in this discussion or post a document
District of Columbia
Those interested in this topic may wish to see these recent announcements from CMS:
- Guidance on integrated care models: http://www.statereforum.org/discussions/care-coordination-financing#comm...
- State Innovation Models Initiative: http://www.statereforum.org/discussions/medicaid#comment-11127
Maine
On January 25 CMS released guidance for organizations seeking to participate in “capitated financial alignment demonstrations” designed to improve the delivery of services to dual eligibles. CMS anticipates that CMS, the State, and health plans or other qualified entities will enter into a three-way contract for delivery of medical, behavioral health, and long-term services and supports. CMS also anticipates a joint plan selection process by CMS and each participating State. This document provides specifics on the demonstration including payment principles, standards in key programmatic areas, state demonstration approval process, and plan selection process. Here at NASHP we are wondering what you think of the specifics.
How do these specifics affect your interest in participating?
What will facilitate your participation? Be a barrier to it?
Were you surprised by anything in the guidance?
Post your answers to these questions or other comments/questions you may have here!
District of Columbia
Texas has received approval of a 1115(a) waiver from the Centers for Medicare & Medicaid Services (CMS). The stated goals of the demonstration are as follows:
• Expand risk-based managed care statewide;
• Support the development and maintenance of a coordinated care delivery system;
• Improve outcomes while containing cost growth;
• Protect and leverage financing to improve and prepare the health care infrastructure to
serve a newly insured population; and
• Transition to quality-based payment systems across managed care and hospitals.
The waiver provides for $8 billion in federal funding over five years. Further information is available below.
District of Columbia
State Refor(u)m user Cindi Jones of the Virginia Department of Medical Assistance Services gave the attached presentation at a recent National Association of Medicaid Directors (NAMD) meeting. The presentation discusses Virginia's use of managed care, and is entitled "Moving Past the Hype: Real World Payment Reforms in Virginia."
Maine
Those interested in this milestone may wish to view Pam Silberman's post available here: http://www.statereforum.org/node/6490#comment-8340
Maine
Those interested in Oregon's progress in this area may wish to see State Rep Mitch Greenlick's post here: http://www.statereforum.org/node/3422
Maine
West Virginia's Medical Home Incentive Pilot includes a Medicaid managed care organization. To learn more, please see the following presentation: www.pcpcc.net/files/medical_home_incentive_pilot_pcpcc_presentation.ppt
Maine
Utah and Idaho jointly submitted a successful CHIPRA Demonstration Grant proposal to, "develop a regional quality system, guided by the Medical Home model, to enable and assure ongoing improvement in the healthcare of children enrolled in Medicaid/CHIP programs. The project will focus attention on improving care and outcomes for children and youth with special health care needs" (proposal abstract). The project is referred to as the Children's Healthcare Improvement Collaboration or CHIC. To learn more, please see the proposal at left or visit: http://medicine.utah.edu/upiq/CHIC-CHIPRA/index.htm.
Arizona
Arizona requested and received Health Home Planning Grant Funding to determine the feasiblity of implementing health homes for the SMI population.
Oregon
Through a multi-stakeholder process, Oregon has developed attributes, standards, and measures that the state will use to recognize practices as Patient-Centered Primary Care Homes (PCPCH). The attached document describes the standards as well as the process for their development. Oregon has also recently established the PCPCH Program within the Oregon Health Authority for implementing the spread of PCPC Homes statewide. As the program develops, information about Oregon PCPC Homes can be found at: http://www.oregon.gov/OHA/OHPR/HEALTHREFORM/PCPCH/index.shtml
Kentucky
The Commonwealth of Kentucky, Department for Medicaid Services realizes the importance of Medicaid member participation and education regarding prevention and management of chronic diseases. Attached, please find the Commonwealth's proposal for the Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) grant opportunity funded through the Patient Protection and Affordable Care Act, Section 4108.
Maine
The ACA appropriated $100 million for the Medicaid Incentives for Prevention of Chronic Diseases Program. States have submitted applications that will be assessed on a competitive basis. Complete applications were due in May 2011; final awards will be made by August 2011.
For further information, please visit http://www.cms.gov/MIPCD/.
Maine
Promoting quality and efficiency are key goals of medical home projects. Massachusetts has launched a multipayer medical home pilot that includes Medicaid, thereby leveraging federal funding. To learn more, please follow this link: http://www.statereforum.org/node/2206
Maine
Promoting quality and efficiency are key goals of medical home projects. Maryland has launched a multipayer medical home pilot that includes commercial payers, Medicaid MCOs, and Medicare Advantage plans. To learn more, please follow this link http://www.statereforum.org/node/2206 and see slide 17 of this presentation http://mhcc.maryland.gov/pcmh/documents/SymposiumPresentationBethesda.pdf
Oklahoma
Community members who are interested in this milestone may wish to learn more about Oklahoma’s Patient Centered Medical Home program for SoonerCare members. To learn more, please follow this link:
http://www.statereforum.org/node/602#comment-7932
District of Columbia
Last week, the Medicaid and CHIP Payment and Access Commission (MACPAC) convened to discuss the issue of Medicaid managed care. In the meeting New York Medicaid Director Jason Helgerson and Oklahoma Health Care Authority CEO Mike Fogarty presented on their state's experiences with managed care. Here is a recent State of Implementation blog post, which provides an overview of the meeting:
http://www.statereforum.org/blog/medicaid-managed-care
District of Columbia
This issue brief explores the potential goals of an Exchange in WA, including: reducing the number of uninsured and increasing access to care; ensuring greater accountability and transparency; increasing the portability and continuity of coverage; simplifying health insurance purchasing; increasing competition in the health insurance marketplace; and driving quality improvement and cost containment. Access the brief here: http://www.statereforum.org/sites/default/files/waexchange_goalvalue_iss...
Washington
Attached please find the Washington State Innovation Proposal: Global Medicaid Modernization Initiative.
Maine
This presentation reviews ACA provisions related to payment reform, discusses payment reform efforts already underway in Maine, and analyzes risks and opportunities for payment reform going forward.
Access the presentation here:
http://www.statereforum.org/sites/default/files/me_paymt_reform_pres.pdf
District of Columbia
This report by the New York State Health Foundation details the challenges and opportunities NY faces in implementing reform, including Exchange, benefit design and payment issues. Access the report here: http://www.statereforum.org/sites/default/files/nyroadmappaper_aug2010.pdf
Pages