Medicaid Innovation and Reform Commission
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- Angelica Norman
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1 Medicaid Innovation and Reform Commission Dr. Bill Hazel, M.D. Secretary of Health and Human Resources October 21,
2 We made it! New modernized Eligibility system went live 10/1 as planned! PPACA compliant solution Approved by Centers for Medicare & Medicaid Services (CMS) New Medicaid eligibility criteria Income based on IRS MAGI methodology 2
3 We made it! Eligibility criteria is checked real-time with Social Security Administration, IRS, Homeland Security Cases coordinated real-time with the federal Exchange New Cover Virginia call center open; enables citizens to apply for Medicaid by phone All 122 Local DSS offices are on-line 3
4 Application Volume (10/1 10/15) 11,347 applications submitted across multiple benefit programs 5688 new Medicaid applications 33.5% CommonHelp portal 27.2% Cover Virginia call center 39.3% Local DSS offices On par (97%) with typical new Medicaid application volume before ACA launched 450 applications transferred to the federal exchange No applications received from the federal exchange feds not ready till 11/1 4
5 Virginia Medicaid Reform Goals Coordinated Service Delivery Efficient Administration DMAS provides a health system where services are coordinated, innovation is rewarded, costs are predictable, and provider compensation is based on the quality of the care. DMAS is efficient, streamlined, and userfriendly. Tax payer dollars are used effectively and for their intended purposes. Significant Beneficiary Engagement Beneficiaries take an active role in the quality of their health care and share responsibility for using Medicaid dollars wisely. 5
6 Status of Phase 1 Reforms Title Progress Timeline/Target Date Dual Eligible Demonstration Pilot SFY14-16 Total Savings 50% enrollment ($27,597,465) 80% enrollment ($44,028,619) Enhanced Program Integrity SFY14-16 Total Additional Savings ($17,066,946) July 2013: Negotiations started with identified health plans August 2013: Began Readiness Reviews with plans September 2013: Contracting, Rates October 2013: Completed desk and on-site Readiness Reviews with plans January 2014: Regional phased-in enrollment begins Continued Enhancement Highlights: referrals to MFCU at the OAG 2. Prevented over $363M in improper payments (over past two fiscal years) 3. $461,654 in restitution and imprisonment in some cases for fraudulent eligibility 4. Eight separate contracts to monitor and audit provider payments 6
7 Status of Phase 1 Reforms Title Progress Timeline/Target Date Foster Care Enrollment into MCOs SFY14-16 Total Savings ($13,940,351) Tidewater: September 1, 2013 (LIVE); Central VA: November 1, 2013; NOVA: December 1, 2013; Charlottesville: March 1, 2014; Lynchburg: April 1, 2014; Roanoke: May 1, 2014; and, Far Southwest: June 1, Eligibility and Enrollment System SFY14-16 Total Savings (General Funds only) ($22,400,000 due to 75% FFP for eligibility functions) October 2013 New VaCMS eligibility system went live for new Medicaid/FAMIS applications; Now taking Medicaid/FAMIS applications using new financial requirements MAGI January 1, 2014 Additional eligibility rules required to begin (e.g., coverage up to age 26 for foster care youth) 7
8 Status of Phase 1 Reforms Title Progress Timeline/Updates Access to Veterans Benefits for Medicaid Recipients SFY14-16 Total Savings Minimal at this time Behavioral Health Services SFY14-16 Total Savings ($133,960,168) Assisting veterans to obtain benefits and avoid Medicaid expenditures when services are more appropriately funded by the Federal Government. To establish the program -DMAS, VDVS and VDSS have together developed an MOU, interagency data transfer and internal procedures to get the program up and running. Now transferring quarterly data match files with federal government to link applicants with federal services when available December 2013: Implement strengthened regulations to improve integrity and quality December 2013: Implement new Behavioral Health Services Administrator (Magellan) 8
9 Status of Phase 2 Reforms Title Progress Timeline/Target Date Commercial Like Benefit Package Cost Sharing and Wellness Weekly discussions with CMS for transition to a Commercial ( alternative ) benefit package in 2014 July 2014: Managed Care Benefit Package Contract Revision to implement commercial benefit package July 2013 Managed Care Changes Chronic Care and Assessments (2013) Wellness Programs (2013) Maternity Program Changes (2013) Limited Provider Networks and Medical Homes July 2013 Managed Care Changes Medallion Care Partnership System (MCSP) October 2013: Addition of Kaiser Health Plan (medical home model) 9
10 Status of Phase 2 Reforms Title Progress Timeline/Target Date Quality Payment and Incentives Parameters to Test Innovative Pilots July 2013 (for MCOs):Program implemented to establish the baseline target July 2014: quality withholds begin Summer 2013: Provided claims data to GMU to assist with VCHI pilots August 15, 2013: Sent proposal to CMS September 2013: Ongoing conversations with CMS & conversations with VCHI regarding potential pilots October 2013: Workgroups established with CMS to establish authority 10
11 Status of Phase 3 Reforms Title Progress Timeline/Target Date ID/DD Waiver Redesign All HCBC Waiver Enrollees in Managed Care for Medical Needs October First Phase of DBHDs Study completed July 2014 ID/DD Waiver Renewal Due/ Redesign; second phase of DBHDS study to be complete July Additional revisions to the ID/DD Waiver systems implemented as needed October 2014 Home and community-based waiver services remain out of managed care and provided through fee-for-service 11
12 Status of Phase 3 Reforms Title Progress Timeline/Target Date All Inclusive Coordinated Care for LTC Beneficiaries (coordinated delivery for all LTC services) Statewide Medicare- Medicaid (Duals) Coordinated Care, including children July 2016 July
13 Potential Virginia Model: Private Option for Low Income Adults Eligible Adults Entry into Private Market Health Plan Accountability Commercial Benefits
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15 Potential Virginia Model: Private Option for Low Income Adults Eligible Adults Entry into Private Market Health Plan Accountability Commercial Benefits Contracted enrollment broker facilitates enrollee s health plan selection Choice of available health plans Mandatory enrollment in a health plan Future Option: Plan selection via the Health Insurance Marketplace 15
16 Potential Virginia Model: Private Option for Low Income Adults Eligible Adults Entry into Private Market Health Plan Accountability Commercial Benefits Assured access to providers statewide coverage Full financial risk using a capitated payment Ability to financially incent high quality and highperformance (Phase 2 Reforms Included) Future Options: Premium assistance (similar to capitated payment) Health Savings Accounts 16
17 Potential Virginia Model: Private Option for Low Income Adults Eligible Adults Entry into Private Market Health Plan Accountability Commercial Benefits Use of Virginia s Approved Benchmark Plan: Anthem Key Care 30 Benefit Package (the largest small group plan in Virginia) Medicaid payment rates Provide wraparound services: Transportation to medical providers with limits Community behavioral health services Beneficiary Responsibility: Cost sharing for enrollees with income over 100% FPL 17 Wellness incentives for all
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