June 2013 Developmental Disability System Design Brief
Situation — NH’s Department of Health and Human Services (DHHS), through established contracts with three commercial Managed Care Organizations (MCOs), system design efforts through the State Innovation Model (SIM) grant, alternate long term care implementation pilots with the Balancing Incentive Program (BIP) funds, and the potential movement to an 1115 Waiver, is making every effort to: 1.) provide equity in services/funding across populations (seniors, people with developmental disabilities/acquired brain disorders, DD/ABD, and children in need of services), 2.) Integrate services across vertical populations, and 3.) Better predict and reduce costs to a growing number of Medicaid /Medicare participants. The Governor has appointed a Commission on Medicaid Care Management (MCM) to provide oversight for future system/care management design that is fair and quality driven for all citizens. The legislature, as part of HB1/2 debate, is considering oversight options to ensure that managed care savings are achieved, as predicted, in the next two years. These efforts, through the Executive, Legislative, and Department levels, must be uniformly influenced by stakeholders in the DD/ABD community to ensure continued quality services and local control.
Timing — DHHS has an aggressive 18-month implementation timeline for system reform to commence January 2015. The SIM three-month stakeholder input process, under the direction of Deloitte consulting, will result in a framework/architecture for system redesign for submission to the Center for Medicaid and Medicare Services (CMS) by September 30. SIM will inform Step 2 long term care MCO design and the 1115 Waiver application; including payment reform elements. The elements defined in the SIM process will be incorporated into the MCO contract amendment scheduled for one year after the implementation of Step 1 acute care management for all populations. Step 1 is slated to go live December 1.
SIM — The State Innovation Model CMS grant supports NH’s development and testing of a model for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for people enrolled in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). To learn more: http://innovation.cms.gov/initiatives/state-innovations/.
BIP — Balancing Incentive Program CMS grant provides seed money to help NH increase access to non-institutional long-term services and supports. It allows for new ways to serve more people in home and community-based settings, in keeping with the integration mandate of the Americans with Disabilities Act (ADA), as required by the Olmstead decision. The Balancing Incentive Program was created by the Affordable Care Act of 2010 (Section 10202). Increases the Federal Matching Assistance Percentage (FMAP) to States that make structural reforms to increase nursing home diversions and access to non-institutional LTSS. The enhanced matching payments are tied to the percentage of a State’s LTSS spending, with lower FMAP increases going to States that need to make fewer reforms. To learn more: http://www.balancingincentiveprogram.org/.
1115 Waiver — The 1115 allows NH to test new approaches in Medicaid that differ from federal program rules; allowing for significant flexibility in how they operate their programs and can have a significant impact on program funding. CMS has seen a recent increase in 1115 Waiver activity as states 1.) Prepare for 2014 expansion coverage 2.) Seek eligibility and enrollment restrictions and premium cost sharing increases to address ongoing budget pressures, 3.) Expand managed care to include high need populations and additional services, 4.) Utilize 1115 waiver authority to support safety-net delivery system improvements, 5.) Restructure payment and delivery systems, and 6.) Focus on dual eligible for Medicaid/Medicare. NH is considering the 1115 Waiver to lay the important groundwork for reform as it expands managed care to high need populations that rely on long term care. Click here to learn more: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8318.pdf.
MCM — A commission established through Executive Order by Gov. Maggie Hassan to look into implementing a managed care network for existing and expansion Medicaid/Medicare clients. Mary Vallier-Kaplan will chair the panel and Donald Shumway will serve as vice-chair. The Commission’s members are Thomas Bunnell, Sue Fox, Wendy Gladstone, MD, Yvonne Goldsberry, Ph.D, Catherine McDowell, Douglas McNutt, Gustavo Moral, Kenneth Norton, and Jo Porter. Click here to learn more: http://www.governor.nh.gov/media/news/2013/pr-2013-04-10-medicaid-care.htm.
Messages for NH System Reform Input
Points of Agreement
Points We Need Included
Points of Concern