June 24, 2014 Karol Dixon HCA Tribal Affairs Office Medicaid Update.

June 24, 2014Karol DixonHCA Tribal Affairs Office

Medicaid Update

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N01,N02 N03,N23 N05 N10,N11,N31 N13,N33Family Medical Pregnancy Medical New Adults Childrens Medical CHIP

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

2,027

93

2,469

9,359

379

1,428

356

7,441

2,241

296

AI/AN Enrollments & Recertifications: Oct 13 - May 14

Had Previous CRVG No Prev CRVG

14,327 Had Previous CVRG11,762 No Prev CVRG26,089 TOTAL

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FFY09 FFY10 FFY11 FFY12 FFY13 -

5,000

10,000

15,000

20,000

25,000

17,955

19,209 19,913

21,048 22,017

AI/AN Children Enrolled in Medicaid & CHIP by year

Payments to I/T

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I/T 2013-$ 2013-clients

2014-$ 2014-clients

Total $50,838,720 21,316 $18,520,156 14,815

Medical $15,312,638 14,825 $5,075,611 8,190

Dental $5,630,161 8,752 $2,253,572 4,627

Mental $11,978,079 3,000 $4,118,933 2,105

CD $16,690,161 1,776 $6,411,460 1,379

POS $1,134,179 4,574 $660,579 3,420

Urbans 2013-$ 2013-clients

2014-$ 2014-clients

Total $1,556,302 2,634 $718,570 1,752

Medical & Mental

$1,219,433 2,175 $575,137 1,393

Dental $100,752 323 $28,045 119

CD $127,886 129 $38,852 66

POS $108,229 943 $76,535 670

Urban Payment Summary

Data pulled May, 2014. Data is expected to change as more claims are billed

Foster Care Medical RFP

• RFP forthcoming• AI/AN kids will remain exempt and enrollment

in Foster Care MC voluntary

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• May 2014: – 1,188,222 Medicaid clients in MC– 9,430 are AI/AN*

* AI/AN is currently reported as race code 4 or 5 in ProviderOne. Due to race being a voluntary field during enrollment there are a large number of AI/AN clients who are in the ProviderOne system as non-native. These clients will be updated to race code 4 as part of a larger clean up project this fall.

How many AI/AN are in MC?

• AI/AN* in MCO plans (9,430 total)• 4,875 AI/AN in Molina• 2,569 AI/AN in CHPW• 788 AI/AN in UHC• 630 AI/AN in CCC• 321 AI/AN in Amerigroup

*AI/AN as defined by race code

Which plans are AI/AN in?

I/T/U and MCOs

With a contract• I/T/U serves as primary care

provider for client in MC• HCA pays MC premium to

MCO• I/T/U bills MCO for visits• I/T/U bills HCA for balance

of encounter• I/T/U utilizes MC network

for referrals

Without a contract• Client has designated

provider in MC network• HCA pays MC premium to

MCO• I/T/U bills MC for visits• I/T/U bills HCA for balance

of encounter• I/T/U refers to FFS

providers, FFS bills HCA

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WAC 284-43-200(7)

To provide adequate choice to covered persons who are American Indians, each health carrier shall maintain arrangements that ensure that American Indians who are covered persons have access to Indian health care services and facilities that are part of the Indian health system. Carriers shall ensure that such covered persons may obtain covered services from the Indian health system at no greater cost to the covered person than if the service were obtained from network providers and facilities. Carriers are not responsible for credentialing providers and facilities that are part of the Indian health system. Nothing in this subsection prohibits a carrier from limiting coverage to those health services that meet carrier standards for medical necessity, care management, and claims administration or from limiting payment to that amount payable if the health service were obtained from a network provider or facility.

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MC Contract Language

15.4 Special Provisions for American Indians and Alaska Natives• In accord with the Section 5006(d) of the American Recovery

and Reinvestment Act of 2009, the Contractor is required to allow American Indians and Alaska Natives free access to and make payments for any participating and nonparticipating lndian health care providers for contracted services provided to American Indian and Alaska Native enrollees at a rate equal to the rate negotiated between the Contractor and the Indian health care provider. If such a rate has not been negotiated, the payment is to be made at a rate that is not less than what would have otherwise been paid to a participating provider who is not an Indian health care provider.

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Health Plan Contact Information

Customer Service: 1-877-542-8997Website: www.uhccommunityplan.com Provider Line - 1-877-542-9231Website: http://www.uhccommunityplan.com/health-professionals

Customer Services: 1-800-600-4441Website: www.amerigroup.comProvider line - 1-800-454-3730Website: http://washington.joinagp.com

Customer Service: 1-800-440-1561Website: www.chpw.orgProvider line - 1-800-440-1561Website: http://www.chpw.org/for-providers/

Customer Service: 1-877-644-4613Website: www.coordinatedcarehealth.com Provider line - 1-877-644-4613Website: http://www.coordinatedcarehealth.com/for-providers/become-a-provider/

Customer Service: 1-800-869-7165Website: www.molinhealthcare.com Provider line - Phone: 1-800-869-7175Website: http://www.molinahealthcare.com/medicaid/providers/wa/Pages/home.aspx

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AI/AN income – SSI related

AIHC request from Oct 2013 & Tribal Consultation Nov 2013:

1. MAGI and SSI rules to be the same; or2. Eliminate $2000 income exclusion limit

• CMS provided technical assistance • Formal response to AIHC forthcoming• WAC 182-512-0770 to be updated• Emergency WAC will be filed 08-01-2014

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State Health Care Innovation Plan

Laura Kate ZaichkinAdministrator,Office of Health Innovation and [email protected]

State Health Care Innovation Plan Implementation Update

WA’s Plan: Three Core Strategies

Drive value-based purchasing across the community, starting with the State as “first mover”

Build healthy communities and people through prevention and early mitigation of disease throughout the life course

Improve chronic illness care through better integration of care and social supports, particularly for individuals with physical and behavioral health co-morbidities

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Supported by

SB 6312and

HB 2572

State Health Care Innovation Plan

1. Quality and price transparency

2. Person and family engagement

3. Regionalize transformation

4. Create Accountable Communities of Health (ACHs)

5. Leverage and align state data

6. Practice transformation support

7. Workforce capacity and flexibility

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Seven Building BlocksThe Keys to Success

State Health Care Innovation Plan

Building Block: Regionalize Transformation

Regions will be determined in partnership with Joint Behavioral Health Legislative Task Force & Counties

• Leverages public purchasing to share accountability for performance results across delivery systems.

• Empowers “local” innovation and engages communities in local priorities

• Enhances opportunities for cross agency efforts around common populations • Builds on lessons from current regional endeavors

7-Region Example

9-Region Example

State Health Care Innovation Plan

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Building Block: Accountable Communities of Health

Regionally driven priorities and solutions to collectively impact health

Align Medicaid purchasing

Develop and activate aregion-wide health assessment and regional health improvement plan

Drive accountability forresults

Forum for harmonizing payment models, performance measures and investments

Health coordination and workforce development

State Health Care Innovation Plan

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Accountable Community of Health InitiativeCommunity Champions and Catalysts for Mutual Community and State Health Transformation Priorities

• Community of Health Planning Grant Released on May 2

• Empower communities to shape and inform ACH development and design

• Opportunity for communities, including governments and tribal entities, to prepare for the anticipated ACH designation process and initial awards as authorized in E2SHB 2572.

• Develop a collaborative partnership between the State and communities

Key Timeline:

• Letter of Intent due May 9, 2014• Full Application due May 30, 2014

State Health Care Innovation Plan

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Q & A

State Health Care Innovation Plan

The Innovation Plan available at: http://www.hca.wa.gov/shcip

Share your thoughts and asked to stay engaged by emailing the Help Desk: [email protected]

Monthly Updates to I/T/U at Medicaid Monthly Meeting

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2014 Meeting Schedule

July 8August 12September 9October 14November 12 * (Wednesday)

December 9

Managed Care Discussion with Planstwo potential dates:

July 25 or August 1 *(9 AM-12 PM)

September 23October 28November 18 * (3rd Tuesday)

December 16 * (3rd Tuesday)

Tribal Billing Workgroup (TBWG)2nd Tuesday, 9:00-11:00 AM unless noted*

Medicaid Monthly Meeting (M3)1:00-3:00 PM unless noted*

As of 04/30/2014. Register or download files online!http://www.hca.wa.gov/tribal/Pages/index.aspx

Thank You

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For comments or questions, contact:Karol Dixon

[email protected]