june 24, 2014 karol dixon hca tribal affairs office medicaid update
TRANSCRIPT
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