section 1115 medicaid waiver renewal workforce development expert stakeholder workgroup framing our...
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Section 1115 Medicaid Waiver RenewalWorkforce Development
Expert Stakeholder Workgroup
Framing Our Discussion
Anastasia DodsonDepartment of Health Care Services
November 20, 2014
Section 1115 Medicaid Waivers
Allow states flexibility to design demonstration projects that promote the objectives of the Medicaid program
Typically approved for 5 years; States may submit request for waiver renewal for 3 -5 years
Must be budget neutral
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CA BTR WaiverCalifornia’s Bridge to Reform Waiver (2010-2015)
Current Waiver sunsets on October 31, 2015
Waiver renewal request must be submitted to the Centers for Medicare and Medicaid Services (CMS) at least 6 months before the end of the current waiver
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2015 Waiver Renewal Initial Concepts
2015 Waiver Renewal Initial Concepts
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Purpose of Section 1115 Medicaid Waiver Renewal
• To further delivery of high quality and cost efficient care for our beneficiaries
• To ensure long-term viability of the delivery system post-ACA expansion
• To continue California’s momentum and successes in innovation achieved under the “Bridge to Reform” Waiver
Shared Goals with CMS
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Objectives
Strengthen primary care delivery and access
Avoid unnecessary institutionalization and services by building the foundation for an integrated health care delivery system that incentivizes quality and efficiency
Address social determinants of health
Use California’s sophisticated Medicaid program as an incubator to test innovative approaches to whole-person care
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Waiver Concepts
Initial Waiver
Concepts
Federal/ State Shared Savings Payment/
Delivery Reform
Incentive Payments
Safety Net Payment Reforms
FQHC Payment/ Delivery Reform
Successor DSRIP
CCS Program Redesign
Shelter for Vulnerable Populations
Workforce Development
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Plan / Provider Incentives
Workforce Development
Goal 1 : Increase number of health workers to provide health care services in medically underserved areas or to serve a high number of Medicaid beneficiaries
Goal 2: Develop innovative ways to address whole person care to meet the unique yet interrelated needs of physical and mental health
Goal 3: Create financial and other incentives to encourage greater commitment to serve Medicaid beneficiaries and practice in underserved areas
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Goal1: Increase the number of health workers to provide health care services in medically underserved areas or to serve a high number of Medicaid beneficiaries
Attract new health professionals to provide health care services in medically underserved areas and/or to serve a high number of Medicaid beneficiaries
Increase retention to stabilize a health care workforce to meet the specific needs of the community Medicaid beneficiaries.
Address scope of practice limitations to increase pool of available health workforce and allow existing professionals to practices at top of scope
Support ability of health professionals to work with greater efficiency
1a
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1b
1c
1d
Develop innovative ways to address whole person care to meet the unique yet interrelated needs of physical and mental health
Create financial and other incentives to encourage greater commitment to serve Medicaid beneficiaries and practice in underserved areas
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Goal 2
Goal 3
Criteria for Consideration• Addresses Workforce Goals• Fits shared CMS 1115 Waiver Renewal Goals
– To further delivery of high quality and cost efficient care for our beneficiaries
– To ensure long-term viability of the delivery system post-ACA expansion– To continue California’s momentum and successes in innovation achieved
under the “Bridge to Reform” Waiver• Feasible
– Medicaid laws and regulations and CMS financial participation requirements
– State law– Stakeholder support
• Measurable for Evaluation
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Questions / Comments:
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