Partnership for Patients: Medicaid Programs and improving care transitions

1. Partnership for Patients: Medicaid Programs and improving care transitions Overview of Medicaid Affordability Care Act Provisions and care transitions

2. Top 5% in Medicaid Expenditures Source: CMS Analysis of MSIS data FY2008

3. CMS Medicaid Programs • States’ community long term care (LTC) programs provide home and community based services for Medicaid eligible individuals including case management and an array of supports • Most 1915c waiver programs offer transition services

4. Medicaid Affordable Care Act (ACA): Care TransitionsSection 2703: Health Homes for Individuals with Chronic Conditions • States are able to offer health home services for individuals with multiple chronic conditions or serious mental illness effective January 1, 2011 • Coordinated, person-centered care • Primary, acute, behavioral, long term care, social services = whole person • Enhanced FMAP (90%) is available for the health home services (first 8 quarters)

5. Medicaid ACA: Care Transitions Section 2703: Health Homes for Individuals with Chronic Conditions (cont’d.) • Medicaid eligible with: 2 or more chronic conditions, or I conditions with risk of developing another, or 1 serious and persistent mental illness conditions • Chronic conditions in statute: mental illness, substance abuse, asthma, diabetes, heart disease, obesity (BMI above 25) • States can add other chronic conditions their State plan for review and approval by CMS

6. Medicaid ACA: Care Transitions Section 2703: Health Homes for Individuals with Chronic Conditions (cont’d.) Implementation Status • Draft Health Home State Plan Amendments have been submitted by 6 States (Missouri, Rhode Island, North Carolina, Iowa, New York, Utah). We anticipate online submission soon! •  The Web based SPA application can be accessed at the following address: http://trpharma.com/CMSDAT/Account.aspx/Login • Refer to the December 22, 2010 Informational Bulletin for more information on the Web based SPA application.

7. Medicaid ACA: Care Transitions Section 2401: Community First Choice Option • Adds Section 1915(k) • Optional State Plan benefit to offer Attendant Care and related supports in community settings, providing opportunities for self-direction • Does not require institutional LOC under 150% FPL • Includes 6% enhanced FMAP

8. Medicaid ACA: Care Transitions Section 2401: Community First Choice Option (cont’d) Implementation status • Notice of Proposed Rulemaking published February 25, 2011 – Comment period closed April 26, 2011 • Final regulation targeted for early Fall • Community First Choice State plan Option is effective October 1, 2011

9. Medicaid ACA: Care Transitions Section 2403: Money Follows the Person • Now extends through 2019-transitions individuals from institutions to community based care and adds resources to balance LTC • Enhanced Federal match for community services for first year following transition from facility • 43 States and the District of Columbia now participating in the demonstration

10. Medicaid ACA: Care Transitions Section 10202: Balancing Incentive Payments Program • Designed to help states balance their system of long-term services and supports (LTSS) • $3B awarded through increased Federal matching payments of 2% or 5% to States that: • Currently spend less than 50% or less than 25% of long-term care budgets on home and community-based services (HCBS)

11. Medicaid ACA: Care Transitions Section 10202: Balancing Incentive Payments Program • Participating States must commit to three structural changes: • Implement a No Wrong Door/Single Entry Point system • Use a Core Standardized Assessment Instrument • Implement Conflict Free Case Management standards

12. Medicaid ACA: Care Transitions Section 10202: Balancing Incentive Payments Program Implementation Status • Release anticipated within the next couple of months • Enhanced FMAP begins effective October 1, 2011

13. Affordable Care Act: Care TransitionsSection 2701: Adult Health Quality Measures • Development of core set of quality measures for adults eligible for Medicaid. • Establishment of a Medicaid Quality Measurement Program

14. Provisions of The Affordable Care Act: Provisions to Improve Care Coordination for Medicare-Medicaid Enrollees Subtitle H – Improved Coordination for Medicare-Medicaid Enrollees Section 2601 – 5-year period for Medicaid waivers for Medicare-Medicaid enrollees Section 2602 –Establishes Federal Coordinated Health Care Office to: • Ensure Medicare-Medicaid enrollees have full access to the services to which they are entitled. • Improve the coordination between the federal government and states. • Develop innovative care coordination and integration models. • Eliminate financial misalignments that lead to poor quality and cost shifting.

15. ACA Provisions to Improve Care Coordination for Medicare-Medicaid Enrollees • Federal Coordinated Health Care Office established, known as the Medicare-Medicaid Coordination Office. • The Medicare-Medicaid Coordination Office is working on a variety of initiatives to improve access, coordination and cost of care for Medicare-Medicaid enrollees in the following areas: • Program Alignment (29 misalignments Federal Register-public notice for comments closed 7/11/11) • Data and Analytics • Models and Demonstrations (through partnership with the Innovation Center) • More information at: http://www.cms.gov/medicare-medicaid-coordination/

16. ACA Provisions to Improve Care Coordination for Medicare-Medicaid Enrollees Implementation Status • 15 states-Planning Grants designing new integrated care models for serving Medicare-Medicaid enrollees. Each received up to $1 million (related to State Plan- Health Homes CMS will facilitate coordination). • Providing all State Medicare data for care coordination, including timely availability of Parts A, B, and D data (announced in May-2 State, historical and going forward). • Implementing initiative to align financing of Medicare and Medicaid (announced in State Medicaid Director letter on July 8, 2011) either 3 way agreement blended capitated rate (acute and community care) or managed fee for service (reimbursement method). • Developing a demonstration (contract RFP will be released-in Fall) to reduce potentially avoidable hospitalizations and improve quality of life among nursing home residents-focus on NH residents-entities-additional clinical staff to avoid hospitalizations announced Friday July 8. ( use evidence based model and test).

17. Additional Information CMS: Community Services and Long-Term Supports • http://www.cms.gov/CommunityServices/01_Overview.asp#TopOfPage State Medicaid Director Letters • http://www.cms.gov/SMDL/SMD/list.asp#TopOfPage MFP Technical Assistance Website • http://mfp-tac.com/