Medicaid Reform Introduction

1. Medicaid Reform Introduction Leading Age Wyoming Conference May 23, 2013 Jesse Springer Special Projects Manager Wyoming Medicaid

2. Option Studies • Last year, the Wyoming Department of Health conducted three options studies at the direction of the Legislature. • The Joint Labor Health Social Services committee used the studies as a basis for committee sponsored legislation in the 2013 session

3. Senate Enrolled Act 82, 2013 • Section a (i)- Reforms impacting health care services, including a study of managed care • Potentially of interest to nursing homes: Incentives to providers for outcomes, health homes, decreased use of emergency rooms for nonemergency care

4. Senate Enrolled Act 82, 2013 • Section a (ii)- Long term care services reforms • A- Development of an assessment tool to replace the “Assessment of Medical Necessity for Long Term Care” required by W.S. 42-6-102 • B- Redesign of nursing facility reimbursements to reflect patient acuity, percentage of Medicaid occupancy and regional economic factors • C- Elimination of caps on LTC and ALF waivers to the extent practical

5. Senate Enrolled Act 82, 2013 • Section a (iii)- Reforms impacting developmental disability and acquired brain injury waiver services

6. Current Evaluation Tool and Process Section a(ii) • Referred to as the LT-101 • 4 page questionnaire based on medical necessity, welfare and safety • Assessment administered by a Public Health Nurse • Determination and notification by a Public Health Nurse

7. Current NF Reimbursement Section a(ii) • Cost based • Components for property, operating and healthcare • Each component has a max or cap • Rate is based on lower of private pay rate, cost based rate or a “max rate” based on historical rates • 31 nursing homes are at “max rate” • Rates have been frozen by Wyoming Legislature since 2009

8. Current Long-Term Care and Assisted Living Facility WaiverSection a(ii) • Were capped legislatively at certain levels • When caps were reached, legislation and application to CMS needed to be coordinated

9. Current Activity to Prepare for Project Kick-Off • Conduct research on expected trends • Conduct Research on major issues impacting segments of the industry serving long-term care needs • Surveys of major groups • Surveys of individual facilities • Facilitated discussions with major groups

10. Reform Kick-Off • The Wyoming Department of Health will host a full-day kick-off meeting with invitees from nursing homes, long-term care waiver providers, the Division on Aging, the Office of Healthcare Licensing and Survey, Assisted Living Facilities, legislators, Governor’s Office, Wyoming Senior Services Board, and other interested parties. • August 2013 in Cheyenne

11. Reform Road Map • The goal of the Kick Off Meeting is to create a “Road Map” or project plan for the LTC Reform • Create four sub-groups to be the drivers of redesign. These groups willmeet more often and will report progress back to larger group at each quarterly meeting. • LT 101 Redesign • Reimbursement Redesign • Eliminating Barriers to HCBS Services • Overall Vision and Strategic Plan

12. Reform Road Map • The Division of Healthcare Financing (Medicaid) is available to meet with associations and other groups throughout the reform process in addition to regular quarterly meetings • Following the Kick Off Meeting, quarterly meetings of the larger group will be held around the state with a call-in number for those that are unable to attend in person.

13. Questions? • Public Knowledge has been retained to assist the Division of Healthcare Financing during this process and will lead a facilitated discussion for the next hour and 30 minutes.