California Mental Health System Delivery by mikeholy


									California’s “Bridge to Health
Care Reform” 1115b Waiver

      Monthly All Directors Meeting
          December 9, 2010
            The 1115b Waiver
• The new waiver:

  ▫ California has received approval for a new 5-year
    waiver as a bridge to federal reform

  ▫ The new waiver began in November and will be
    implemented over the course of 2011 and throughout
    the demonstration period

  ▫ If savings are achieved & milestones met, may bring
    $10B new federal funds to support expanded coverage,
    access to care, improvements in health care delivery
 Key Programmatic Elements

• Expand coverage to more uninsured
• Support uncompensated care costs;
• Improve care coordination for vulnerable
  populations; and
• Promote public hospital delivery system
  Low Income Health Program
• Low Income Health Program (LIHP) – two
   – Medicaid Coverage Expansion (MCE)
     •   Up to 133% FPL
     •   Mental Health Minimum Benefit Required
     •   FFP not capped
     •   May be CPE or capitated
  – Health Care Coverage Initiative (HCCI)
     •   134% to 200% FPL
     •   Mental Health Minimum Benefit Not Required
     •   FFP is capped – county will get an allocation
     •   Financed through IGT
       Implementation Timeline
• Jan 1 - Current HCCI counties to indicate if
  intent to participate
• Jan 3 – DHCS to release application forms
  and process
  • Application conferences north (Jan 20 Sac) and
    south (TBD)
• Jan 10 – Last day to submit questions
• Jan 10 – Letters of Intent due to DHCS
• Jan 17 – Answers to questions posted
       Implementation Timelines
• Feb 3 – Applications Due
  • Can come in later BUT remaining HCCI funds may
    be limited
• April 3 – Approve/Deny Application
• April 13 – Counties respond if denied
• May 3 – DHCS responds to denied counties
• May 17/20 - HCCI county allocations provided
• June 1 – Plans implement
Note: existing HCCI counties may go earlier;
retroactive payments up to 3 months
            Minimum Benefit
• County establishes minimum mental
  health (at least the required) and
  substance use disorder benefit
  – Must be available to all
  – Cannot provide differential benefit for specific
  – May refer to specialty mental health system
    (county system) and remain a part of MCE or
    HCCI for general health care
              Dual Eligibles
• Dual Eligible Integration
  – Next steps:
     • Understand innovation opportunities
       offered by CMS
     • Continue local discussions of options
     • Develop detailed proposal
     • Pursue waiver amendments
• Pursuant to SB 208
             Dual Eligibles
• 2011 – Work w CMS Center for Medicare
  & Medicaid Innovation & CA stakeholders
  – Draft RFI
  – Revise proposal
  – Draft RFP
• 2012 - Counties to submit proposals, pilots
  selected, pilots begin
  – At least 1) one 2 plan model county and 2)
    one county organized health system county
    The Safety Net Care Pool
• Funding is comprised of four components:
  – 1. Uncompensated Care Pool: partial funding
    to public hospitals for uncompensated care
  – 2. Approved State Health Programs: federal
    funding up to $400 million annually
    • County mental health; Developmental services;
  – 3. Health Care Coverage Initiative
           The Safety Net Care Pool
• Delivery System Reform Incentive Pool (DSRIP)
  – $3.3B federal funds over 5 years for public hospitals
  – Ties federal funding to milestones in care delivery
  – Available for work in four areas:
     • Infrastructure Development
     • Innovation and Redesign
     • Population Focused Improvement
     • Urgent Improvement in Care
   Managed Care for Seniors and Persons
           with Disabilities (SPDs)
• Plan to move Medi-Cal enrollees who are
  Seniors or Persons with Disabilities
  (SPDs) into mandatory managed care
  – Goal to provide more coordinated care and
    contain costs.
  – State must meet specific requirements in
    order for this transition to managed care to
    take place.
• Review of data A MUST for % of SMI
                  Budget Neutrality
• Justification for additional federal funds for:
   – Safety Net Care Pool
   – Low Income Health Program – Health Care Coverage
• Based on two elements
   – Inclusion of managed care under the waiver
   – Consideration of unexpended room in Public Hospital
     Upper Payment Limit

                 Service - Accountability - Innovation     13
            Two Next Steps
• Want to come late to the Jarvis Financial
  Planning Tool party? Still possible

• Readiness Assessment
  – Reviewing for California issues
  – Counties to complete
     • Help you
     • Help CiMH

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