PowerPoint Presentation

2013 Legislative Wrap Up Insurance Exchange and Medicaid ExpansionMedicaid Program Changes

Larry TisdaleVice-President of Finance , IHA

Legislative Wrap Up

2HB 17: Board of Pharmacy Recodification (Law)HB 98: Indigent Statute Amendments (Law)HB 109: Board of Pharmacy Diversity (Law)HB 188: Authentication of Physician Orders (Law)HB 190: Health Provider Truth in Advertising (House H&W Failed)HB 268: Minors Tanning Beds (House Failed)HB 291: Mental Health Holds for Minors (Law)HB 292: Assault and Battery on Healthcare Workers (Senate Failed by 1)HB 308: Repeal of Medical Indigent/CAT Fund (Not Formally Heard)HB 315: Personal Property Tax Repeal (Law)HCR 10: Time-sensitive Emergency Care System (Adopted)SB 1063: Medical Consent/Natural Death Act Amendments (Law)SB 1115: Radiologic Imaging and Radiation Therapy Licensure (Not Heard)

PPACA Initiatives

3State Based Insurance Exchange (HB248)

Medicaid Expansion (HB309)

State Based Insurance Exchange

4Governors Insurance Exchange Work Group

Broad Based Coalition Including Multiple Associations

Focal Issue is Local Control and Risk Pool

Political Environment became Toxic

Bill passed and Signed into Law

Medicaid Expansion

5Governors Medicaid Expansion Work Group

Broad Based Coalition Including Multiple Associations

Financial Cost of Not Expanding

Economic Cost of Not expanding

Bill was Printed but Not Heard in Committee

Governors Medicaid Work Group

6The work group unanimously recommended that Idaho expand its Medicaid program in a manner that provided more efficiency and participant accountability

The work group included three legislators, multiple association representatives, representatives from the Department of Health and Welfare and others

Broad Based Coalition Support

7IHA participated in a broad based coalition to support the expansion of the Medicaid program in Idaho.

The coalition included IHA, IMA, Chambers of Commerce and Others

Financial Cost of Not Expanding Medicaid

8Ten year cost of Mandatory Medicaid Coverage is $394 Million*

State and local savings if Idaho were to expand Medicaid to 138% of FPL would be $403.9 Million* over ten years.

Expanding the Medicaid program would more than offset the cost of the mandatory expansion of the Medicaid program.

* Milliman Client Report: Impact of PPACA On the Medicaid Budget Including state and Local Cost offsets

Economic Cost of Not Expanding

9The Milliman Client Report was provided to Professor Steven Peterson, of the University of Idaho, to project the economic effects of Medicaid Expansion using the 2010 IMPLAN model for the State of Idaho.Federal funding for expanded Medicaid program represents new money entering the Idaho economy.$985.5 Million* for mandatory and $8.2 Billion* for optional expansion in new federal funds/money. When new money enters into an economy it creates jobs as well as state and local tax revenue.10

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14Medicaid Expansion Will Continue to be IHAs Top Legislative Priority

Medicaid Program Changes

15Medicaid Patient-centered Medical Homes (PCMH)This is part of the governors Multi-Payer Medical Home Collaborative. IHA is a member of the Collaborative.

Medicaid Community Care Networks (CCN)This is a provider based network approach to Medicaid managed care. It is part of Idahos State Multi-Payer Innovation Model (SIM) grant project from CMS.

Medicaid Patient Centered Medical Homes

16In 2010 Governor Otter Established the Multi-Payer Medical Home Collaborative to create a more coordinated approach to care for patient with certain chronic conditions and at least one of the identified risk factors.Chronic Conditions:Diabetes type 1&2AsthmaMental IllnessRisk Factors: Hypertension, Dyslipidemia, Tobacco Use, BMI>25, Coronary Arterial Disease, Disease of the Respiratory System

PCMH Enhanced Payment

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For patients that qualify under the program, PCMH practices/clinics will be paid $15 per month by Medicaid instead of the lower Healthy Connections fee. Private insurance payment will vary.

The additional payment is intended to cover the cost of care coordination and the attainment of NCQA medical home recognition.

Currently Medicaid, Blue Cross, Blue shield and Pacific source are participating in the pilot program that began in January.

Medicaid Community Care Networks (CCN)

18The 2011 Legislature declared that Medicaid was unsustainable.

Passed House Bill 260 mandating a move to managed care.Improve current healthcare delivery systemInstitute gain sharing, risk sharing or capitationIncrease participant accountability

Joint Managed Care Forum.19In December of 2011 The Department of Health and Welfare jointly hosted a forum on managed care.

Joint participant were the Department, IHA, IMA and IPCAIHA hired a consultant to explore alternatives to traditional MCO modelsProvider-based managed care was presented as an alternative MCOs

NASHP/North Carolina Grant

20Shortly after the joint health care forum, NASHP solicited grant application for a State Learning Transformation opportunity based on the experience of the Community Care North Carolina Program.

A coalition from Idaho applied for the grant and was selected to participate.

After a visit to North Carolina the coalition decided to pursue an adaptation of their CCN Model.

CMS/CMMI SIM Grant

21The coalition developed an application for Governor Otter to apply for a State Innovation Model (SIM) Grant offered by CMS Center for Medicare and Medicaid Innovation.

The state was awarded $3 million for the purpose of designing the CCN managed care delivery system for Idaho.

The grant was for a multi-payer design which put the coalition better in line wit the Governors multi-payer medical home initiative which would be leveraged by the CCN model.

CCN SIM Project Organization

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CCN SIM Project Roles & Responsibilities

CCN Project Timeline

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25QUESTIONS?ROLES

APRIL 2013

MAY 2013

JUNE2013

JULY 2013

AUGUST2013

SEPTEMBER 2013

RESPONSIBILITIES AND TIMELINE

Idaho Medical Home Collaborative

Integrated Delivery System Advisory Grp

Project Staff

Consulting Company

Stakeholder Work Groups

Medicaid Administra-tion

Meets monthly to provide decision making as needed to engage stakeholders and develop plan. Identifies Work Group Stakeholders.

Advises on Plan Draft

Endorses Plan

Meets regularly to review overall progress, and work on the public policy aspect of the plan. The group reports on progress to the Stakeholder Advisory group and initiates key discussion around decisions.

Meet Weekly to study their assigned topic, analyze data from the focus groups and subject matter experts, and make recommendations.

Endorses Plan

Project Manager prepares Consulting Request for Proposals

Hires Consultant, Business Analyst and Administrative Assistant.

Project Manager monitors consulting contract, project timeline and deliverables.Business Analyst consults with agency about integration of proposed operational changes.

Conducts comprehensive needs assessment as guided by stakeholders. Facilitates regular work group meetings. Conducts regional focus groups. Drafts the plan.

Responds to RFP

Stakeholder Work Groups are formed.

Oversees staff and administers the grant.

Stakeholders

Consultants

State Staff

State Administration

Revises Plan Until it Receives Endorsement

Advises on Plan Draft

Advises on Plan Draft

Advises on Plan Draft

Endorses Plan

Submits Final Plan to State

Submits Plan To CMI