To: CEOs, CMOs, and government relations staff
Please forward as appropriate to ambulatory medical group leaders and clinical administrators
From: Chelene Whiteaker, Policy Director
Claudia Sanders, Senior Vice President, Policy Development
Staff Contact: Chelene Whiteaker at chelenew@wsha.org or 206-216-2545
Subject: HCA Releases Information on Initial Demonstration Dollar Amounts
Purpose
The purpose of this bulletin is to make you aware of recent developments on the Medicaid demonstration waiver. Recently, the Health Care Authority’s technical advisory consultant, Manatt, released information on the magnitude of dollars available through this work. In year one of the demonstration, which starts in December 2017, there is up to $138 million statewide available for transformation activities, pending CMS’ approval. The majority of these dollars will go to providers who participate in projects.
ACHs are in the process of making decisions now on what projects to pursue in the demonstration. Many ACHs are also forming project-level committees. If your hospital or health system is interested in participating in the demonstration projects, we strongly encourage your staff to be involved in those ACH discussions.
Funding Available for ACHs
An ACH’s total demonstration dollars are based on Medicaid enrollment and the number of projects selected. Below is Manatt’s recently released information on the scale of dollars available to ACHs. These are the preliminary allocation amounts pending CMS approval. While these amounts will change depending on the final projects selected, it is important to understand the opportunity available.
HCA is requiring all ACHs to submit two specific projects: bidirectional behavioral health clinical integration and addressing opioid use. ACHs must also select at least two other projects but may select up to six other projects. Each project has a weight, that will be used in determining the amount of funds allocated to it. Behavioral health integration is the most heavily weighted of the ACH projects at 32 percent.
Important Considerations
More information is coming out each week about the demonstration work and there are still a lot of unanswered questions. Some important considerations, include:
- Right now, it is unclear if providers do not participate in year one, if they can join the demonstration work at a later date;
- This is not a grant. While participation and dollars will flow based on process measures initially, achieving outcomes will be important. Even if your organization has already implemented some of this transformation, you still may be eligible for dollars based on process and outcomes for the Medicaid population.
- Once an application by the ACH is made, it is unclear if major changes to projects will be able to be made. It’s important that your voice is heard during the process; and
- Understand at what point your ACH will be asking for a letter of commitment for projects.
Background
ACH project applications are due to the Health Care Authority on October 23. The application will include all of the final selected projects, as well as a list of participating providers. Projects will be judged in part by the engagement of the providers in the region. Year one of the demonstration’s funding will be released to ACHs in December 2017 for distribution to providers at some time in 2018. Please keep in mind, the ACHs will not physically be receiving the dollars but they will flow through a financial executor to participating providers.
The nine ACHs are confronted with two decision points in completing the application: 1) what projects should the ACH pursue. Four are required, but should they select more; 2) what are the main elements of the project and what providers will be participating in the work. Many ACHs will be making final project selections in July.
The nine ACHs are each setting up project-level committees or groups, separate from the ACH governing board, to discuss, design and make recommendations on projects. If your hospital and health system wants to be involved in this effort, it is important to be engaged in the design process.
For more information from Manatt about the distribution of demonstration dollars, please click here. The Centers for Medicare and Medicaid Services will also need to approve the final funding distribution model for the demonstration.
WSHA Work
To assist in the project-level discussions, WSHA is working to create two sample projects: one on behavioral health integration into primary care and the other on what hospitals and health systems can do to address the opioid crisis. Our goal is to help standardize the projects across ACH boundaries in hope that patients seeing providers in multiple regions will experience care in a similar fashion. We expect these sample projects to be available in the next few weeks.
ACH Information on Activities
Each ACH has provided WSHA with information about their timelines and project committees or groups. If you would like to know more about how to engage in these discussions with your ACH, please click here. Please do not hesitate to contact your ACH’s executive director if you have questions. Click here for the map of the ACH regions.
