Healthier WA Draft Project Toolkit Released – $1.1 billion in Medicaid Transformation Funds Available

November 28, 2016

To: CEOs and Administrators; Government Affairs Staff
From: Chelene Whiteaker, Policy Director
Claudia Sanders, Senior Vice President
Staff contact: Chelene Whiteaker, or 206-216-2545

The purpose of this bulletin is to share with hospitals and health systems the pre-draft toolkit for the Medicaid waiver transformation projects. Once final, the toolkit will guide the work of global waiver in the nine Accountable Communities of Health (ACH) regions over the next five years. Up to $1.1 billion in funding will be available for providers interested in participating in the identified projects, with funding released when project milestones are achieved.

Based on the pre-draft toolkit, each of the ACHs are required to develop three specified projects and, in addition, can pick from a small menu of optional projects. Hospitals and health systems will be critical participants in the required and optional projects of the regions.

WSHA was very vocal with the Washington State Health Care Authority (HCA) in the global waiver development discussions, especially in advocating for an emphasis on behavioral health, as well as for a more limited set of projects. We expressed our concern that if work was too scattered, there would be no sustainable change at the end of the demonstration.  We are pleased to see the HCA has provided a focused menu of work and that the three required projects are aimed at improving behavioral health.

HCA does not believe the outcome of the recent election will impact the state’s Medicaid transformation waiver, since the agency anticipates details will be finalized before the change in administrations. Over the next month, HCA will continue to negotiate with the Centers for Medicare and Medicaid Services (CMS) on the final details of the global waiver and the project toolkit. That said, we do not think this draft toolkit will be changing significantly moving forward. The toolkit should be finalized shortly after a public comment period in mid-December and project protocols will then be finalized within the next two or three months. Click here for more information about HCA’s waiver timeline.

Begin thinking about whether and how your organization would like to participate in the three required projects and what optional projects you would like to work on. The waiver demonstration will likely start shortly after the New Year and will be moving extremely fast. Participation in the projects developed by the ACHs is voluntary.  The opportunity for providers is that there will be new dollars to incentivize providers to participate and make meaningful changes to improve health outcomes.

ACH staff and board members will be critical decision makers moving forward on the global waiver work. At a governance level, each ACH will need to have a process in place for suggesting the projects to undertake in their region and for forwarding these suggestions on to the state for approval.   The ACH must have a process for evaluating local provider applications and contracting with providers on the required and selected project domains.

Next Steps
The public comment period for the toolkit will start on December 15. The toolkit will be finalized shortly after agreement between HCA and CMS on the specific terms and conditions of the waiver.  At that point, the global waiver demonstration year one period will begin. WSHA expects the ACH project selection and contracting process with local providers to happen quickly in the spring of 2017.

WSHA will share the final project toolkit when it is available.

In September 2016, HCA announced that it had reached an “agreement in principle” with CMS to draw down $1.5 billion in funds to transform Medicaid in Washington State. The overall initiatives of transformation activity include: 1) transformation projects through ACHs; 2) improved supports for people needing long-term services; 3) supported housing and employment services. Most of the dollars, up to $1.1 billion, will flow through initiative one and the ACHs.

HCA has released a pre-draft toolkit for the ACH work in initiative one and will be submitting the toolkit to CMS for approval. The project toolkit contains three required projects and five optional projects. These projects fall into two areas (care delivery redesign and prevention and health promotion). Each project has specific target populations and outcome metrics intended to be used to track performance.

Required projects include:

  • Bi-Directional integration of care and primary care transformation (Project 2A);
  • Community-based care coordination for high needs populations (Project 2B); and
  • Addressing the opioid use public health crisis (Project 3D).

Optional projects include:

  • Transitional care to eliminate avoidable admissions or readmissions (Project 2C);
  • Diversion interventions away from high-cost medical and legal settings (Project 2D);
  • Chronic disease prevention and control (Project 3A);
  • Maternal and child health services (Project 3B);
  • Access to oral health services (Project 3C).

Funding will also be provided at a statewide level for health and community systems building capacity. This will be used to enhance value based payment, support workforce transformation, and expand systems for population health management.

Background and References
For more information, visit the HCA website.


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