PROGRAM DESCRIPTION AND OBJECTIVES. On August 6, 2012, the State of Kansas submitted a Medicaid section 1115 demonstration proposal, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home and Community-Based Services (HCBS) waivers and together provides the authority necessary for the state to require enrollment of almost all Medicaid beneficiaries (including the aged, disabled, and some dual eligibles) across the state into a managed care delivery system to receive state plan and HCBS waiver services. This represents an expansion of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, and to provide incentives to hospitals for programs that result in delivery system reforms that enhance access to health care and improve the quality of care. This five year demonstration will: • Maintain Medicaid state plan eligibility; • Maintain Medicaid state plan benefits; • Allow the state to require eligible individuals to enroll in managed care organizations (MCOs) to receive covered benefits through such MCOs, including individuals on HCBS waivers, except: o American Indian/Alaska Natives will be presumptively enrolled in KanCare but will have the option of affirmatively opting-out of managed care. • Provide benefits, including long-term services and supports (LTSS) and HCBS, via managed care; and • Create a Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsured. The KanCare demonstration will assist the state in its goals to: • Provide integration and coordination of care across the whole spectrum of health to include physical health, behavioral health, mental health, substance use disorders and LTSS. • Improve the quality of care Kansas Medicaid beneficiaries receive through integrated care coordination and financial incentives paid for performance (quality and outcomes); • Control Medicaid costs by emphasizing health, wellness, prevention and early detection as well as integration and coordination of care; and • Establish long-lasting reforms that sustain the improvements in quality of health and wellness for Kansas Medicaid beneficiaries and provide a...
PROGRAM DESCRIPTION AND OBJECTIVES. The state‟s goal in implementing the Partnership Plan section 1115(a) Demonstration is to improve access to health services and outcomes for low-income New Yorkers by: • Improving access to health care for the Medicaid population; • Improving the quality of health services delivered; • Expanding access to family planning services; and • Expanding coverage with resources generated through managed care efficiencies to additional low-income New Yorkers. The Demonstration is designed to use a managed care delivery system to deliver benefits to Medicaid recipients, create efficiencies in the Medicaid program, and enable the extension of coverage to certain individuals who would otherwise be without health insurance. It was approved in 1997 to enroll most Medicaid recipients into managed care organizations (MCOs) (Medicaid managed care program). As part of the Demonstration‟s renewal in 2006, authority to require the disabled and aged populations to enroll in mandatory managed care was transferred to a new demonstration, the Federal-State Health Reform Partnership (F-SHRP). In 2001, the Family Health Plus (FHPlus) program was implemented as an amendment to the Demonstration, providing comprehensive health coverage to low-income uninsured adults, with and without dependent children, who have income greater than Medicaid state plan eligibility standards. FHPlus was further amended in 2007 to implement an employer-sponsored health insurance (ESHI) component. Individuals eligible for FHPlus who have access to cost-effective ESHI are required to enroll in that coverage, with FHPlus providing any wrap-around services necessary to ensure that enrollees get all FHPlus benefits. During this extension period, the state will expand Family Health Plus eligibility for low-income adults with children. In 2002, the Demonstration was expanded to incorporate a family planning benefit under which family planning and family planning-related services are provided to women losing Medicaid eligibility and to certain other adults of childbearing age (family planning expansion program). In 2010, the Home and Community-Based Services Expansion Program (HCBS expansion program) was added to the Demonstration. It provides cost-effective home and community-based services to certain adults with significant medical needs as an alternative to institutional care in a nursing facility. The benefits and program structure mirrors those of existing section 1915(c) waiver programs, and strives to pr...
PROGRAM DESCRIPTION AND OBJECTIVES. The Principal Recipient shall implement the Program as described in the “Program Implementation Description” included as Annex A of this Agreement. The “Performance Framework(s)” attached to Annex A of this Agreement set forth the main objectives of the Program, key indicators, intended results, targets and reporting periods of the Program. Unless otherwise indicated, the targets set forth in the Performance Framework(s) attached to Annex A of this Agreement are cumulative and do not include the baseline values.
PROGRAM DESCRIPTION AND OBJECTIVES. Minnesota’s section 1115 PMAP+ demonstration was initially approved and implemented in July 1995. Minnesota was one of the early States to use health care reform waivers to cover uninsured populations. The PMAP+ demonstration provides health care services through a prepaid, capitated managed care delivery model that operates statewide for both MinnesotaCare Program eligibles and Medicaid State plan groups. The goal of Minnesota’s health care reform effort is to provide organized and coordinated health care that includes pre-established provider networks and payment arrangements, administrative and clinical systems for utilization review, quality improvement, patient and provider services, and management of health services. The Demonstration affects coverage for certain specified mandatory State plan eligibles, and the Demonstration also expands coverage to those that would not traditionally qualify for Medicaid, such as higher income parents/caretaker adults.
PROGRAM DESCRIPTION AND OBJECTIVES. This section 1115(a) demonstration provides authority for the state to offer two distinct health care coverage benefit packages to specified populations. The Hoosier Healthwise (HHW) Program supplements state plan benefits for Medicaid eligible children and those otherwise eligible adults who are not aged, blind or disabled. The HIP provides health care coverage for uninsured adults not otherwise eligible for Medicaid through a high deductible managed care health plan and an account styled like a health savings account called a Personal Wellness and Responsibility (POWER) Account. Separate from this demonstration, Indiana offers the Indiana Select Program which includes case management services to supplement state plan benefits offered through Medicaid Select managed care programs for current Medicaid eligible adults who are aged, blind or disabled. Hoosier Healthwise Program Indiana began the Hoosier Healthwise program in 1994, when it initially mandated managed care enrollment for all section 1931 children and adults through a waiver granted by the Secretary under the authority of section 1915(b) of the Social Security Act (the Act). By July 1997, the program was implemented statewide using a combination of managed care organizations (MCOs) and a Primary Care Case Management (PCCM) delivery system. Effective December 2005, all Hoosier Healthwise enrollees are served exclusively by MCOs. Effective January 1, 2008, the authority for the Hoosier Healthwise program was provided solely through this demonstration. Healthy Indiana Plan (HIP) The HIP provides a high-deductible health plan and an account styled like a health savings account called a POWER Account to uninsured adults including low-income custodial parents and caretaker relatives of Medicaid and Children’s Health Insurance program (CHIP) children and uninsured non-custodial parents and childless adults. Participation in HIP is voluntary, but all enrollees will be required to receive medical care through the high deductible health plans and POWER Accounts. Enrollees must also make specified contributions to their POWER Accounts as a condition of continued enrollment. These accounts will be used by enrollees to pay for the cost of health care services until the deductible is reached; however, preventive services up to a maximum amount will be exempt from this requirement. Once the deductible has been met, the health plan will provide coverage for medical services up to an annual maximum amount. Eligi...
PROGRAM DESCRIPTION AND OBJECTIVES. The Georgia P4HB section 1115(a) Medicaid Demonstration expands the provision of family planning (FP) services to uninsured women, ages 18 through 44, who have family income at or below 200 percent of the Federal poverty level (FPL), and who are not otherwise eligible for Medicaid or the Children’s Health Insurance Program (CHIP). In addition, the Demonstration provides Interpregnancy Care (IPC) services to women who meet the same eligibility requirements above and who deliver a very low birth weight (VLBW) baby (less than 1,500 grams or 3 pounds, 5 ounces) on or after January 1, 2011. WellCare Contract #0654 Women, ages 18 through 44, who have family income at or below 200 percent of the FPL, who deliver a VLBW baby on or after January 1, 2011, and who qualify under the Low Income Medicaid Class of Assistance, or the Aged Blind and Disabled Classes of Assistance, under the Georgia Medicaid State plan are also eligible for the Resource Mothers Outreach component of the IPC services which are not otherwise available under the Georgia Medicaid State plan. Under this Demonstration, Georgia expects to achieve the following to promote the objectives of title XIX: · Reduce Georgia’s low birth weight (LBW) and VLBW rates; · Reduce the number of unintended pregnancies in Georgia; · Reduce Georgia’s Medicaid costs by reducing the number of unintended pregnancies by women who otherwise would be eligible for Medicaid pregnancy-related services; · Provide access to IPC health services for eligible women who have previously delivered a VLBW baby; and · Increase child spacing intervals through effective contraceptive use.
PROGRAM DESCRIPTION AND OBJECTIVES. This demonstration had its origins in an earlier demonstration, the Partnership Plan that sought to improve the economy, efficiency, and quality of care by requiring families and children to enroll in managed care entities to receive services. This mandatory managed care is known as Mandatory Mainstream Managed Care (MMMC). The Partnership Plan demonstration is ongoing, but MMMC enrollees in 14 counties are now included instead in this demonstration. New York also has authority under this demonstration to expand MMMC to elderly and disabled populations. In 2004, the state was presented with significant reform opportunities including the aging of New York’s population, the continued shift in care from institutional to outpatient settings, and the quality and efficiency advantages that are available through health information technology. The state created the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) capital grant program in that year to invest an anticipated $1 billion over a four-year period, to effectively reform and reconfigure New York’s health care delivery system to achieve improvements in patient care and increased efficiency of operation. In 2005, the state asked the federal government to partner with its HEAL NY initiative to implement reform projects that would improve the quality of care and result in long-term savings for both the state and federal government. This demonstration was approved for an initial 5-year period beginning October 1, 2006; under that demonstration authority, the state committed to pursue the following reform initiatives: • Rightsizing Acute Care Infrastructure. New York’s acute care infrastructure is outdated and oversized, while the facilities are highly leveraged with debt. The inexorable migration of health care services to the outpatient setting has added to the significant excess capacity that exists in the state, estimated at over 19,000 beds. As a result, state law was enacted in 2005 establishing the Commission on Health Care Facilities in the 21st Century (Commission) which is charged with recommending reconfiguration measures, including downsizing, restructuring, and/or facility closures. Such measures will reduce future Medicaid inpatient hospital costs.
PROGRAM DESCRIPTION AND OBJECTIVES. In this extension of the demonstration, the Commonwealth and CMS have agreed to implement major new demonstration components to support a value-based restructuring of MassHealth’s health care delivery and payment system, including a new Accountable Care Organization (ACO) initiative and Delivery System Reform Incentive Program (DSRIP) to transition the Massachusetts delivery system into accountable care models. The Safety Net Care Pool (SNCP) has been redesigned to align SNCP funding with MassHealth’s broader accountable care strategies and expectations and to establish a more sustainable structure for necessary and ongoing funding support to safety net providers. During the new extension period approved for state fiscal year (SFY) 2018-2022, the goals of the demonstration are:
PROGRAM DESCRIPTION AND OBJECTIVES. In January 2004, the Adult Benefits Waiver (ABW) was initially approved and implemented as a title XXI funded section 1115 Demonstration. The ABW provides a limited ambulatory benefit package to previously uninsured, low-income non-pregnant childless adults ages 19 through 64 years with incomes at or below 35 percent of the Federal poverty level (FPL) who are not eligible for Medicaid. The ABW services are provided to beneficiaries through a managed healthcare delivery system utilizing a network of county administered health plans (CHPs) and Public Mental Health and Substance Abuse provider network. The programmatic goals for the ABW Demonstration include: • Improve access to healthcare; • Improve the quality of healthcare services delivered; • Reduce uncompensated care; • Encourage individuals to seek preventive care and choose a healthy lifestyle; and • Encourage quality, continuity, and appropriate medical care.
PROGRAM DESCRIPTION AND OBJECTIVES. The DSHP section 1115(a) demonstration is designed to use a managed care delivery system to create efficiencies in the Medicaid program and enable the extension of coverage to certain individuals who would otherwise be without health insurance. The initial demonstration was approved in 1995 to mandatorily enroll most Medicaid recipients into managed care organizations (MCOs) beginning January 1, 1996. Using savings achieved under managed care, Delaware expanded Medicaid health coverage to uninsured Delawareans with incomes up to 100 percent of the federal poverty level (FPL) and provides family planning coverage to women losing Medicaid pregnancy coverage at the end of 60 days postpartum or losing DSHP comprehensive benefits and have a family income at or below 200 percent of the FPL. The demonstration was previously renewed on June 29, 2000, December 12, 2003, December 21, 2006, and January 31, 2011. Through an amendment approved by CMS in 2012, the state was authorized to expand the demonstration to create the Diamond State Health Plan Plus (DSHP-Plus) to mandate care through MCOs for additional state plan populations, including (1) individuals receiving care at nursing facilities (NF) other than intermediate care facilities for the mentally retarded (ICF/MR);
