Upload File

medicaid services are established in state medicaid plans and are approved by the federal center for...

  • Home
  • Documents
  • Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows
19
Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver

Upload: halie-servais

Post on 15-Dec-2015

216 views

Category:

Documents


0 download

Report

Tags:

TRANSCRIPT

Page 1: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver

Page 2: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS).

CMS allows for exceptions to the state plan based on a waiver process

Waivers are subject to CMS approval and must be budget neutral

What is a Medicaid Waiver

Page 3: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

A 1115 Waiver allows the state to test innovative approaches

to new Medicaid Services

Page 4: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

The waiver is intended to be in effect during the 2011 – 2016 time frame

Page 5: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

The Texas 1115 waiver seeks to be innovative by expanding the Medicaid

managed care plan

• This expansion encroaches on the UPL, or Upper Payment Limit payments that some Texas healthcare facilities currently receive and therefore suggests that a review of UPL is necessary to ensure that changes don’t drastically undermine these facilities.

Page 6: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

Upper Payment Limit

• Supplemental payments made to hospitals for inpatient and outpatient services

• Upper Payment Limit (UPL) is the difference between what Medicaid reimbursed for the service and what Medicare would have paid

• The non-federal portion of the UPL is funded with local tax funds – usually through a taxing authority or hospital district

Page 7: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

19%

17%

39%

25%

Texas Hospital Financing FY09

DSHOutpatientInpatientUPL

Upper Payment Limit

Page 8: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

The 1115 Waiver allows for

• Expansion of managed care services in the state including a pharmacy and dental services

• Allowed for the preservation of Upper Payment Limit for hospitals in light of the fact that the state is expanding managed care services

• Created Regional Healthcare Partnerships or RHP’s

Page 9: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

The waiver allows for additional funds to be drawn down from the

federal level to be used at the state level

• 2011 UPL payments to hospitals amounted to an estimated 2.8 billion dollars. Over the five year life of the waiver, that would amount to almost 14 billion in funds that would be drawn down from the federal government.

• Under the new waiver, there is an ability to drawn down nearly 29 billion in federal funds for the same time period.

• There is obvious advantages from a financial perspective for the state to pursue this program

Page 10: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

UPL transitions to 1115

Page 11: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

How the split progressesYear UCC DSRIP

2012 88% 12%

2013 80% 20%

2014 70% 30%

2015 60% 40%

2016 50% 50%

Page 12: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

Regional Health Partnerships

• Formed around facilities already receiving UPL payments and a public hospital typically serves as an anchor for a region

• Anchors coordinate the activity of the RHP and serve as a single point of contact for the region

• Anchors serve as administrators for the RHP but do not control the funds.

• Focus will be on improved quality, access, and coordination.

Page 13: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows
Page 14: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

Regional Health Partnerships

• Anchors will bring stakeholders together to develop plans with public input.

• RHP participants with match funds will choose hospitals that will receive payments based on their incentive plans.

• Performance metrics will be established and payments will be issued based on facility performance against those metrics.

Page 15: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

Anchors• Public hospitals will normally serve as anchors

• In regions without a public hospital, other entities such as a hospital district, a hospital authority, a county, or a state university with a health science center or medical school may serve as the anchor.

Page 16: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

Tasks of Regional Health Partnerships• Identification of RHP participants• Providing a health assessment of the region• Identifying projects by DSRIP categories

• Infrastructure development• Program innovation and redesign• Quality Improvements• Population focused improvement

Page 17: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

What RHP’s don’t do• They can not require participation.

• Even if an entity starts the program in the first year, the RHP can’t mandate participation for all four years. • They don’t determine health policy.

• They don’t determine Medicaid program policy.

• They don’t determine regional reimbursements.

• They don’t determine manage care requirements.

Page 18: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

ReferencesTexas Health and Human Services Commission. HHSC Gets Approval for Medicaid Improvements. http://www.hhsc.state.tx.us/1115-waiver.shtml

Texas Association of Counties. Medicaid 1115 Waiver. https://www.county.org/resources/legis/medicaid1115/index.asp

Page 19: Medicaid services are established in State Medicaid Plans and are approved by the federal Center for Medicare and Medicaid Services (CMS). CMS allows

Questions??


CMS Manual System - Centers for Medicare & Medicaid Services...Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal

Centers for Medicare & Medicaid Services (CMS) Public ...€¦ · Centers for Medicare & Medicaid Services (CMS) ... The orthosis is custom fabricated, and includes fitting, ... including

Centers for Medicare & Medicaid Services (CMS) Healthcare

CMS ICD-10 Basics - Centers for Medicare & Medicaid Services

CMS manual guidance - Home - Centers for Medicare & Medicaid Services

THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS): … · enrollment system, accurate calculation ... The Centers for Medicare & Medicaid Services (CMS) is a United States federal

Medicaid 201: Home and Community Based Services CMS MEDICAID 201.p… · – Laboratory and X-ray services – Family Planning services – Nurse Midwife services – Certified Pediatric

The Centers for Medicare & Medicaid Services (CMS ...€¦ · Medicaid Services (CMS) Emergency Preparedness Resource Inventory (EPRI) Pilot Project Evaluation Report . October 2009

CMS Manual System€¦ · CMS Manual System . Department of Health & Human . Services (DHHS) Pub 100-04 Medicare Claims . Processing . Centers for Medicare & Medicaid Services (CMS)

CMS INFORMATION SECURITY RISK ASSESSMENT (IS … · Chief Information Officer . Office of Information Services . Centers for Medicare & Medicaid Services. CMS INFORMATION SECURITY

Centers for Medicare & Medicaid Services (CMS) Healthcare ...€¦ · Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) Public Meeting

Centers for Medicare & Medicaid Services (CMS) Physician

Department of...CMS Rulings Department of Health. and Human Services . Centers for Medicare & Medicaid Services ───────────────────────────────────────────────────────────

CMS Manual System - Centers for Medicare & Medicaid Services

CENTERS FOR MEDICARE & MEDICAID SERVICES-CMS … · Medicare CMS Officers Page - 1 of 39 [email protected] 714-964-4056 CENTERS FOR MEDICARE & MEDICAID SERVICES-CMS

Centers for MediCare & MediCaid serviCes CMS RoadMapS oveRview · The Centers for Medicare & Medicaid Services (CMS) is the single largest payer for health care in the United States

Centers for Medicare & Medicaid Services (CMS) Healthcare

CENTERS FOR MEDICARE & MEDICAID SERVICES 2020insurance.ky.gov/ppc/Documents/DOI_ChoosingaMedigap2020.pdf · Developed jointly by the Centers for Medicare & Medicaid Services (CMS)

Centers for Medicare & Medicaid Services’ (CMS’ or the ...€¦ · 02/09/2014  · Centers for Medicare & Medicaid Services ATTN: CMS–1613-P 7500 Security Boulevard Baltimore,

Centers for Medicare & Medicaid Services (CMS) End-Stage ......Centers for Medicare & Medicaid Services (CMS) End-Stage Renal Disease Quality Incentive Program (ESRD QIP) Payment Year

Medicaid Services’ (CMS) Electronic Health Record › system › files › advocacy-issues › ... · Medicaid Services’ (CMS) Electronic Health Record (EHR) Incentive Program

DEPARTMENT OF HEALTH AND HUMAN ... - CMS Innovation Center · The Centers for Medicare & Medicaid Services’ (CMS’) Center for Medicare and Medicaid Innovation (Innovation Center)

Centers for Medicare & Medicaid Services Centers for Medicare & Medicaid Services CMS PROGRAM INTEGRITY EFFORTS 2003 Jim Bryant CMS, Boston Regional Office

Personal Care Services Booklet - CMS€¦ · Preventing Medicaid Improper Paments for Personal Care Services 2 Content Summary Medicaid personal care services (PCS) are valuable,

Centers for Medicare & Medicaid Services [CMS-1613-FC] · AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule with comment period. SUMMARY: This final

CMS Manual System · CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal

CMS Policy on Medicaid in · PDF fileCMS Session Objectives • Understand Medicaid school-based services (SBS) concepts and CMS policies and principles. • Understand key issues

Centers for Medicare & Medicaid Services (CMS) Healthcare Common

CENTERS FOR MEDICARE MEDICAID SERVICES · 2019-06-22 · Medicaid Services (CMS) approval of state plan amendment (SPA) 13-0022-MM2, which was submitted to CMS on September 11,2013

MD - Home - Centers for Medicare & Medicaid Services | CMS

Medicare & Workers’ Compensation Ian Fraser Centers for Medicare & Medicaid Services (CMS)

CMS Manual System - Home | Centers for Medicare & Medicaid Services

Centers for Medicare & Medicaid Services CMS’ Progress Toward Implementing Value-Based Purchasing

CENTERS for MEDICARE & MEDICAID SERVICES Tom Scully CMS Administrator

The Centers for Medicare & Medicaid Services (CMS) ICD … · The Centers for Medicare & Medicaid Services (CMS) ICD-10 Planning . ... Standard Analytical Files from NCH and NMUD