SMART Hearing January 4, 2018 Tom Massey, Interim Executive Director John Bartholomew, Chief Financial Officer Gretchen Hammer, Medicaid Director Chris Underwood, Health Information Office Director Judy Zerzan, Chief Medical Officer https://www.colorado.gov/hcpf/legislator-resource-center 1
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Presentation Agenda Department Overview • Governor’s Dashboard & Performance Plan • Major Initiatives • Hot Topics: Opioids, Colorado interChange, CHIP • Budget Requests • Legislative Agenda • Regulatory Agenda & Required Statutory Updates • Committee Questions • 3
Department Overview 4
Coverage in Colorado Source: Insurance coverage percentages are from the Colorado Health Access Survey, September 2017. 2015 Colorado Health Access Survey data 5
Examples of Department Administered Programs Health First Child Heath Colorado Plan Plus (Medicaid) (CHP+) Old Age Pension Colorado (OAP) Medical Indigent Care Programs Program (CICP) 6
Health First Colorado Members 2017 Federal Poverty Levels by Family Size* Family Family of of 1 4 133% $16,044 $32,724 260% NA $60,625 (CHP+) Source Note: FY 2016-17 data, the sum does not equal 100% due to rounding and exclusion of individuals who receive partial coverage. 7
CHP+ Program Overview CHP+ Caseload as of November 30, 2017 75,333 Kids 842 Pregnant Women Data Note: Breakout by age is based on 2016 annual caseload, the latest monthly County by County Caseloads available at Colorado.gov/hcpf 8
Medicaid & CHP+ Enrollment 9
Caseload & Costs Overview Caseload Expenditures by Population by Population * Calendar Year 2016 Data *Age 20 & younger and qualifying former foster care youth 10
Medicaid Funding FY16-17 Data 11
Who Gets Paid for Services? Calendar Year 2016 Data 12
Governor’s Dashboard and Department Performance Plan 13
Governor’s Health Goals Support healthy weight of kids and adults Reduce substance use disorder Reduce impact on daily life of mental illness Increase immunization rate Improve health coverage Improve value in health care service delivery 14
Department Performance Plan Long-Range Goals 15
Department Performance Plan Strategic Policy Initiatives 16
Improving Customer Service: Enhanced Provider Search https://www.healthfirstcolorado.com/find-doctors/ 17
Major Initiatives 18
Accountable Care Collaborative 19
Accountable Care Collaborative Key Concepts Single regional administrative entity for physical • To improve health care and behavioral health services health and life outcomes Strengthen coordination of services by advancing • for Members health neighborhood Population health management approach • To use state Payment for integrated care and value • resources wisely Greater accountability and transparency • 20
Regional Accountable Entities Region Vendor Ownership Structure United HealthCare Services [Inc., a Minnesota corporation, which is a 1 Rocky Mountain Health wholly owned subsidiary of UnitedHealth Group Incorporated, a Delaware corporation.] Corporate members: Plan de Salud de Valle Inc., North Range Behavioral Northeast Health 2 Health, Centennial Mental Health Center, Sunrise Community Health (Own Partners 25% each) Corporate members: University of Colorado Health and University of 3 Colorado Access Colorado Medicine (collectively, the University), Children’s Hospital Colorado, and the Colorado Community Managed Care Network Owners: Valley-Wide Health Systems, Inc., Health Solutions, Beacon Health 4 Health Colorado, Inc. Options Inc., San Luis Valley Behavioral Health Group, Solvista Health Group, Southeast Health Group (Own 16 2/3 % each) Corporate members: University of Colorado Health and University of 5 Colorado Access Colorado Medicine (collectively, the University), Children’s Hospital Colorado, and the Colorado Community Managed Care Network. Members: Colorado Community Health Alliance, LLC (a partnership between Colorado Community Physician Health Partners, LLC, Primary Physician Partners, LLC, and Centura 6 Health Alliance Ventures, LLC), and Anthem Partnership Holding Company, LLC, a wholly owned subsidiary of Anthem, Inc. Members: Colorado Community Health Alliance, LLC (a partnership between Colorado Community Physician Health Partners, LLC, Primary Physician Partners, LLC, and Centura 7 Health Alliance Ventures, LLC), and Anthem Partnership Holding Company, LLC, a wholly owned subsidiary of Anthem, Inc. 21
Accountable Care Collaborative 22
Long Term Services & Supports 23
What are Long-Term Services and Supports? At Home (e.g. personal or family home; group homes; assisted living facilities) In Community (e.g. day programs; supported employment) Within Institutions (e.g. nursing homes; intermediate care facilities) 24
Who Receives LTSS? 7% 44% 49% Children & Adolescents Adults Older Adults ages 20 & younger ages 21-64 65 or older & qualifying former foster care youth Source Note: CY 2016 data; Data represent percentage of people receiving Medicaid LTSS in various age groups 25
Medicaid Waivers for Home and Community Based Services (HCBS) Children’s Children with Brain Injury Children with Habilitation Life Limiting Waiver Autism Waiver Residential Illness Waiver Program Waiver Children’s Home Community Elderly, Blind, and Community- Spinal Cord Mental Health and Disabled Based Services Injury Waiver Support Waiver Waiver Waiver Persons with Children’s Developmental Supported Living Extensive Disabilities Services Waiver Support Waiver Waiver Certain federal rules for the Medicaid State Plan can be waived so we can provide additional services so members can live in the community. 26
STREAMLINE IMPROVE SERVICE INCREASE SERVICE ACCESS TO SERVICES COORDINATION OPTIONS AND QUALITY Person-Centered Support No Wrong Door (NWD) Self-Direction Tools Planning Process Person-Centered Budgets New Functional Assessment Tool Colorado Choice Transitions (CCT) Cross System Crisis Response Financial Eligibility Reform Regional Center Task Force CHRP CCB Case Management Medicaid Buy-In Expansion Community First Choice Waiting List(s) Elimination (State Plan Option) Intensive Case Management for Regional Center Transitions Housing & Transportation CHRP – Cut Child Welfare Requirement Case Management Redesign CDASS & IHSS Expansion OPERATIONAL EXCELLENCE INTIATIVES Employment First + WIOA • Background Checks • Electronic Visit Verification Waiver Redesign • Conflict-Free Case Management • Mandatory Reporting • Rate Setting • CHRP Transfer GJRC Relocation • COMMIT/Revalidation • eLTSS Record + Personal Health Record • CCB Transparency • OCL Re-org HCBS Settings Rule Compliance 27
Value-Based Payment 28
Value- Based Payment: Current Initiatives Federally Hospitals Qualified Health Centers Primary Care Pharmacy 29
Hot Topics: Opioids, Colorado InterChange & Children’s Health Insurance Program 30
Opioids: Our Work to Date 2015: Pre-2012: 2017: DUR letters to Quantity limits on long- Quantity limit on 2013: prescribers; acting opioids; Made short-acting opioids Colorado Consultation services Suboxone a covered for treatment naïve Consortium for through DUR contractor; benefit without a limited members; Prescription Drug Project ECHO; Physical time of coverage Reducing MME Abuse Prevention Therapy Rate Increase 2014: 2016: 2012: Pain resource page on MME policy; National Governor’s Department’s website; Buprenorphine Association Prescription Tightened policy on Project ECHO Drug Abuse Reduction short-acting opioids program Policy Academy Combating the Opioid Crisis 31
Colorado interChange: Regional Field Representatives 32
Update on CHIP Child Health Plan Plus Medicaid CHP (MCHIP) (CHP+) # of Kids and 67,024 children 75,333 children Pregnant Women 2,391 pregnant women 842 pregnant women Covered MCHIP Kids: Up to $2,911/month Family Income Limits Up to $5,330/month ($ Estimate is for a Family of 4) MCHIP Pregnant: Up to $3,998/month Current Federal 88% 88% Match Rate Source: November 2017 Caseload Data 33
Budget Requests • R6 - Electronic Visit Verification • R7 – HCBS Transition Services Coordination • R8 - Medicaid Savings Initiatives • R9 - Provider Rate Adjustments • R10 - Drug Cost Containment Initiatives • R11 - Administrative Contracts Adjustments • R12 – Children’s Habilitation Residential Program Transfer • R13 - All Payer Claims Database (APCD) Funding • R14 – Safety Net Program Adjustments • R15 - CHASE Administrative Costs • R16 - CPE for Emergency Medical Transportation • R17 – Single Assessment Tool Financing • R18 – Cost Allocation Vendor Consolidation • R19 – IDD Waiver Consolidation Administrative Funding 34
Legislative Agenda Achieve Cost Savings Through Transition Services & Community Living Align Managed Care Statute with Federal Regulations Implement Conflict-free Case Management for SEPs Redesign of Children’s Habilitation Residential Program Waiver Remove Outdated Waiver Language from Statute 35
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