Update on Cascade Care procurement activities and proposed timeline Senior Citizens’ Foundation Fall Conference October 24, 2019
Agenda Introduction to Engrossed Substitute Senate Bill (ESSB) 5226: Cascade Care Health Care Authority’s (HCA) contract and procurement role in Cascade Care Timeline for program development 2
ESSB 5226 introduction The three main parts to the Cascade Care bill: Standard plans: Health Benefit Exchange (HBE) is developing standard plans, which will be more understandable, more affordable, and of more value for Washington Healthplanfinder customers. Public option plans: HCA will procure public option plans, which will build off the standard benefit plans HBE develops. These plans will also have additional quality and value requirements, and reimbursement rate caps. Subsidy study: HBE is developing a plan to implement state subsidies for Washington Healthplanfinder customers with income up to 500 percent Federal Poverty Level. 3
Health Benefit Exchange HBE is leading the first phase of work to develop the standard benefit designs, with help from an actuarial consultant, stakeholder workgroups, and carrier workgroup. HBE will post proposed benefit designs to their website. There will be a public comment period for people to comment and provide input. HBE site: wahbexchange.org/about-the-exchange/cascade-care-2021- implementation/ 4
Cascade Care implementation timeline HBE September 2019 May 2020 September 2020 June 2019 October 2019 December 2019 January 2020 First draft of Second draft of Finalize Standard standard plan standard plan standard Board designs plan Begin designs Public Federal AV calculator plan designs certifies presented to Comment stakeholder standard presented to finalized; standard plan and present 2021 stakeholders stakeholders Period group plan design designs updated if necessary for Board plans commences and feedback and feedback approval received received HCA September 2019 May 2020 September 2020 June 2019 October 2019 December 2019 January 2020 Review RFP submissions and Develop RFP criteria including value, quality, care management, and HCA procurement process negotiate contracts for 2021 reimbursement rate requirements, in consultation with HBE public option plans Participate in standard plan stakeholder group OIC May 2020 September 2020 June 2019 September 2019 October 2019 December 2019 January 2020 Receive issuer Publish filing Review and approve 2021 plans instructions filings Participate in standard plan stakeholder group
Purchasing standards that are legislatively mandated Affordability opportunity: legislation outlines reimbursement rate caps and floors for health carriers payments to providers. Cap set at aggregate of 160 percent of Medicare. Floors are set so: Primary care physicians may not be paid less than 135 percent of Medicare. Rural critical access hospitals or sole community hospitals may not be paid less than 101 percent of Medicare (allowable costs). 6
Purchasing standards that are legislatively mandated continued Quality and value participation requirements: Must incorporate recommendations of the Robert Bree Collaborative and health technology assessment program. Align to state agency value-based purchasing (VBP) goals and reduce barriers to maintaining and improving health. Meet additional participation requirements to reduce barriers to maintaining and improving health. Use an integrated delivery system or a managed care model that includes care coordination or care management. 7
HCA approach in developing Cascade Care purchasing standards Strive to increase affordability and value, while aligning with state purchasing standards. Align to HCA’s VBP goals . Success is dependent on carrier and provider participation; administrative barriers to participation should be minimized. Program development and refinement will be a continual process with a phased-in approach. 8
In other news: Universal Health Care Work Group In 2019, the Legislature directed HCA to convene a work group study. This group will provide recommendations on how to create, implement, maintain, and fund a universal health care system. HCA selected Universal Health Care Work Group members based on their experiences, perspectives, and role in health care. This work group will meet through October 2020, with HCA providing a final report to the Legislature in November 2020. HCA site: hca.wa.gov/about-hca/healthier-washington/universal-health- care-work-group 9
Questions? Mich’l Needham chief policy officer Mich'l.Needham@hca.wa.gov HCA site: hca.wa.gov/about-hca/cascade-care HBE site: wahbexchange.org/about-the- exchange/cascade-care-2021-implementation/ 10
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