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1115 WAIVER Utah Department of Health Division of Medicaid and Health Financing 1Chacon.

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Presentation on theme: "1115 WAIVER Utah Department of Health Division of Medicaid and Health Financing 1Chacon."— Presentation transcript:

1 1115 WAIVER Utah Department of Health Division of Medicaid and Health Financing 1Chacon

2  The primary goal of Utah’s reform is to significantly reduce the rate at which Utah Medicaid expenditures are increasing each year.  To align incentives in such a way that the delivery patterns move away from billable events and focus more on patient outcomes and quality of care. 2Chacon

3  Utah has a 1915(b) Freedom of Choice, Waiver, Utah Choices of Health Care Delivery Program which has been in place since  Current waiver requires enrollees to make a plan choice in the four most populous counties of the state or be assigned to a plan.  Pharmacy, mental health services, transportation and dental are carve outs. 3Chacon

4  Requires submission of a waiver proposal to CMS by July 1,  Grant’s preferential funding consideration when expenditures are less that appropriated funding or historical expenditures. 4Chacon

5  Allows the residual amount to be deposited in a new “Medicaid Growth Reduction and Budget Stabilization Account.”  Requires the State to implement the waiver within the fiscal year following approval by CMS. 5Chacon

6  Accountable Care Organization Model  Risk Adjusted, Capitated Payments  Funding and Special Considerations  Budget Management Strategy 6Chacon

7  Out of Network Payment Limitations  ACO Scope of Benefits, Pharmacy  Quality of Care Standards  Individual Accountability and Responsibility 7Chacon

8  Client Incentives  Premium Subsidy Option  Prioritizing Services- Oregon Model  State’s four most populous counties: Salt Lake, Davis, Utah and Weber. Chacon8

9  Psychotropic medications  Mental health services  Substance abuse services  Emergency and non-emergency Transportation  Dental  Long term care services 9Chacon

10  Less than 3 months eligibility  Retroactive eligibility  Medicaid Spend down Cases  Utah State Hospital and Utah Developmental Center Residents  Primary Care Network Program  H.O.M.E. Program Chacon10

11  More Detail on Medical Home Model  Emphasis on prevention may overshadow chronic disease management  Concerns regarding coordinated case management services for disabled populations  Cost sharing Chacon11

12  Objections to premium assistance options for State plan populations  Prioritized service list and concerns regarding rationing of care- Oregon Model Chacon12

13  Utah is meeting with CMS on a weekly basis  Goal- Approval from CMS no later than December 31, 2011  Implementation- July 1, 2012 Chacon13


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