Source: http://itup.org/author/jeffrey/page/2/
Timestamp: 2017-09-21 22:55:39
Document Index: 247007704

Matched Legal Cases: ['§1115', '§1115', '§1115', '§1115', '§1115', '§1115']

Insure The Uninsured Project (ITUP) - Health Policy Research of California's Uninsured Jeffrey Kho, Author at Insure The Uninsured Project - Page 2 of 4 Health Policy Research of California's Uninsured
February 4, 2016 Posted by Jeffrey Kho under Latest ITUP News, Legislation/Policy, Medi-Cal, Public Coverage, State, Waiver Reports
ITUP has prepared a six-part summary of California’s Medi-Cal 2020 §1115 waiver, which went into effect at the beginning of 2016. The new waiver aims to build off of the successes of the Bridge to Reform waiver, which expired at the end of 2015.
The analysis is freely available in six parts:
Managed Care Expansions and Demonstrations Continuation
Public Hospital Redesign and Incentives in Medi-Cal
Before the Medi-Cal 2020 waiver, the federal/local financing of care for the uninsured was anachronistic. It incentivizes treating uninsured individuals at the hospital emergency room (the most expensive setting) at the latest possible stage of illness (the most expensive point in an illnesses trajectory). Public Hospital Redesign and Incentives in Medi-Cal (PRIME), a program in the newest waiver, will be assisting public hospitals in transforming their delivery systems to one that is compatible with Medi-Cal managed care; it will replace fee-for-service (FFS) payments with ones involving value, improved patient outcomes, capitation, and other alternative payment methods. Similar to PRIME, the Global Payment Program (GPP) aligns incentives to treat the uninsured population outside the hospital, by improving access to preventive and primary care.
Download the full analysis: §1115 Waiver Renewal Analysis: Global Payment Program (GPP)
Public Hospital Redesign and Incentives in Medi-Cal (PRIME) is an ambitious follow-up program to the successful Delivery System Reform Incentive Pool (DSRIP) for county, district, and University of California hospitals. Up to $7.5 billion will be used to transition public hospital systems to managed care models. This includes shifting the prevailing current fee for service (FFS) payment model in public hospitals towards alternative payment method (APM) models that incorporate more risk-based methodologies. Public hospital systems will be held even more accountable for cost and quality outcomes for their managed care systems. PRIME will accelerate this transition and root APM as the enduring and new standard for payment to public hospitals. Incentives will help hospitals better integrate different aspects of care, increase team-based care, improve population health and practice resource stewardship.
Download the full analysis: §1115 Waiver Renewal Analysis: Public Hospital Redesign and Incentives in Medi-Cal
Under the Medi-Cal Dental program, dental services are provided to about 5.5 million Medi-Cal beneficiaries under the age of 20. The program aims to facilitate consistent and easy access to high quality dental services so beneficiaries achieve good oral health; to implement effective and efficient delivery systems; to maintain engagement with stakeholders; and to hold DHCS and their providers, plans, and partners accountable for performance and health outcomes. Services are provided via two delivery systems: Fee-for-Service (FFS) and Dental Managed Care (DMC). The Department of Health Care Services (DHCS) oversees and facilitates access to oral health services for FFS and DMC delivery systems in multiple ways, such as conducting outreach and education, monitoring utilization, and providing reports to stakeholders. All data associated with DTI will be based on annual reporting period by program year (PY).
The program has two key domains:
Increasing preventative services utilization for children
Caries Risk Assessment and Disease Management Pilot
Read the full analysis: Analysis of §1115 Waiver Renewal: Dental Transformation Initiative
Over the next couple of weeks, ITUP will be posting a number of papers analyzing the terms and conditions of the new §1115 waiver. These papers will look closely at the new requirements and their implications for the Medi-Cal program.
Managed Care Expansion on Demonstrations Continuation
This page will be periodically updated as new reports are released.
On December 30, 2015, the Centers for Medicare and Medicaid Services formally approved California’s §1115 waiver renewal, replacing the existing Bridge to Reform waiver. Medi-Cal 2020: Continuing Transformation and New Initiatives to Improve Health Outcomes, a brief by Harbage Consulting with support from The California Endowment, lays out the key components of the new Medi-Cal 2020 waiver as laid out in the approved Special Terms and Conditions, and explains how they build upon the foundation laid by the Bridge to Reform waiver.
Read the report: Medi-Cal 2020
Premiums increased by 4%; offer rates and take up rates did not change; worker’s wages increased by 2% and inflation fell by 0.2% between 2014 and 2015.