June 24, 2014 Karol Dixon HCA Tribal Affairs Office Medicaid Update

2 14,327 Had Previous CVRG 11,762 No Prev CVRG 26,089 TOTAL

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Payments to I/T 4 I/T 2013-$2013- clients 2014-$2014- clients Total $50,838,720 21,316 $18,520,156 14,815 Medical $15,312,638 14,825 $5,075,611 8,190 Dental $5,630,161 8,752 $2,253,572 4,627 Mental $11,978,079 3,000 $4,118,933 2,105 CD $16,690,161 1,776 $6,411,460 1,379 POS $1,134,179 4,574 $660,579 3,420

Urbans 2013-$2013- clients 2014-$2014- clients Total $1,556,302 2,634 $718,570 1,752 Medical & Mental $1,219,433 2,175 $575,137 1,393 Dental $100, $28, CD $127, $38, POS $108, $76, Urban Payment Summary Data pulled May, Data is expected to change as more claims are billed

Foster Care Medical RFP RFP forthcoming AI/AN kids will remain exempt and enrollment in Foster Care MC voluntary 7

May 2014: – 1,188,222 Medicaid clients in MC – 9,430 are AI/AN* * AI/AN is currently reported as race code 4 or 5 in ProviderOne. Due to race being a voluntary field during enrollment there are a large number of AI/AN clients who are in the ProviderOne system as non-native. These clients will be updated to race code 4 as part of a larger clean up project this fall. How many AI/AN are in MC?

AI/AN* in MCO plans (9,430 total) 4,875 AI/AN in Molina 2,569 AI/AN in CHPW 788 AI/AN in UHC 630 AI/AN in CCC 321 AI/AN in Amerigroup *AI/AN as defined by race code Which plans are AI/AN in?

I/T/U and MCOs With a contract I/T/U serves as primary care provider for client in MC HCA pays MC premium to MCO I/T/U bills MCO for visits I/T/U bills HCA for balance of encounter I/T/U utilizes MC network for referrals Without a contract Client has designated provider in MC network HCA pays MC premium to MCO I/T/U bills MC for visits I/T/U bills HCA for balance of encounter I/T/U refers to FFS providers, FFS bills HCA 10

WAC (7) To provide adequate choice to covered persons who are American Indians, each health carrier shall maintain arrangements that ensure that American Indians who are covered persons have access to Indian health care services and facilities that are part of the Indian health system. Carriers shall ensure that such covered persons may obtain covered services from the Indian health system at no greater cost to the covered person than if the service were obtained from network providers and facilities. Carriers are not responsible for credentialing providers and facilities that are part of the Indian health system. Nothing in this subsection prohibits a carrier from limiting coverage to those health services that meet carrier standards for medical necessity, care management, and claims administration or from limiting payment to that amount payable if the health service were obtained from a network provider or facility. 11

MC Contract Language 15.4 Special Provisions for American Indians and Alaska Natives In accord with the Section 5006(d) of the American Recovery and Reinvestment Act of 2009, the Contractor is required to allow American Indians and Alaska Natives free access to and make payments for any participating and nonparticipating lndian health care providers for contracted services provided to American Indian and Alaska Native enrollees at a rate equal to the rate negotiated between the Contractor and the Indian health care provider. If such a rate has not been negotiated, the payment is to be made at a rate that is not less than what would have otherwise been paid to a participating provider who is not an Indian health care provider. 12

Health Plan Contact Information Customer Service: Website: Provider Line Website: Customer Services: Website: Provider line Website: Customer Service: Website: Provider line Website: Customer Service: Website: Provider line Website: Customer Service: Website: Provider line - Phone: Website: 13

AI/AN income – SSI related AIHC request from Oct 2013 & Tribal Consultation Nov 2013: 1.MAGI and SSI rules to be the same; or 2.Eliminate $2000 income exclusion limit CMS provided technical assistance Formal response to AIHC forthcoming WAC to be updated Emergency WAC will be filed

15 State Health Care Innovation Plan Laura Kate Zaichkin Administrator, Office of Health Innovation and Reform State Health Care Innovation Plan Implementation Updat e

WA’s Plan: Three Core Strategies Drive value-based purchasing across the community, starting with the State as “first mover” Build healthy communities and people through prevention and early mitigation of disease throughout the life course Improve chronic illness care through better integration of care and social supports, particularly for individuals with physical and behavioral health co-morbidities 16 Supported by SB 6312 and HB 2572 State Health Care Innovation Plan

1. Quality and price transparency 2. Person and family engagement 3. Regionalize transformation 4. Create Accountable Communities of Health (ACHs) 5. Leverage and align state data 6. Practice transformation support 7. Workforce capacity and flexibility 17 Seven Building Blocks The Keys to Success State Health Care Innovation Plan

Building Block: Regionalize Transformation Regions will be determined in partnership with Joint Behavioral Health Legislative Task Force & Counties Leverages public purchasing to share accountability for performance results across delivery systems. Empowers “local” innovation and engages communities in local priorities Enhances opportunities for cross agency efforts around common populations Builds on lessons from current regional endeavors 7-Region Example 9-Region Example State Health Care Innovation Plan 8

Building Block: Accountable Communities of Health Regionally driven priorities and solutions to collectively impact health Align Medicaid purchasing Develop and activate a region-wide health assessment and regional health improvement plan Drive accountability for results Forum for harmonizing payment models, performance measures and investments Health coordination and workforce development State Health Care Innovation Plan 11

Accountable Community of Health Initiative Community Champions and Catalysts for Mutual Community and State Health Transformation Priorities Community of Health Planning Grant Released on May 2 Empower communities to shape and inform ACH development and design Opportunity for communities, including governments and tribal entities, to prepare for the anticipated ACH designation process and initial awards as authorized in E2SHB Develop a collaborative partnership between the State and communities Key Timeline: Letter of Intent due May 9, 2014 Full Application due May 30, 2014 State Health Care Innovation Plan 12

Q & A State Health Care Innovation Plan The Innovation Plan available at: Share your thoughts and asked to stay engaged by ing the Help Desk: Monthly Updates to I/T/U at Medicaid Monthly Meeting 21

2014 Meeting Schedule July 8 August 12 September 9 October 14 November 12 * (Wednesday) December 9 Managed Care Discussion with Plans two potential dates: July 25 or August 1 * (9 AM-12 PM) September 23 October 28 November 18 * (3rd Tuesday) December 16 * (3rd Tuesday) Tribal Billing Workgroup (TBWG) 2 nd Tuesday, 9:00-11:00 AM unless noted Tribal Billing Workgroup (TBWG) 2 nd Tuesday, 9:00-11:00 AM unless noted* Medicaid Monthly Meeting (M3) 1:00-3:00 PM unless noted Medicaid Monthly Meeting (M3) 1:00-3:00 PM unless noted* As of 04/30/2014. Register or download files online!

Thank You 23 For comments or questions, contact: Karol Dixon