Transcript Illinois Medicaid 1115 Waiver - Illinois Hospital Association

Transforming Illinois Health Care
Illinois Medicaid 1115 Waiver
Transforming Illinois Health Care
State’s Vision to Achieve Triple Aim

Transform Illinois’ Medicaid program and health care delivery
system

Transition from fee for service system to an integrated, patientcentered delivery model

Strengthen community based & primary care infrastructure

Empower providers to manage care and incentivize quality and
improved patient outcomes
Transforming Illinois Health Care
Illinois hospitals have the infrastructure to
bring together a wide range of providers
Accountable Care Entities

Unique to Illinois

Established by IL law in 2013

Provider owned and operated

A group of doctors and hospitals; not an insurance company

Doctors and hospitals within an ACE are connected to easily share
information

Responsible for all care provided
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What is a Medicaid 1115 Waiver?
 Allows states to apply for program flexibility from the Centers for
Medicare & Medicaid Services to test new approaches to financing &
delivering Medicaid
 Provides incentives to providers to develop new models of care
 Lasts five years, but can be renewed/amended
 Must be budget neutral, leading to overall savings
Our State’s Waiver Application
 Called the Path to Transformation Waiver
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Four Pathways to Transformation
State
Waiver
Goals:
Better Health Outcomes
Lower Costs
Application
Population Health
Delivery System
Transformation
Pathway 1
Workforce
Pathway 2
Pathway 3
Home- & CommunityBased Supports
Pathway 4
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1st Pathway: Delivery System Transformation
Waiver promotes care coordination & integrated
delivery system development
 Hospital performance & integration
pool
 Institution transition pool
Delivery System
Transformation
 Access Assurance Pool
 Innovation and transformation
resource center
 Public hospital pool
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2nd Pathway: Population Health
 Fund regional public health
collaboratives
 Expansion of maternal-child
home visitation program
Population Health
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3rd Pathway: Workforce
Strengthen the state’s health care
workforce

Provide incentives for training physicians

Funding for loan repayment programs

Safety Net and Critical Access Hospital
loan program

Establish training and certify community
health workers
Workforce
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4th Pathway: Home & Community-Based
Supports
Consolidation of nine existing home- &
community-support waivers
 Behavioral
 Increase funding &
health
uniformity in benefits
expansion &
integration
 Increase capacity of
care provided in the
Home- & Communitycommunity
Based Supports
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Challenges
 Many needs
 Limited funding
 Negotiatons with CMS will determine final funding
allocations.
 Incentive pools, workforce, behavioral health home,
transformation resource center, and public health
integration provisions are critical for hospitals and
continued transformation.
 Waiver often has general descriptions of proposals.
Will need provider input when finalizing details.
 Incentive funding provisions need to have realistic
expectations.
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How is a Waiver Financed?
Costs Not Otherwise Matchable (CNOM)

One of the most powerful provisions in Section 1115
allows CMS to grant approval of Costs Not Otherwise
Matchable or CNOM

Includes services not normally qualifying as Medicaid
expenditures

Must be budget neutral
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Budget Neutrality Under 1115 Waiver
CNOM counts toward budget neutrality gap
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Waiver Examples Aligned With Hospital
Transformation Efforts
Integration & Incentive Pool
Institution Transition Pool
GME funding
1115 Waiver Payments
and Initiatives
Loan forgiveness
Community-Based Training and certification
Behavioral health homes
Integration with public health
Enhanced home and community supports
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What does Waiver Mean for Providers?

Financial & Technical Assistance to transform care
models

Incentives for quality improvement, transformation
and integration activities

Increased capacity for behavioral health referrals

Funding to recruit, train and retain qualified health
care workforce

Better crisis, referral and discharge services
Model Test Grant- CMMI

$100 million- four years

Six integrated delivery systems

Public and private payer participation

Align quality metrics across plans

Linkages with community supports via public health
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How is state receiving input?
Alliance for Health
Alliance Steering Committee

•
All major stakeholders
Five workgroups

•
Integrated Delivery System Reform
•
Public Health Integration
•
Workforce
•
Data and Technology
•
Services and Supports
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Conclusion
 Waiver and Model Test are consistent with IHA goals
 Key hospital provisions are critical to achieving waiver
goals
 Funding needs to reach providers
 State can set criteria and standards
 Rural health and health literacy needs can be enhanced
 Waiver provides up-front investment for transformation
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