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8.1 - Growth in DSHS Medical Programs Costs Compared to Washington's Personal Income

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Health Care Final 11-16-11
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Health Care Final 11-16-11 > Cost > 8.0 - DSHS > 8.1 - Growth in DSHS Medical Programs Costs Compared to Washington's Personal Income > ActionPlan  
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DescriptionFilterStatus CommentFilter
Monitor Medical Purchasing Administration (MPA) medical program expenditures on a monthly basisUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, Annette Meyer2010-11-15
This is ongoing monthly monitoring of DSHS medical program costs.
To track costs and identify areas of concernIn Progress
This is ongoing monthly monitoring of DSHS medical program costs.
 
MPA continues to track total computable (federal and state) expenditures, which have declined since January 2009 primarily due to budget savings initiatives, for DSHS medical programs.
10/5/2010
Publish DSHS MPA's CY 2009 Healthy Options (HO) managed care ratesUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareMaryAnne Lindeblad2009-07-15
DSHS MPA annually publishes its managed care rates, with any increases or decreases, for the upcoming calendar year by September 1 of the preceding year.
To notify managed care organizations of the monthly premium rates that will be paid by DSHS for CY 2009 when entering into contracts with DSHS HRSA for the upcoming calendar yearCompleted
6/24/20099/1/2008
Establish and maintain 5 DSHS MPA steering committees to manage program services and develop, propose, and implement purchasing strategiesUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareSteering Committee Chairpersons: Erin Mayo, Travis Sugarman, Myra Davis, Allen Hall, and Bev Court2010-08-15
The five steering committees, including (1) facilities (inpatient and outpatient hospital services and ambulatory surgery centers), (2) licensed health care professionals (e.g., physicians, dentists, therapists), (3) prescription drugs, (4) durable medical equipment (DME) and supplies, and (5) contracted services, meet on a monthly basis.  
 
The steering committees set program-specific goals and priorities, review current costs and utilization and historical trends, and develop purchasing strategies and measures to demonstrate achievement of program goals and priorities.
 
Purchasing strategies under consideration include:
  • Strengthen evidence-based utilization review for inpatient hospital services, including reduction in caesarean-section births;
  • DME selective contracting;
  • Reduce avoidable emergency department (ED) utilization through physician payment rate increases for primary care. ED Diversion pilot projects, and payment for transportation to sobering centers.  
Work interdependently across MPA divisions to identify, discuss, and agree on data-driven strategies to best manage DSHS HRSA's medical programs. Completed
The steering committees meet on a monthly basis and are continually developing purchasing initiatives to better manage costs.
7/6/2010
Reduce expenditures for dental servicesUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
ESHB 1244 directed DSHS to reduce dental expenditures by 4% of total expenditures during the 2009-2011 biennium. These reductions will prioritize rolling back some of the dental rate increases provided during the 2007 legislative session and measures to control utilization rather than terminating any dental services.
Manage MPA costs in light of budget reductionsCompleted
8/27/20097/1/2009
Reduce Alien Emergency Medical program fundingUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
ESHB 1244 reduced funding for non-emergent services provided to individuals otherwise eligible for Medicaid but for their citizenship status. Services are retained for renal dialysis, cancer-related treatment, and other services that are approved under federal Medicaid definitions for emergency services.
Manage MPA costs in light of budget reductions and comply with federal requirements about the AEM program.Completed
12/7/200911/1/2009
Reduce General Assistance-Unemployable (GA-U) medical care services (MCS) fundingUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
Expenditures are reduced to approximately 82% of current expenditures, with savings expected from moving clients into a managed care delivery system that will include mental health benefits.
Manage MPA costs in light of budget reductions and provide needed mental health benefits to this population statewide.Completed
Currently, GA-U clients in King and Pierce counties are enrolled in GA-U managed care which includes mental health benefits. This delivery system has been expanded statewide with the same carrier (Community Health Plan of Washington).
12/7/200911/1/2009
Eliminate Foster Care PilotUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
Funding is eliminated for the implementation of the Center for Foster Care Health Services pilot
project, which sought to provide care coordination services and maintain individual health histories for approximately 2,000 children
in foster care.
Manage MPA costs in light of budget reductionsCompleted
8/27/20097/1/2009
Reduce Maternity Support ServicesUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
Maternity Support Services (MSS) provide preventive health care services for pregnant and postpartum women that include professional observation, assessment, education, intervention, and counseling as provided by interdisciplinary team comprised of community health nurses, nutritionists, and behavioral health specialists. Funding for MSS services is reduced by 20 percent and the department is directed to prioritize funding for women with high-risk pregnancies.
Manage MPA costs in light of recent budget reductionsCompleted
8/27/20098/1/2009
Obtain enhanced federal match for pregnancy servicesUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, Manning Pellanda, MaryAnne Lindeblad, Roger Gantz2009-07-15
Approximately 200 pregnant women on the Medicaid caseload who cannot verify citizenship will be transferred to the non-citizen pregnant program which receives enhanced federal match (federal medical assistance percentage (FMAP)).
Maximize federal financial participation for services already provided to eligible individualsCompleted
8/27/20097/1/2009
Eliminate funding for the Health Navigator pilot projectUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
Funding is eliminated for the Health Navigator Pilot, which links populations at disproportionate risk of receiving poor health care due to language and cultural barriers with "navigators" who guide them through the health care system. The pilot targeted 1,000 children with language and cultural barriers to help them access evidence-based care through improved service
coordination.
Manage MPA costs in light of recent budget reductionsCompleted
8/27/20097/1/2009
Obtain enhanced federal match for interpreter servicesUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
The federal Children's Health Insurance Program Reauthorization Act of 2009 provides an enhanced matching rate of 75 percent in Medicaid and the Children's Health Insurance Program (CHIP) for translation and interpretation services for families for whom English is not the primary language.
Maximize federal financial participation for services already provided to eligible individualsCompleted
8/27/20097/1/2009
Obtain increased federal medical assistance percentage (FMAP) under the American Recovery and Reinvestment Act (ARRA)Use SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly2009-07-15
The American Recovery and Reinvestment Act of 2009 (ARRA) provides a temporary increase in the state's Federal Medicaid Assistance Percentage (FMAP). This increased federal revenue is expected to be roughly $1.8 billion for Medicaid FMAP-eligible payments, of which over $1 billion will be for services provided under the Medical Assistance Administration from FY 2009 through FY 2011.
Maximize federal financial participation for services already provided to eligible individualsCompleted
To receive the enhanced ARRA FMAP, Washington may not implement eligibility standards, methodologies, or procedures that are more restrictive than those in effect on 7/1/2008.
8/27/20097/1/2009
Obtain enhanced federal match for Medicaid transportation servicesUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
Reimbursement for contracted administration of transportation services will be at the standard federal medical assistance percentage (FMAP) instead of the lower administrative match rate.
Maximize federal financial participation for services already provided to eligible individualsCompleted
8/27/20097/1/2009
Obtain enhanced federal match for children in families with incomes between 133-200% of the federal poverty level (FPL)Use SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-ly, MaryAnne Lindeblad2009-07-15
The recently passed federal Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), provides enhanced Title XXI match ($2 federal for every $1 state) for children from 133 to 200 percent of the federal poverty level currently on the Medicaid program which typically reimburses $1 federal for $1 state. Previously Washington State was able to receive enhanced Title XXI federal match for children between 150 and 200 percent of the federal poverty level, but only up to 20 percent of the state's State Children's Health Insurance Program (SCHIP) allotment.
Maximize federal financial participation for services delivered to this populationCompleted
8/27/20097/1/2009
Retain a portion of medical support payments collected for children receiving state-subsidized careUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly2010-11-15
SHB 1845 enacts federal regulations allowing courts to obligate parents to pay medical support equal to the obligated parent's proportionate share of the health insurance premium paid by the other parent or the state. The medical support payments shall not exceed 25 percent of the basic child support obligation. The state assumes savings beginning in FY 2011.
 
The effective date of this legislation is October 1, 2009. DSHS currently does not have the ability to identify and retain medical support collected for children receiving medical assistance benefits. It is estimated that the systems necessary to retain medical support could be developed by July 1, 2010. As such, any medical support collected between October 1, 2009 and June 30, 2010 will be disbursed to the other parent. Beginning July 1, 2010, DSHS will retain medical support collections to offset the costs of medical benefits provided to children for whom the collections have been made.
 
It will be necessary to develop a system to:
•Match children receiving medical benefits with those for whom a medical support collection has been made.
•Correctly account for and offset medical benefit costs with the retained medical support payments.
Ensure that medical support payments made for children who receive state-subsidized health care coverage are paid to the party (DSHS) that provides access to health care services for those children Deferred
MPA has begun receiving payments from the Division of Child Support (DCS) in Economic Services Administration on a limited number of cases. Now that ProviderOne has launched, we are working with DCS on the format for transferring MPA data to them. Testing will begin shortly, with full implementation to begin by the due date of 9/1/10.
 
Work on this project has been suspended because of new federal health care reform legislation.  MPA continues to process payments on existing child support medical cases, but we are not moving forward with data exchange because of the new legislation.
10/5/20109/1/2010
Reduce transportation, x-ray, and laboratory expendituresUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
Transportation services and laboratory and X-ray service expenditures are to be reduced by approximately four percent of their total expenditures for the 2009-11 biennium. The department may reduce rates or take measures to control utilization or a combination of both in order to achieve these savings
Manage MPA costs in light of recent budget reductionsCompleted
8/26/20097/1/2009
Obtain federal match for services provided to legal immigrantsUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad, Manning Pellanda, Roger Gantz2009-07-15
The federal Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) allows for Medicaid match for legal immigrants who would otherwise be eligible for Medicaid but have resided in the country for five years or less. Savings will be achieved through receipt of federal Medicaid match for approximately 3,600 legal immigrants residing on the Children's Health Program (CHP) which is currently almost 90 percent state funded.
Maximize federal financial participation for services already provided to this populationCompleted
8/26/20097/1/2009
Reduce nursing home hospice ratesUse SHIFT+ENTER to open the menu (new window).
DSHSHealth CareThuy Hua-Ly, MaryAnne Lindeblad2009-07-15
The specific hospice rates that are tied to nursing home rates are reduced to reflect the nursing home rate reduction in the Aging and Disability Services Administration (ADSA) budget for the 2009-11 biennium.
Ensure consistency with nursing home rate reductionsDeferred
The nursing home rate reduction is currently in litigation.
8/26/2009
Examine payment reform demonstration grants available under National Health Reform and determine which ones to pursue.Use SHIFT+ENTER to open the menu (new window).
DSHSHealth CareMPA Executive Committee2010-08-15
Many demonstration grants related to payment reform and benefit design were established under the national health reform legislation enacted in March 2010. These include, for example, health homes for enrollees with chronic health conditions, an evaluation of integrated care around hospitalization, global payment systems, and pediatric accountable care organizations.
To explore options for developing a more cost-effective, high quality delivery system.In Progress
6/30/2010
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