CHA News Article

Stakeholder Session on 1115 Waiver Renewal and Proposed Shared Savings Initiative Set for Jan. 30
DHCS engages stakeholders in 1115 waiver renewal process

The California Department of Health Care Services (DHCS) will hold a stakeholder session Jan. 30 from 12:30 p.m. – 3:30 p.m. in Sacramento  — and concurrently via webinar — to discuss its proposed federal-state shared savings initiative, a key concept of recent 1115 waiver renewal discussions. The initiative would maximize federal financial investment in California’s public safety net and allow the state to implement other waiver initiatives that incentivize delivery system transformation that can result in optimal health outcomes for Medi-Cal members. The session is open to the public, and stakeholders may submit comments in person or through a web-based portal. Meeting materials and an agenda will be posted to the DHCS website in advance of the meeting, and online webinar registration is available.

Meeting Location
DHCS Auditorium
1500 Capitol Avenue
Sacramento

Background
As DHCS continues its 1115 waiver renewal stakeholder engagement process, it has outlined upcoming meeting dates and locations, along with summaries of each meeting, on its website. CHA has been appointed to serve on many of the 1115 waiver renewal stakeholder workgroups and will continue to provide members with updates about the process in CHA News. All 1115 waiver renewal discussions are open to the public.

California’s current section 1115 “Bridge to Reform” waiver – set to sunset Oct. 31, 2015 – is a five-year demonstration of health care reform initiatives to prepare California for significant changes under the Affordable Care Act (ACA). California is seeking a waiver renewal that will build on the approaches and successes of the existing waiver as it moves forward, with the goal of expanding and improving the Medi-Cal program through delivery and payment system transformation. California will submit its waiver renewal request to the Centers for Medicare & Medicaid Services (CMS) in spring 2015 (requests to CMS must be submitted at least six months before the end of the current demonstration).

In July, DHCS shared its initial waiver renewal concepts with stakeholders, with the stated goals to: 1) further delivery of high-quality and cost-efficient care for Medi-Cal members, 2) ensure the long-term viability of the delivery system post-ACA expansion, and 3) continue California’s momentum and successes in innovation achieved under the current “Bridge to Reform” waiver. DHCS’ initial waiver renewal concepts include: 1) a federal/state shared savings initiative, 2) payment/delivery system reform incentive payment programs, 3) safety net payment reforms that support coordinated and cost effective care for the remaining uninsured, 4) Federally Qualified Health Care (FQHC) payment and delivery reform, 5) a successor Delivery System Reform Incentive Payment program, 6) California Children’s Services (CCS) program improvements, 7) Medicaid-funded shelter for vulnerable populations, and 8) a workforce development initiative.

DHCS’ initial waiver renewal concepts are built around the core objectives of strengthening primary care delivery and access, avoiding unnecessary institutionalization and services by building the foundation for an integrated health care delivery system that incentivizes quality and efficiency, addressing social determinants of health, and using California’s Medicaid program as an incubator to test innovative approaches to whole-person care.

Key themes that have emerged from initial stakeholder discussions include alignment of metrics across providers, health plans and delivery systems; developing shared savings/accountable care arrangements between entities toward higher-quality, more cost-effective care; behavioral health integration strategies within each of the workgroup concept areas; expanding workforce capacity and access to Medi-Cal members by incentivizing new providers to serve Medi-Cal members, and for existing providers to serve additional Medi-Cal members; strategies to maximize federal financial investment under the authority of section 1115 waivers; and evaluation design for delivery system transformation.

Future 1115 waiver renewal stakeholder workgroup meetings will be conducted as follows:

Housing/Shelter
Jan. 28: 10 a.m. – 3 p.m.

DSRIP 2.0
Jan. 26: 10 a.m. – 3 p.m.
Feb. 3: 10 a.m. – 3 p.m.

Safety Net Financing
Jan. 29: 10 a.m. – 3 p.m.

Federal/State Shared Savings
Jan. 30: 10 a.m. – 3 p.m.

DHCS will convene CCS program improvements and FQHC payment reform discussions on a separate track. For more information on the CCS program improvements stakeholder engagement process, visit www.dhcs.ca.gov/services/ccs/Pages/CCSStakeholderProcess.aspx. Stakeholders may submit comments to DHCS on its 1115 waiver renewal at WaiverRenewal@dhcs.ca.gov. All stakeholder input submitted to DHCS can be accessed on its website at www.dhcs.ca.gov/provgovpart/Pages/Stakeholder-Input-Letters.aspx.

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