Transcript DHCS Medicaid Managed Care Regulations Powerpoint

Medicaid Managed Care Regulations
CBHDA Medi-Cal Policy
August 17, 2016
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Presentation Overview
I. Medicaid Managed Care (MMC) Regulations
Overview
II. DHCS Review Process
III. MHSD Review Process
IV. Key Provisions
V. Impact of the Final Rule
VI. Questions
Service - Accountability - Innovation
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Final Rule Overview
• Federal Managed Care Regulations – Part 438 of
title 42 Code of Federal Regulations
• Issued in the Federal Register on May 6, 2016
• Applies to the provision of Medicaid Managed
Care (MMC) programs and managed care
organizations (MCOs)
• Mental Health Plans classified as Pre-paid
Inpatient Health Plans (PIHPs)
• Effective date of Final Rule was July 5, 2016
• Phased implementation of new provisions over a
3 year period
Service - Accountability - Innovation
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CMS’ Goals of the Final Rule
The final rule advances CMS’ mission of better care,
smarter spending, and healthier people.
Key Goals:
• To support State efforts to advance delivery
system reform and improve the quality of care
• To strengthen the beneficiary experience of care
and key beneficiary protections
• To strengthen program integrity by improving
accountability and transparency
• To align key Medicaid and CHIP managed care
requirements with other health coverage
programs
Service - Accountability - Innovation
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DHCS Review Process
• Implementation effort led by Jennifer Kent
• Impacts across DHCS divisions
Service - Accountability - Innovation
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MHSUDS Impact
• Medi-Cal Specialty Mental Health Services
• 1915(b) Waiver – Special Terms and
Conditions
• Knox-Keene Health Care Service Plan Act
(1975)
• ACA expansion of Medi-Cal mental health
services
• Drug Medi-Cal Organized Delivery System
(DMC-ODS) Waiver
Service - Accountability - Innovation
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MHSD Review Process
• MMC Final Rule Implementation Team
– Led by Rachelle Weiss and Autumn Boylan
– Includes all three Branches in MHSD
– Meets twice weekly on Mondays and Fridays
– Responsible for reviewing, analyzing, determining
the impact of the Final Rule, and developing
implementation work plans
Service - Accountability - Innovation
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Key Provisions
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State Monitoring Requirements
Network Adequacy
Data Quality
Quality Measurement and Improvement
External Quality Review
Beneficiary Support and Protections
Program Integrity
MHP Reporting Requirements
Service - Accountability - Innovation
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Impact of Final Rule
• Significant changes to the mental health
delivery system for Medi-Cal managed care
• MHP Contract amendments
• Regulation amendments
• New reporting requirements
• Enhanced monitoring by State and EQRO
• County Behavioral Health Directors
Association of California (CBHDA)/DHCS Work
Group
Service - Accountability - Innovation
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QUESTIONS?
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