2013 Session

Budget Amendments - HB1500 (Member Request)

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Chief Patron: O'Bannon
Co-Patron(s): Brink, Dance, Jones, May, Merricks, Peace, Poindexter, Rust
Medicaid Reform Initiative (language only)

Item 307 #8h

Item 307 #8h

Health And Human Resources
Medical Assistance Services, Department of

Page 280, after line 14, insert:
"JJJJ.1.  The Secretary of Health and Human Resources and Department of Medical Assistance Services (DMAS) are directed to prepare and file no later than September 1, 2013 an appropriate waiver or series of waivers with the Centers for Medicare and Medicaid Services (CMS) to:
a. Incorporate existing plans to improve the coordination and management of care for persons eligible for both Medicaid and Medicare (dual eligibles), building on lessons learned in other states as well as the state's own experience with the Program for All-Inclusive Care for the Elderly (PACE) and including provisions for an equitable sharing of savings for both the Virginia Medicaid and the federal Medicare programs from any cost-avoidance that results from improved care coordination and quality.
b. Develop an enhanced managed care program for the highest cost Medicaid patients, such as frequent emergency department users, patients with 10 or more active prescriptions, and other high-cost patients identified by the department.
c. Enhance the ability of the Department of Medical Assistance Services to oversee and assess the value provided by managed care plans regarding quality and cost effectiveness of care and patient health outcomes.
d. Enhance the coordination of care for all populations covered by Medicaid or FAMIS, drawing on lessons from best practices in other states and the Commonwealth’s Medicaid managed care systems.
e. Improve the effectiveness of community mental health services with the goal of reducing, in a manner consistent with public health and safety, the incidence of incarceration of mentally ill adults and children.
f. Improve the quality of prenatal care and post-partum education provided to pregnant women covered by Medicaid to improve birth outcomes and reduce infant mortality.
g. Strengthen chronic disease prevention among children covered by Medicaid and FAMIS, focusing on preventing childhood obesity and related co-morbidities such as diabetes.
h. Take advantage of federal funding to extend coverage to newly eligible individuals, provided that:  (i) federal funding commitments are maintained at current levels; and (ii) that the waiver allows the Commonwealth to customize benefits and other program parameters appropriate for the newly covered population to provide access to high quality, cost effective care, including (1) benefits emphasizing primary care, prevention, wellness and mental health care, (2) incentives for healthy behaviors, (3) limits on nonessential benefits such as non-emergency transportation, and (4) a patient engagement requirement.  The patient engagement requirement shall include, but not be limited to, keeping appointments, obtaining appropriate health screenings, and as necessary, participating in smoking cessation, weight management, and substance abuse programs.
i. Other issues as may seem appropriate to further the overall goals of improving access to quality, cost effective care.
2.  As a condition of this appropriation, DMAS is authorized to use such nongeneral funds as may be available and shall be necessary to assist in implementation of this item contingent upon the continued receipt of federal financial participation at the current federal medical assistance percentage (FMAP) or higher as provided for in federal law.
3.  As a condition of this appropriation, the implementation and maintenance of a Medicaid reform plan that includes any extension of coverage to newly eligible individuals shall be contingent upon the continued receipt of federal financial participation at the current FMAP or higher as provided for in federal law.
4.  The Department of Medical Assistance Services shall provide copies of waiver applications, as well as a summary of any expenditure of nongeneral funds in implementing this item to the chairmen of the Senate Education and Health, Senate Finance, House Appropriations, and House Health, Welfare, and Institutions Committees; and the Joint Commission on Health Care."

(This amendment adds language directing the Secretary of Health and Human Resources and the Department of Medical Assistance Services to develop a fiscally responsible and sustainable Medicaid reform proposal that will require a revised federal-state relationship, including significantly enhanced state flexibility. The overall goals of the Medicaid reform proposal are to: (i) put the Medicaid program on a path toward long-term fiscal sustainability; (ii) build on current care management systems and redesign care delivery to improve patient health and quality of care; and (iii) promote patient engagement in the health care delivery system. The federal Patient Protection and Affordable Care Act presents states with significant implementation challenges, especially with regard to the Medicaid program. Virginia’s Medicaid program has more stringent eligibility limits, better cost containment, and lower provider rates than programs in many other states. However, costs of the existing program have consistently grown at rates in excess of state revenues over the last twenty years, due in part to federal policy constraints imposed on the state. Accordingly, simple expansion of the existing Medicaid program is not in the best long-term interests of the Commonwealth. However, broader state flexibility would allow Virginia to (i) reform and strengthen the existing Medicaid program, (ii) design a benefit package and delivery reforms better suited for a potential newly covered population of low-income able bodied adults, and (iii) take advantage of the health improvement and economic benefits from related federal funds.)