Connecting the Dots - nastad

Jul 29, 2015 - Harm Reduction Services. ○Prioritized by Governor's ... support services ... Vermont, Rhode Island & Maryland have developed health homes ...
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Medicaid Reform & HIV in New York: Emerging Strategies & Opportunities NASTAD Technical Assistance Meeting July 29, 2015 Daniel Raymond [email protected] www.harmreduction.org

From HIV-specific to Systemic ●Harm Reduction SPA ●Medicaid health homes ●Delivery System Reform Incentive Payment (DSRIP) waiver ●Home & Community-based Services ●Other opportunities: ●Criminal justice/re-entry ●Behavioral health initiatives ●Supportive housing

Harm Reduction Services ●Prioritized by Governor’s Medicaid Redesign Team ●Coverage for array of harm reduction services ●State Plan Amendment pending

Medicaid health homes ●Provide care coordination for select populations (2 chronic conditions or 1 chronic condition + risk for another or serious & persistent mental illness) ●90% FMAP for first eight quarters ●Flexible design (can target by condition, geography) ●Requires state plan amendment (SPA) ●HIV included as qualifying chronic condition in New York

Mandated Core Services ●Comprehensive care management ●Care coordination ●Health promotion ●Comprehensive transitional care and follow-up ●Individual and family support ●Referral to community and social support services

Example: New York • Broad range of qualifying chronic conditions, including HIV/AIDS • 158,460 enrolled by December 2014 • HIV case management transitioned under health homes

Example: Opioid Use Disorder • • •

Vermont, Rhode Island & Maryland have developed health homes for Medicaid beneficiaries with opioid use disorders Designated providers: Opioid Treatment Programs (and Office-Based Opioid Treatment settings in VT) Enrollment (as of 12/14): 4,436 in Vermont, 2,657 in Rhode Island, 515 in Maryland

Challenges for Ryan White How do health homes enrolling PLWHIV interact with traditional Ryan White case management? • Payment/rates • Generalists vs. HIV specialists • Training & cultural competency

Delivery System Reform Incentive Payment (DSRIP) Waivers • 1115 waiver • Requires budget neutrality • Typically focuses on safety net hospitals • General goals: • Infrastructure development • System redesign • Clinical outcome improvements • Population focused improvements

DSRIP example: New York •





Four main goals: • Reducing potentially avoidable hospitalizations by 25% over 5 years • Reducing potentially avoidable ER visits • Reducing other potentially avoidable complications • Improving patient experience Providers must select two priorities for clinical improvement (including HIV/AIDS) and one priority for population health (including preventing HIV and STDs) $6.42 billion funding pool

Home & Community-Based Services • Requires 1915i waiver from CMS • Peer support, rehabilitation, crisis intervention, supported employment • Available for beneficiaries enrolled in HARPs (or HIV SNPs)

Other Opportunities ●Substance use: 1115 demonstration projects (SMD #15003) ●CJ/re-entry: suspending eligibility (e.g. COCHS) ●Supportive housing (ASPE 2014 report on emerging practices)

Key lessons ●Multiple mechanisms & opportunities for innovation ●Look beyond HIV-specific services to structural & systemic population health approaches to social determinants ●Both health systems & HIV community need support in understanding implications ●Move towards value-based payments will reward measurable outcomes