On December 30, 2015, CMS approved California’s request for a five-year waiver to extend California’s Section 1115(a) demonstration project, entitled “California Medi-Cal 2020 Demonstration.” According to the CMS approval letter, the extension gives California five more years to extend its “safety net care pool” in order to support the state’s efforts towards “the adoption of robust alternative payment methodologies and support better integration of care.” California’s extension is effective from December 30, 2015 through December 31, 2020.
Section 1115(a)(1) of the Social Security Act allows the Secretary to waive compliance with any of the requirements listed in Section 1902, to the extent necessary to allow the state to carry out the demonstration project. 42 U.S.C. 1315. Section 1115(a)(2) of the Act allows the costs for such demonstration project, which would not otherwise be included as expenditures, to be regarded as expenditures under the State plan to the extent and for the period prescribed by the Secretary. The approval letter highlights the following four elements of the waiver:
-
Public Hospital Redesign and Incentives in Medi-Cal or PRIME: This new redesigned pool will build upon California’s previous Delivery System Reform Incentive Payment program. California has committed that 60 percent of Medi-Cal managed care beneficiaries will receive all or a portion of their care through systems paid through alternative payment methodologies by the end of 2020. The approval letter notes that funding for this pool will not exceed $7.464 billion in combined federal and state share.
-
Global Payment Program for the Public Health System: California will create and test a new global payment approach for the uninsured, which will assist designated public hospital systems.
-
Dental Pilot Project: California will implement a dental pilot project for low-income children, which will offer financial incentives to dental providers for delivering necessary preventative care and treatment.
-
Whole Person Care Pilot Program: California will also create a Whole Person Care pilot program to give counties new options to provide coordinated care for “vulnerable, high utilizing Medicaid recipients.” The approval letter notes that the “overarching goal of the WPC pilot is to better coordinate health, behavioral health and social services, as applicable, in a patient-centered manner with the goals of improved beneficiary health and wellbeing through more efficient and effective use of resources.”
Reporter, John Whittaker, Sacramento, +1 916 321 4808, jwhittaker@kslaw.com.
