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DHCS1115 WAIVER

CSRHA – November 10, 2010. DHCS1115 WAIVER. WAIVER PROCESS. Stakeholder and Technical Workgroups Discussion about specific rural issues and how rural communities would participate Focus on “organized delivery systems” $10 billion over 5 years Effective 11/1/2010 through 10/31/2015.

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DHCS1115 WAIVER

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  1. CSRHA – November 10, 2010 DHCS1115 WAIVER

  2. WAIVER PROCESS • Stakeholder and Technical Workgroups • Discussion about specific rural issues and how rural communities would participate • Focus on “organized delivery systems” • $10 billion over 5 years • Effective 11/1/2010 through 10/31/2015

  3. KEY ELEMENTS • Expand coverage to more uninsured adults; • Help to preserve the safety net; • Improve care coordination for vulnerable populations; and • Promote public hospital delivery system transformation.

  4. EXPANDED COVERAGE • Implement Coverage Expansion and Enrollment Demonstration (CEED) • Coverage for as many as 500,000 persons • Transition plan to Medi-Cal 2014 • Funding to support expanded coverage through 2013 with county matching funds • $2.3 billion for eligibles 0-133 FPL • $600 million for eligibles 133-200 FPL

  5. Expanded Coverage • Requirements for covering 0-133 eligibles • Benchmark-like benefits • Due process for eligibility and benefit access • Network adequacy standards; contract with at least one FQHC • Out of network hospital emergency care • Prospective payment system rates required • Mental health and substance abuse parity rules will apply according to forthcoming Medicaid rules

  6. NEXT STEPS • Prepare for health reform • Early enrollment of childless adults • Initiate process for existing Coverage Initiative to transition to CEED projects • Initiate process for new counties to become CEEDs

  7. Two Perspectives • Lee Kemper Executive Director, CMSP Governing Board • Dean Germano CEO, Shasta Community Health Center

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