Arc Update on Implementation of the 1115 Medicaid Transformation Waiver
These comments are, to the best of my ability, a report of the development of the
1115 Medicaid Transformation Waiver and where we are headed. These are not
the Administration’s comments.
Included in the report:
Governor’s Office of Health Innovation & Transformation (GOHIT)
For your information, GOHIT (Governor’s Office of Health Innovation and
Transformation) is responsible for leading and coordinating the implementation
of the transformation principles in the Innovation Plan, including the 1115
Waiver, and supporting stakeholder engagement. Its Executive Director is
Michael Gelder, who still remains as a Senior Advisor on Health Care to the
Governor.
Some history here: the 1115 Waiver was rolled out in October, 2013. It is the
largest and most comprehensive 1115 Waiver ever submitted to the Centers
for Medicare and Medicaid (CMS). All eyes are now on Illinois as it is proposing
major and sweeping changes to the way it delivers health care and human
services.
If the CMS approves the Illinois 1115 Waiver, it will combine the current 9
Waivers in Illinois into one Super Waiver. The objective of this Waiver is that
the silos of the current 9 Waivers will be broken down thereby creating a
statewide seamless service delivery system that is person-centered, not
relying solely on person’s.
Between October and February, 2014 numerous stakeholder meetings were
held for public comment. The Arc submitted written testimony on the Draft
1115 Waiver no less than three times during that process. Many advocates
including, The Arc, expressed their concerns that the Draft 1115 Waiver was
lacking details on how this was going to be implemented and what specific
actions would be required of individuals and providers.
Developmental Disability specific areas of the 1115 Waiver included:
Elimination of the PUNS Waiting List
Increasing Direct Support Professionals wages & benefits
Increased funding for Employment First Initiatives
Creating and downsizing CILA and other community living options
Resources for Developmental Disabilities included:
Resources to reduce the waiting list – $60,000,000
Increase in service costs to bring parity to waivers – $150,000,000
Children’s Mental Health Services – $30,000,000
Increased rates for residential providers – $38,400,000
After reviewing the comments from advocates, the Administration submitted
“The Path to Transformation: Illinois 1115 Waiver Proposal,” on June 4, 2014.
As I read through this document, I saw only minor changes to the sections on
Developmental Disabilities.
It is estimated that discussions between the Administration and CMS could
move as quickly at 6 to 8 months for approval of the 1115 Waiver or years.
The Administration is now beginning deliberations on the Proposed 1115
Medicaid Transformation Waiver with the Centers for Medicare & Medicaid
about Illinois’ ability to implement this massive Waiver.
The time has now come to add detail and specifics to implement the Proposed
1115 Medicaid Transformation Waiver. This will be the focus of the various
work groups now being created by GOHIT starting today, developing
actionable goals and recommendations.
Lorrie Rickman Jones, Ph.D., Senior Policy Advisor for Behavioral Health,
GOHIT, began the meeting by outlining the objectives of the meeting:
Review the ground rules for participation and the communication
pathways for outcomes of this process.
Establish the Children’s Services and LTSS subcommittees and
introduce chairs.
Review the scope of work for the two subcommittees and identify the
initial priorities.
Propose and receive feedback on principles and values.
She then moved to the vision of the work groups which is:
Providing an open and participatory process for policy makers and
stakeholders to advise the state on how best to implement Alliance for Health
and Section 1115 Waiver innovations to improve health, improve health care
delivery, and lower costs. Work groups will address issues of stakeholder
concern fairly and deliberately, and leverage the work of existing advisory
groups.
She also shared the Charter of the group:
The Governor’s Office of Health Innovation and Transformation (GOHIT),
created by the Governor’s Executive Order 14-01, is responsible for
implementing the Alliance for Health Innovation Plan in coordination with the
multiple State and federal agencies and private sector health care
stakeholders involved in the Plan’s creation.
The Innovation plan includes the very important Section 1115 Waiver request
to the Center for Medicare and Medicaid Services (CMS) in the Department
of Health and Human Services. This waiver is essential to receive substantial
new funding through the Medicaid program and affords the State flexibility to
achieve its rebalancing, work force, public health integration and technology
objectives. This effort will require stakeholder engagement and support.
The Alliance for Health developed the Alliance for Health Innovation Plan out
of a six-month planning grant awarded from the Center for Medicare and
Medicaid Innovation. GOHIT is responsible for leading and coordinating
implementation of the transformation principles in the Innovation Plan,
including the 1115 Waiver, and supporting stakeholder engagement.
Five Work Groups have been created for this task:
Services & Supports
Delivery System Reform
Workforce
Data & Technology
Public Health Integration
The Principles that will drive this Work Group process will be to operationalize
our values and help us realize our goal of providing quality, accessible,
community-based care that provides a full range of options to individuals who
seek our services. In Illinois, the following principles guide the design, delivery,
and evaluation of all mental illness prevention, treatment, and recovery support
services:
Services for individuals of all ages are person centered, strengths based,
trauma informed, and culturally competent. Services are founded on
evidence-based, evidence-informed, best, and emerging promising
practices
Services are flexible, tailored, and provided in the least restrictive setting
appropriate to the individual’s needs
Adults with specific needs are provided with the support they need to
live in mainstream housing and have real jobs that pay a living wage
Children and families have access to a broad, flexible array of effective
services and supports that are integrated at the system level and
individualized to each child’s and family’s needs
Individual and families are served wherever and whenever they present
for care (“no wrong door”)
Holistic approach to assessment process will enhance the linkage of
consumers to services and supports and result in better health outcomes
Where conflict exists, firewalls and appropriate safeguards are
established that assure consumer choice and protect consumer rights
Services are integrated to the greatest extent possible across specialty
providers and primary care settings. Coordination extends to adult- and
child-serving systems and to all systems that serve veterans and
individuals currently or previously involved in criminal or juvenile justice
systems
Outcomes are standardized and measured at the individual, provider, and
service system level. Outcome data drives quality improvement efforts
The work group that I believe will have the most impact on the Developmental
Disability System will be the Supports and Services Work Group Chaired by
Lorrie Rickman Jones, Ph.D. Senior Policy Advisor for Behavioral Health, GOHIT,
and Co-Chaired by Grace Hou, President, The Woods Fund of Chicago.
This work group will have two Sub-Committees:
Long Term Services and Supports
Children’s Behavioral Health
Within these two sub-committees, Long Term Services & Supports will have the
greatest implications for developmental disabilities and where The Arc will be
focusing most, but not all, of its attention.
The Long Term Services & Supports Sub-Committee will be Chaired by Laura
McCurdy of the Dept. of Health Care & Family Services (HFS).
The Children’s Behavioral Health Sub-Committee will be Chaired by Deborah
McCarrel.
The various Work Groups and Sub-Committees will work together to develop
actionable steps and recommendations on their areas of expertise for the
implementation of the strategic plan to GOHIT. The Work Groups are also to
make sure their actionable goals and recommendations are compatible with the
new Centers for Medicare & Medicaid Rules for Community Living & Services
and managed care principles and moving away from fee for service.
The Work Groups are expected to make their final report and recommendations
by January, 2015.
GOHIT will gather and process the recommendations and the GOHIT Executive
Advisory Committee will finalize the strategic plan. The GOHIT Executive
Advisory Committee is made up of the Directors of State Agencies.
GOHIT Resources:
Anyone wishing to sign up for a Work Group/Subcommittee should e-mail
GOV.GOHIT@illinois.gov
Please provide your name, title, organization, e-mail address and identify the
Work Group/Subcommittee you wish to join
Meeting materials will be posted here:
http://www2.illinois.gov/gov/healthcarereform/Pages/GOHIT.aspx
Governor’s Office Health Reform
www.healthcarereform.illinois.gov
1115 Waiver Information
http://www2.illinois.gov/gov/healthcarereform/Pages/1115Waiver.aspx
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)
Tony@www.thearcofil.org
