Medicaid Transformation Basics
What are the projects?
Last fall, the BHT Board selected four project areas from the state Toolkit:
- Bi-directional Integration of Care
- Chronic Disease Management
- Addressing Opioid Public Health Crisis
- Community-Based Care Coordination
In addition to the four project areas, the BHT Board approved four local priority areas:
- Reduce unintended pregnancies
- Improve oral health
- Increase behavioral health access
- Reduce jail recidivism
Why did BHT also select priority areas?
The Board selected these priority areas to honor the topics that came out of the early BHT focus groups, to highlight activities that came from the projects that were not select from the toolkit, and because there is a lot of opportunity in these areas for community alignment. Approving these priorities gave BHT the authority to continue to drive transformation in those areas.
What is BHT doing with the data now?
We are using the information to make recommendations for future region-wide technical support and tools. Each Collaborative will receive a summary to inform the Partnering Provider and Collaborative Transformation Plans. BHT will use the data to aid in completing the semi-annual, state-level reporting to the Health Care Authority (HCA).
How can I get a copy of my organization’s assessment results?
Key contacts from each organization received a copy of any assessment completed. If you don’t know who the key contact is at your organization, please email Justin Botejue at email@example.com and you will be connected with the appropriate person.
How much is our organization getting paid for doing the assessment(s)?
BHO contracted Mental Health and Substance Use Medicaid providers who completed the FIMC Readiness assessment qualified for a payment of $15,000 for tribal organization and $20,000 for all others. The payment MTP assessment was $15,000 for primary care providers and $5,000 for behavioral health providers.
Can I request additional information from the assessments?
Yes, there were more questions about several other topics than we were able to include in the webinar. If you have a specific request, please contact Hadley Morrow at firstname.lastname@example.org to see if we have data available.
Partnering Provider Transformation Plans
Who is supposed to be submitting Plans?
In this phase of the planning, BHT is asking for Plans from behavioral health and primary care Partnering Providers.
When are Transformation Plans due?
Partnering Provider Transformations Plans are due to BHT on or before August 1, 2018. This deadline allows BHT time to review plans, communicate with the Partnering Provider if there are any questions, and then formulate our report to the HCA. BHT will notify Partnering Providers by September 5 if we have any outstanding questions regarding their Plans.
How rigid are the deadlines?
We have to set rigid deadlines in order to meet all fast-paced milestones necessary to earn Transformation dollars. That being said, our goal is to prepare Partnering Providers for Transformation, not to penalize anyone who needs more support in order to be successful. As long as Partnering Providers communicate openly about any challenges to meeting deadlines, BHT staff can be flexible in supporting high-quality and complete deliverables.
How do I submit my Transformation Plan?
You can submit your Transformation Plan either via the secure webform on the Collaborative Workspace or you can email your plan to Hadley Morrow at email@example.com.
Is the review of the Collaborative Transformation Plans pass or fail?
No. It is BHT's intent that every Collaborative and Partnering Provider succeed. After the review, BHT will provide feedback and Collaboratives can refine the plan as needed. Final plans will be due by end of September and should display and alignment between the Collaborative Plan and the Partnering Provider Plans.
Who is reviewing the Plans?
BHT and the Health Management Associates (HMA) consulting team reviewed the Collaborative Plans. BHT staff provided feedback to each of the Collaborative leads.
Who is HMA?
Health Management Associates (HMA) is a healthcare research and consulting firm that has been providing technical assistance to BHT team for the last year.
BHT, HMA, and a group of volunteers from our Technical Councils will be reviewing the Partnering Provider Transformation Plans, due on August 1. Plans will be reviewed during the month of August with feedback delivered back to Partnering Providers by September 5.
How do the BHT technical councils fit into this work?
Each technical council is a specialized group, meant to help inform and guide the transformation process. The councils developed the recommendations that led to the framework of the Transformation Plan. Also, members from each council will participate in the review of the plans.
How are these plans different than the Collaborative Transformation Plan?
The Collaborative Transformation Plans were developed by all Partnering Providers within each Collaborative. The idea is for these plans to help provide a framework of regional goals and activities. These Plans also contain the regional framework for activities related to community-based care coordination.
The Partnering Provider Transformation Plans will be specific to how that each provider will make changes to their practice; describing their strategies/activities, goals, timeline, and budget for activities within the project areas of bi-directional integration, chronic disease, and opioids. It is intended that the Partnering Provider Plans will be driven by the framework established in their Collaborative’s Plan.
Does an organization need to be a member of the Collaborative in order for them to be included in a Partnering Provider Transformation Plan?
No. You can write any community partner into your Plan.
If only behavioral health and primary care Partnering Providers are completing individual Plans, how are the other Partners meant to participate?
BHT would encourage pharmacy, oral health, social determinants of health, and other key Partnering Providers to develop their value proposition of how they could assist behavioral health and primary care Partnering Providers in meeting their setting requirements and value-based payment (VBP) goals. It is also expected behavioral health and primary care Partnering Providers would be developing their plans with eye towards establishing the linkages necessary to meet the setting requirements. BHT will continue to convene Collaborative members with an aim towards each Collaborative developing a deeper understanding of the individual organizations involved and how Partners can work together.
How would a Partner who is not filling out a Transformation Plan get funding to support their work?
A behavioral health or primary care Partnering Provider could include other organizations and key partners into their Plan as part of their network for how they will meet the setting requirements for projects. This could include budget items for what that partner would need to support the work.
What level of contractual relationship does BHT want to see in the Partnering Provider Transformation Plans?
BHT needs proof of intent and capacity to partner, but recognize that because plans will be refined after reviewed, it is premature to put contractual agreements in place. But it is our expectation that any partnership between behavioral health, primary care, social determinant of health, or other key partners will have declared their intent to work together prior to submitting the Partnering Provider Transformation Plan. This could include an intent to partner letter of support or an MOU.
It could be that each if two Partnering Providers are both filling out Plans, then each partner notes in their Plan the intent to work together. For example, if a primary care clinic mentioned a behavioral health practice they want to partner with in their Plan, BHT would expect to see that partnership also described in the behavioral health provider’s Plan. This would display that both sides agree to this partnership.
If a primary care Partnering Provider Transformation Plan mentioned a partnership with an organization that is not being asked to submit a Plan (such as a social service organization) we would expect that, if asked, that organization would confirm the intent to partner.
We expect that partnerships will have formal agreements (likely a contract) in place by early 2019.
Are providers required to do activities within every project area?
Yes. BHT does not see Transformation as separate projects but as a set of aligned activities. We hope that all Partnering Provider Transformation Plans contain answers for all three project areas. However, if you are not able to take on one of these projects, we ask you to explain why in your Plan. We are using these answers to identify gaps and needs, so this type of information is important and gives us a better picture of the provider network.
One notable exception is that the opioid project area has four strategies, and while each Collaborative needs to address all four strategies, not every Partnering Provider will need to do all four.
If a partner does not select a project/activity, how will that impact how much money they can earn?
We have not made any decisions on how incentive and performance payments will flow past the policies in place. However, it is unlikely that there will be a set dollar amount, or score tied to specific projects and activities.
What is an ACO?
An Accountable Care Organization (ACO) is a group of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.
CMS offers different learning opportunities for providers and organizations interested in learning more about ACOs. Visit the CMS Innovation Center website and Medicare Shared Savings Program website periodically to learn about the latest opportunities.
What kind of support is BHT providing to the Partnering Providers while they create their Transformation Plans?
BHT has planned an extensive support plan including the following:
- Webinars covering every aspect of the Partnering Provider Transformation Plan Template
- Regularly updated FAQ (email your questions to Kim Brinkmann at firstname.lastname@example.org)
- Links to documents and resources on Collaborative Workspace web page, such as:
- HCA Toolkit
- Performance measures and baseline data
- Assessment summaries
- Office hours: call (509) 960 8593 to be directed to staff who can answer questions or to set up a one-on-one appointment
- Subject matter experts: available for T.A. calls/questions about the models
What additional suggestions for support do you have?
Project Funds & Budget
For specifics in regard to receiving payments from the FE Portal read our How Do I Get Paid post.
How much money is there?
Approximately, $61.7 million is available to the BHT region to earn over the next five years. The Waiver Finance Workgroup has approved the following allocation breakdown:
- 55% to Collaboratives
- 30% to Regional Infrastructure
- 10% to a Community Resiliency Fund
- 5% to BHT for Administrative costs
Should the source of the payments be classified as state, federal, or private donations?
Payments from the ACH are earned incentives under a performance contract. These are not federal or state grants or awards, and therefore are not required to be reported on an organizations SEFA (Schedule of Federal Expenditures) report. We recommend all organizations consult their own legal or finance teams for guidance on how to categorize the funds or any other reporting questions.
What is the legal/fiduciary responsibility of BHT for funds that pass by, but not through, BHT in the FE Portal? If an ACH is audited, do they need to know how a provider spent earned dollars?
BHT will need to track how partnering providers earned the incentives according to our region’s approach to funds flow. However, BHT is not required by the state to manage how the money is spent by providers/partners. BHT may elect to work with providers/partners to capture provider/partner-level spending of incentive dollars.
Will BHT need any additional detail or reporting other than what is already outlined in the FE Portal and Project Plans?
HCA encourages ACHs to keep detailed records of their budget and funds flow to partnering providers in preparation for implementation plans and semi-annual reports. It is likely that BHT may be asked for further detail regarding how they are investing incentive dollars. Therefore, it would be a smart practice for Providers to keep detailed information on how their incentive payments were spent. Further guidance will be issued as implementation plan and semi-annual reporting templates are developed.
Who is considered the payer on the 1099 form?
The FE will be considered the payer on the 1099 form, there will be a memo that identifies the payment was made by the specific ACH.
When will the Collaborative Lead money be released?
For the rural Collaboratives, $15,000 of the $50,000 will be released once Collaborative's Plan is deemed complete. The balance will be released after Collaborative's Plan has been crosswalked with Provider Plans and all areas are complete.
The Spokane Collaborative has not determined how they will allocate funding.
What is the Community Resiliency Fund?
The Community Resilience Fund (CRF) will grow from the 10% allocation of project funds over 5 years, for a total of approximately $7.1 million, to be expended by 2022. It is meant to ignite and support regional, community-led initiatives aimed at strengthening resilience in our community through social determinant investments and key system investment to promote improved population health. We expect the Community Resilience Fund will deepen and strengthen existing investments as well as provide a model for future investments that is attentive to the ever-changing landscape.
How will the Community Resiliency Fund be spent?
No decision has been made yet on how these funds will be distributed. We will be conducting a community process to generate ideas from the region via brainstorming sessions with our council. We plan to have a model for distribution ready for board review this fall, with funds being distributed in early 2019.
Core Principles of the Fund:
- Utilize data to drive community decision making
- Extensive and expansive community feedback to inform where change is needed
- Balanced community-based governance on fund distribution
- Aligned priorities and leveraged investment across regional health and community
- Utilize shared savings model to drive additional investment
What are the rural accelerator funds?
The rural accelerator funds were earned by each of the five rural Collaboratives ($50,000 each), to be used for supporting integration of primary care and behavioral health. It is anticipated funds will be used to support planning activities such as; staff to coordinate identified collaborative activities, technology to manage relationships and interactions among member organizations, cost to convene meetings and trainings, including materials. The funds may not be used for programs and/or services covered by Medicaid and other funders.
What are the equity accelerator funds?
The equity accelerator dollars were earned by primary care and behavioral health organizations that serve a client pool with greater than 10% racial diversity. This is meant to support organizations who take on serving a higher percentage of the underserved populations, who often correlate with a higher probability of negative health outcomes. This is a onetime payment to demonstrate the BHT’s commitment to closing the gap on health inequities.
What are the volume equalizer funds?
The volume equalizer dollars were earned by primary care and behavioral health organizations serving a higher percentage (>10%) of the Medicaid population, recognizing that the more people your practice serves the more your organization will need to do to meet Transformation goals.
Who will the funding be disbursed to?
The Collaborative Lead funding will be released in chunks and dispersed directly to the Lead organization.
The Rural Accelerator will be released after the BHT Board approves distributions at the August board meeting. We can allocate the dollars as the Collaborative directs us. If it’s easier to distribute directly to Partners we can do that or release directly to the Lead for distribution.
Will future money only go to primary care and behavioral health Partnering Providers?
We have not determined how resources will be allocated for years 2-5. It is possible that primary care and behavioral health will receive a majority of the funds and then allocate to other partners, but this has not been decided.
We have not identified how the Community Resiliency Fund will be allocated; we expect to release this process in late 2018 with funding being available in early 2019. We expect these funds to support linkages between social determinant of health and health care organizations. This is not intended to be the SDOH partner funding.
How will money be earned after this planning year?
The region (via BHT) earns money differently than how providers earn dollars.
BHT earns the regional funding by submitting two reports to the Health Care Authority (HCA) each year. As long as we can demonstrate that we have met the anticipated milestones, we will earn 100% of the dollars.
BHT and the Waiver Finance Workgroup have not yet made any additional decisions on how Project dollars will be earned by Partnering Providers other than the allocations established for this planning year (MOU, volume and equity accelerators, assessments, and Implementation Plans for behavioral health and primary care Partnering Providers).
BHT does expect that Project Fund allocations for Year 2-5 will be comprised of a combination of pay-for-reporting and pay-for-performance measures and will be informed by the Collaborative and Partnering Provider Implementation Plans. The Waiver Finance Workgroup will allocate dollars to specific improvement activities in late 2018 or early 2019. If Partnering Providers are able to meet all those activities, they will be able to earn 100% of the dollars.
If we don’t know how much is available to earn, then how can we make a budget?
Transformation Plan Budgets are for informational purposes only and it is not expected Project funds will fully cover projected costs. Providers should build their financial plans with a view towards weaving together funding to meet setting requirements, not “pitching” specific project ideas. For each budget category in the template, BHT is requesting Partnering Providers to identify estimated costs associated with Transformation Plan activities along with costs associated with project management and convening. BHT will be reviewing Transformation Plans with an eye for whether or not each Providers is able to meet all of the of pay-for-reporting and pay-for-performance measures. If yes, they would earn the full amount allocated to those activities.
Can items on the budget be retroactive?
(Example, reimbursing organizations for time already spent organizing.)
No. Plans are for Implementation year activities only.
Can BHT include some examples of line-items for each of the 4 categories of spending on the budget?
Yes! Check out our Budget Webinar where we go over examples and tips for filling out the budget template!
I’m a public hospital district and I received IGT funds. Who should I talk to about that?
Please email Ben Lindekugel, executive director of the Association of Washington Public Hospital Districts at email@example.com. This article explains the IGT funding process in more detail.
Who is receiving FIMC funds?
The first round of FIMC funding goes to BHO contracted Medicaid Providers and Tribal BH Providers in order to help them prepare for financial integration in 2019.
How much did they receive?
BHO Contracted Medicaid Partnering Providers, regardless of volume or geography, earned $70,000 each. Tribal behavioral health Partnering Providers, regardless of volume or geography, earned $45,000 each.