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One year extension and amendment
MTP is a five-year Section 1115 demonstration from the Centers for Medicare & Medicaid Services (CMS). HCA is seeking CMS approval to amend our existing waiver to:
- Provide flexibility related to long-term services and supports (LTSS).
- Align the value-based payment (VBP) target for year 5 of MTP because of state adjustments due to COVID-19.
HCA is also seeking CMS approval to extend for one year to create a sixth year for MTP.
The COVID-19 pandemic has strained our health care system, essential workers, families and communities. It has uncovered structural inequities in the health care system, and dramatically affected vulnerable populations and the providers who serve them. MTP is well-positioned to mitigate the challenges of COVID-19.
An extension would allow Washington State to continue its COVID-19 relief efforts through each of the MTP initiatives. It would also serve to further the continued implementation of the MTP’s transformational goals and progress toward value-based care.
We are requesting an amendment to:
- Extend the long-term services and supports (LTSS) presumptive eligibility process so patients can access essential services immediately, rather than having to undergo a financial eligibility determination and a full functional eligibility assessment first. This change would also include access to appropriate LTSS programs through Community First Choice and 1915(c) waivers.
- Change the definition to allow transportation to community supports and services. Through this amendment, Washington State will offer transportation—according to a participant’s service plan—to MTP-based services, community supports, as well as other activities specified in the service plan.
- Adjust the 2021 managed care organization value-based payment (VBP) adoption target from 90 percent to 85 percent. This adjustment has already been made within Apple Health contracts. This change will ensure the MTP target aligns with the Apple Health Appendix and state VBP target because of COVID-19. In addition, the state is seeking an adjustment to the way improvement is calculated for VBP-related incentives under MTP.
The waiver allows Washington State to create and continue to develop projects, activities, and services that improve our state’s health care system. All work under MTP benefits those enrolled in Apple Health. MTP includes the following initiatives:
- Transformation through Accountable Communities of Health and Indian Health Care Providers: transforming the Medicaid delivery system through a regional approach. Each region, through its Accountable Community of Health (ACH), pursues projects aimed at transforming the Medicaid delivery system to serve the whole person and use resources more wisely. Washington’s Tribes and Urban Indian Health Programs are implementing projects to improve care and the health of people served through Indian Health Care Providers.
- Long-term services and supports: supporting Washington’s aging population and family caregivers who provide care for their loved ones, through Medicaid Alternative Care and Tailored Supports for Older Adults.
- Supportive housing and supported employment: helping people get and maintain stable housing and employment in support of their broader health needs.
- Substance use disorder (SUD) treatment services: providing additional federal funding for expanded SUD treatment in participating health care facilities.
- Mental health IMD: if approved, would support the development of extended services in participating facilities for enrollees with serious mental health conditions.
- View one-year extension application package (submitted to CMS on January 8, 2021)
- Read one-year extension application summary (executive summary)
- View amendment request package (submitted to CMS on January 15, 2021)
- Read amendment request summary (executive summary)