PUBLIC INFORMATION & COMMUNICATIONS

Centennial Care 2.0

Centennial Care 2.0 1115 Demonstration Amendment #2

Centennial Care 2.0 1115 Demonstration Amendment #2 Submitted to CMS

 

2021 Centennial Care 2.0 Waiver Application

Amendment #2 to 1115 Demonstration Waiver

Draft Waiver Application

Attachment A:  Assessment of the Availability of Mental Health Services

Public Hearing Presentation

Request for Comments

The Human Services Department (HSD), Medical Assistance Division (MAD), invites comments from the public about changes to the Centennial Care 2.0 program that are being considered as part of an amendment that is proposed to be effective July 1, 2021. Comments will be accepted until 5:00pm MST on Sunday, January 31, 2021. Read below to learn more about the Centennial Care 2.0 waiver amendment.

HSD will hold two public hearings to receive comments via teleconference due to the Public Health Emergency (PHE) regarding the draft amendment to the waiver. Please see below information for the public hearings.

All comments will be reviewed and evaluated to inform additional modifications prior to submission of the final waiver amendment application to CMS.

Public Hearings

Tuesday, January 19, 2021

1:00 p.m. – 4:00 p.m.
Medicaid Advisory Committee Meeting
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Thursday, January 28, 2021
9:30 a.m. – 10:30 a.m.
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About Centennial Care 2.0

The New Mexico Human Services Department (HSD) is proposing improvements to the Centennial Care 2.0 program and is seeking input from stakeholders throughout New Mexico for consideration before submitting a final waiver amendment to the federal Centers for Medicare and Medicaid Services (CMS).

HSD has released a draft Section 1115 Demonstration Waiver amendment application for Centennial Care 2.0.The draft amendment outlines HSD’s modifications to improve the program.  The draft amendment can be reviewed by clicking here. HSD is seeking federal authority to amend the 1115 Centennial Care 2.0 Waiver (Project Number 11W-00285/6) to make the following changes:

  1. Expand the Medicaid program toward a more integrated model of behavioral health care delivery by providing Medicaid reimbursement for extended IMD stays for individuals with Serious Mental Illness/Severe Emotional Disturbance (SMI/SED) in residential and inpatient Institutions for Mental Disease (IMD) settings;
  2. Establish High-Fidelity Wraparound (HFW) as an intensive care coordination approach for children and youth who have high intensity needs;
  3. Establish a Primary Care Graduate Medical Education (GME) expansion funding mechanism designed to develop new and/or expanded GME programs focusing on the specialists of General Psychiatry, Family Medicine, General Pediatrics, and General Internal Medicine; and
  4. Expand coverage of the Coronavirus (COVID-19) vaccines, to the extent not covered by the federal government during the period of Centennial Care 2.0 demonstration and its administration to individuals who have limited benefit plan coverage including Family Planning Category of Eligibility (COE), Emergency Medical Services for Aliens (EMSA), individuals covered under the COVID-19 uninsured population (FFCRA) and also those receiving only Pregnancy – related services.
  1. Program Description, Goals, and Objectives
    The state’s goals for the Centennial Care 2.0 demonstration include providing the most effective and efficient health care possible for eligible New Mexicans, as well as continuing the healthcare delivery reforms of Centennial Care. Specifically, the state will further the following goals:
  • Assure that Medicaid members in the program receive the right amount of care, delivered at the right time, and in the right setting;
  • Ensure that the care and services being provided are measured in terms of their quality and not solely by quantity;
  • Slow the growth rate of costs or “bend the cost curve” over time without inappropriate reductions in benefits, eligibility or provider rates; and streamline and modernize the Medicaid program in the state.
  • Today, Centennial Care 2.0 features an integrated, comprehensive Medicaid delivery system in which a member’s Managed Care Organization (MCO) is responsible for coordinating his/her full array of services, including acute care (including pharmacy), behavioral health services, institutional services and home and community-based services (HCBS).

The waiver amendment provides the opportunity for the state to continue advancing successful initiatives under the demonstration while continuing to implement new, targeted initiatives to address specific gaps in care and improve healthcare outcomes for Centennial Care members. Key initiatives under the Centennial Care 2.0 program include:

  • Refine care coordination to better meet the needs of high-cost, high-need members, especially during transitions in their setting of care;
  • Continue to expand access to long-term services and supports (LTSS) and maintain the progress achieved through rebalancing efforts to serve more members in their homes and communities;
  • Improve the integration of behavioral and physical health services, with greater emphasis on other social factors that impact population health;
  • Expand payment reform through value-based purchasing arrangements to achieve improved quality and better health outcomes;
  • Continue the Safety Net Care Pool and time-limited Hospital Quality Improvement Initiative; and

Further simplify administrative complexities and implement refinements in program and benefit design.

As part of the demonstration amendment, the state seeks to strengthen its support to cover New Mexicans through an integrated and comprehensive Medicaid delivery system.

  1. Proposed Health Care Delivery System and Eligibility Requirements, Benefit Coverage, and Cost-Sharing
    1. Delivery System & Eligibility Requirements
      Centennial Care 2.0 provides a comprehensive benefit package to eligible populations through an integrated managed care model that includes a number of innovations. The following are descriptions of the current eligible populations and covered benefits:

Table 1: Eligibility Groups Covered in Centennial Care

Population Group Populations
TANF and Related

Newborns, infants, and children

Children’s Health Insurance Program (CHIP)

Foster children

Adopted children

Pregnant women

Low-income parent(s)/caretaker(s) and families

Breast and Cervical Cancer

Refugees

Transitional Medical Assistance

Supplemental Security Income (SSI) Medicaid

Aged, blind and disabled

Working disabled

SSI Dual Eligible

Aged, blind and disabled

Working disabled

Medicaid Expansion Adults between 19-64 years-old up to 133% of Modified Adjusted Gross Income (MAGI)

 

The following populations are excluded from Centennial Care:

  • Qualified Medicare Beneficiaries;
  • Specified Low-Income Medicare Beneficiaries;
  • Qualified Individuals;
  • Qualified Disabled Working Individuals;
  • Non-citizens only eligible for emergency medical services;
  • Program of All-Inclusive Care for the Elderly;
  • Individuals residing in Intermediate Care Facilities for Individuals with an Intellectual Disability; and
  • Individuals eligible for family planning services only.

The following services are excluded from Centennial Care:

  • Medically Fragile 1915(c) waiver participants for HCBS;
  • Developmentally Disabled 1915(c) waiver participants for HCBS;
  • Mi Via 1915(c) waiver participants for HCBS; and
  • Supports Waiver 1915(c) waiver HCBS.
  1. Benefit Coverage 

Centennial Care 2.0 provides a comprehensive package of services that includes behavioral health, physical health, and long-term care services and supports (LTSS). Members meeting a Nursing Facility Level of Care (NF LOC) are able to access LTSS through Community Benefit (CB) services (i.e., home- and community-based services) without a waiver slot. The CB is available through Agency-Based Community Benefit (ABCB) services (services provided by a provider agency) and Self-Directed Community Benefit (SDCB) services (services that a participant can control and direct).
As outlined in the draft amendment waiver application, the state has proposed some additional refinements to benefits and eligibility, including:

  • Expand the Medicaid program toward a more integrated model of behavioral health care delivery by providing Medicaid reimbursement for extended IMD stays for individuals with Serious Mental Illness/Severe Emotional Disturbance (SMI/SED) in residential and inpatient Institutions for Mental Disease (IMD) settings;
  • Establish High-Fidelity Wraparound (HFW) as an intensive care coordination approach for children and youth who have high intensity needs;
  • Establish a Primary Care Graduate Medical Education (GME) expansion funding mechanism designed to develop new and/or expanded GME programs focusing on the specialists of General Psychiatry, Family Medicine, General Pediatrics, and General Internal Medicine; and
  • Expand coverage of the Coronavirus (COVID-19) vaccines, to the extent not covered by the federal government during the period of Centennial Care 2.0 demonstration and its administration to individuals who have limited benefit plan coverage including Family Planning Category of Eligibility (COE), Emergency Medical Services for Aliens (EMSA), individuals covered under the COVID-19 uninsured population (FFCRA) and also those receiving only Pregnancy – related services.

 

  1. Cost-Sharing – Co-Payments & Premiums

The Centennial Care 2.0 does not have premium requirements (monthly payments) for individuals

III. Budget Neutrality

  1. Budget Neutrality Overview 

The proposed waiver amendment proposals will have a minimal impact to the budget neutrality.

  1. CHIP Allotment Neutrality

The amendment proposals will not impact allotment neutrality.

  1. Budget Neutrality Summary

The federal share of the combined Medicaid expenditures for the populations included in this demonstration, excluding those covered under the Title XXI Allotment Neutrality, will not exceed what the federal share of Medicaid expenditures would have been without the demonstration.
The federal share of the combined Medicaid expenditures for the populations included in this demonstration, excluding those covered under the Title XXI Allotment Neutrality, will not exceed what the federal share of Medicaid expenditures would have been without the demonstration.
HSD makes the following assumptions regarding budget neutrality:

  • HSD proposes a per capita budget neutrality model for the populations covered under the demonstration, outlines the per capita limit by Medicaid Eligibility Group (MEG) and proposes an aggregate cap, trended annually for uncompensated care and Hospital Quality Improvement Incentive expenditures;
  • State administrative costs are not subject to the budget neutrality calculations;
  • The projected savings is the difference between the without and with waiver projections;
  • Nothing in this demonstration application precludes HSD from applying for enhanced Medicaid funding as CMS issues new opportunities or policies; and
  • The budget neutrality agreement is in terms of total computable so that HSD is adversely affected by future changes to federal medical assistance percentages.

Current Approved Without Waiver and With Waiver Projected Medicaid Expenditures (Toal Computable) 

Waiver Period Description

Current

Approved

Amendment

Proposals

Total 5 Year Member Months (Without Waiver) 49,499,763 49,576,615
Total 5 Year Member Months (With Waiver) 49,499,763 49,576,615
Current Waiver Variance (DY1-DY5) $3,762,696,140 $3,762,696,140
Renewal Waiver (DY6-DY10)
Without Waiver $40,386,951,910 $40,412,589,964
With Waiver $34,313,721,693 $34,434,661,132
Savings (Without Less With Waiver) $6,073,230,217 $5,977,928,832
Savings after Phasedown of Savings $4,156,379,601 $4,101,403,392

Savings with D1-DY5 Carryover and DY6-DY10

Phase-down

$7,919,075,741 $7,864,099,532

Please refer to Section 6 of the draft application for the complete approach to Budget Netrality.

  1. Hypothesis and Evaluation Parameters of the Demonstration
    HSD will maintain the hypotheses and evaluation design plan of Centennial Care 2.0 and expect Waiver metrics to be combined for SMI/SED and SUD specific goals of the demonstration as set forth in the CMS Guidance.  The table below describes the hypotheses of Centennial Care 2.0, and how HSD will evaluate the impact.

Table 4 – Quality Goals and Evaluation

   Hypothesis Methodology Data Sources
Goal 1: Improve Member outcomes with refinements to care coordination
1.1 Enhancements to care coordination will result in decreases for avoidable emergency room visits and hospital readmissions. Track and trend member utilization of avoidable emergency room visits and hospital readmissions and monitor MCO adherence to common chronic disease management and other social support services requirements for care coordination.

Claims data

HEDIS reports

MCO reporting

 

1.2 Birthing outcomes will improve with pregnant women participating in the home visiting pilot. Track and trend low birthweight, pre-term birth, prenatal/post-partum visits and well child visits for members in pilot.

Claims data

HEDIS reports

MCO reporting

 

Goal 2: Increase Behavioral Health Integration
2.1 Member’s utilization of Health Homes will increase. Track and trend the number of members participating in Health Homes.

Claims data

MCO reporting

 

2.2 Treatment outcomes of members participating in Health Homes will improve. Track and trend Health Homes’ treatment outcomes of common behavioral/physical health conditions and care coordination outcomes such as avoidable emergency room visits, hospital readmissions and follow up after hospitalization for mental illness.

Claims data

HEDIS reports

MCO reporting

 

Goal 3: Expand member access to Long Term Services and Supports
3.1 Allowing all Medicaid-eligible members who meet a nursing facility level of care to access the Community Benefit will maintain New Mexico’s accomplishments in rebalancing efforts. Track and trend members accessing community benefits. Claims data
3.2 Increasing caregiver respite hours will improve member outcomes and utilization. Track and trend member utilization and member outcomes.

Claims data

HEDIS reports

3.3 Automatic Nursing Facility Level of Care (NFLOC) approvals will achieve administrative simplification for HSD, the MCOs and members. Track and trend automatic NFLOC approvals. MCO reporting
Goal 4: Increase quality of care with Value Based Payment (VBP) arrangements.
4.1 Healthcare outcomes will improve for members served by providers that have VBP arrangements for the full delegation of care coordination. Track and trend member utilization and common chronic disease management outcomes of providers with VBP arrangements that include full delegation of care coordination.

Claims data

HEDIS reports

MCO reporting

 

4.2

 

 

 

Implementing incremental minimum VBP requirements will support bending the cost curve of Medicaid program costs through alignment with Centennial Care 2.0 program goals of improving care coordination, focus on transitions of care. Track and trend program expenditure.

Claims data

HEDIS reports

MCO reporting

 

Goal 5: Promoting Member Engagement and Responsibility
5.1 Members participating in the Centennial Rewards program will continue to have improved healthcare outcomes with decreases in higher-cost services, such as inpatient stays.

Track and trend member utilization of preventive services and rewards credits.

 

Claims data

HEDIS reports

MCO/Reward Program Contractor reporting

 

Goal 6: Improve administrative effectiveness and simplicity.
6.1 Members will have increased access to inpatient services at an Institution for Mental Disease (IMD). Track and trend member utilization of IMDs. Claims data
Goal 7: Improve Delivery System and Access to Services
7.1 Members will have increased access to CHWs and CHRs. Track and trend member utilization. MCO reporting
7.2 Members will have increased access to telehealth. Track and trend member utilization. Claims data
7.2 Members will have increased access to Patient Centers Medical Homes. Track and trend member utilization. MCO reporting

 

  1. Waiver and Expenditure Authorities 
  1. Expenditure Authority Requests

Under the authority of section 1115(a)(2) of the SSA, expenditures made by HSD for the items identified below, which are not otherwise included as expenditures under section 1903 shall, for the period of this demonstration, be regarded as expenditures under the Medicaid State Plan but are further limited by the special terms and conditions for the section 1115 demonstration.

 

  1. Expenditures for members in managed care and FFS to receive expanded services provided through an IMD. Expanded services will be available to eligible adults with SMI and children with SED in the event they meet the diagnostic criteria mandated by the included assessment (Attachment A) so long as the cost of care is the same as, or more cost effective than, a setting that is not an IMD.
  2. Expenditure authority to provide grant funding and technical assistance to new and/or expanded primary care medical residency programs in community-based primary care settings, such as Federally Qualified Health Centers, rural health clinics, and tribal health centers.
  3. Expenditure authority to provide reimbursement for the cost of the COVID-19 vaccine, to the extent not covered by the federal government during the period of the Centennial Care 2.0 demonstration,  and its administration to all populations covered under this demonstration waiver and to extend such coverage and reimbursement to the following limited benefit plan populations:
  1. Family Planning;
    b. COVID-19 Uninsured Group;
    c. Emergency Medical Services for Aliens; and
    d. Pregnancy-related services.
  2. Expenditure authority to provide coverage and reimbursement for HFW services for children and youth with high intensity needs.
  3. Waiver Authority Requests

Under the authority of section 1115(a)(1) of the SSA, waivers of applicable provisions of section 1902 of the SSA to support the following initiatives:

 

  1. Waiver of any requirement in section 1902 of the SSA required to implement coverage and reimbursement for HFW services for children and youth with high intensity needs.

Submit a comment:

HSD continues to welcome input from New Mexicans regarding the Centennial Care program. To submit a comment, please fill out the online form below. You may also email it directly to HSD-PublicComment@state.nm.us or send it by mail to:

Human Services Department
ATTN: HSD Public Comments
P.O. Box 2348
Santa Fe, NM 87504-2348