DHS submits revised 1115 waiver application and comments, releases RFI

The Hawaii Department of Human Services (DHS) submitted its revised “Quest Integration” § 1115 Waiver Extension Application on September 14th. DHS had reopened the comment period on the waiver extension application on July 31^st after revising the document to include additional information regarding the financing approach, evaluation results, annual post award forum, and the process for tribal consultation.

For the second comment period, Medicaid Director and MED-QUEST Director Judy Mohr Peterson, proactively solicited feedback to the revised application. The agency received comments from 32 organizations and individuals across both comment periods. Comments center around the following major themes:

• Praise for continued investments in primary care, behavioral health integration, strategies for addressing the social determinants of health (SDOH), and restoration of the Medicaid dental benefit and oral health initiative.
• The need for on-going focus on care coordination for people with complex health and social needs. Comments pointed to the need for improved availability and transparency of data, along with the need to develop a common platform for data sharing.
• Support for the movement toward value-based purchasing (VBP) and alignment across VBP strategies and MCOs in order to ensure consistency. Commenters favored use of data to track improved costs and health outcomes, including consideration of incentives to facilitate the transition.
• Continued emphasis on community-based health reform initiatives, especially those locally-created and implemented. Some commenters emphasized the need for community-based initiatives to be “standardized” or aligned across all MCOs.
• The need to consider workforce shortages and investments in the context of the HOPE initiative, including the need for new ways to think about teaching facilities for example “teaching health centers” vs. “teaching hospitals.”
• Concerns regarding the wavier implementation process including, potential duplication of services and care coordination, payment reform strategies, and the need for community stakeholder input.

Along with releasing the revised waiver application, on September 20^th DHS also released a Request for Information (RFI) to solicit information and comments to prepare the QUEST Integration re-procurement Request for Proposal (RFP).  The RFI asks stakeholders to comment on several main topic areas which include detailed questions to focus input for the drafting of the RFP in alignment with proposed service delivery initiatives. Responses are due by 2:00 pm on October 20th. Topics include:

• Procurement criteria;
• Community care services (CCS) re-procurement;
• Dually eligible special needs plans (D-SNPs);
• Quest Integration health plan alignment;
• Value-based payments (VBP) and alternative payment models (APMs);
• High-needs, high-costs (HNHC Patient Centered Care, Team-Based Care, and Provider Practice Development) Medicaid population
• Managed long term services and supports; and
• Community Care Teams

The RFP for re-procurement was initially expected in January 2019. However, with the delayed waiver application and the intermediate RFI solicitation, there is speculation that it will be delayed until February or March for a contract term of January 2020 to December 2025.

Entities interested in providing feedback to the RFI are being requested to email replies to QUEST_Integration@dhs.hawaii.gov, with questions and clarification directed to the same address.