HCA Asks for Rural Medicaid Waiver

The HCA has submitted to CMS a waiver request that would end a burdensome Medicaid administrative process known as “reconciliation” and attempt to institute an incentive based methodology for care delivery in the rural setting.

The waiver is accompanied by a letter from Doug Porter letter to Cindy Mann, the head of CMS, which states the waiver’s goal.

We are requesting approval of our “Apple Health Innovations” initiative to adopt a new alternative payment methodology that provides per-member-per-month payments through managed care organizations on a prospective basis. Payments would start at our existing APM rate and would be trended forward using an approved trend factor. Our goal is to provide the necessary flexibility for rewarding improvements in the quality of health care delivered rather than incenting increased numbers of visits per person.

A shared emphasis of our request is the preservation of payment protections intended under Section 1902(bb) of the Social Security Act. We believe this can be achieved without the current onerous year-end reconciliation process that is currently embroiled in litigation (Neighborcare Health, et al v. Porter) and has been a significant, continuous administrative undertaking by the state and our FQHC/RHC partners for the last three years.

In its letter accompanying the waiver request, the Rural Health Clinic Association of Washington said it “remains fully committed to working with the HCA and CMS” as the process moves forward.  Mary Looker, CEO of the Washington Association of Community and Migrant Health Centers, made a similar comment in her letter saying her association “commits to working with the Health Care Authority over the next several months as the details of this payment reform model are further developed and refined.”