Strengthening Medicaid Managed Care for Children with Chronic and Complex Health Care Needs

Strengthening Medicaid Managed Care for Children with Chronic and Complex Health Care Needs

State Learning Collaborative

Request for Applications

Project Description

The National Academy for State Health Policy (NASHP) is inviting applications from states to participate in a year-long project to improve care for children with chronic and complex health care needs. With support from the Lucile Packard Foundation for Children’s Health (LPFCH) and in partnership with the Association of Maternal and Child Health Programs (AMCHP), NASHP is providing peer-to-peer technical assistance (TA) through a Learning Collaborative forstates interested in improving Medicaid managed care programs and related services and supports for children and youth with special health care needs (CYSHCN),including those provided by state Title V CYSHCN programs. All states (47 and the District of Columbia) serving Medicaid beneficiaries in Medicaid managed care are enrolling at least some CYSHCN. NASHP is offering states an opportunity to strengthen their approaches to servingthis population.

The Learning Collaborative will help states to build upon and align their Medicaid managed care programs withexistingfederal and state initiatives and health care delivery system reforms impacting children with chronic and complex health care conditions, such as theState Innovation Model (SIM), Patient-Centered Medical Homes (PCMH) or Health Homes, pediatric Accountable Care Organizations (ACOs), and Value-Based Payment models. There are many policy levers that states are using to improve systems of care for CYSHCN, and this Learning Collaborative will provide an opportunity for states to look at these existing efforts with a special emphasis on Medicaid data and quality metrics for CYSHCN. Finally, emphasis will be placed on using the National Standards for Systems of Care for Children and Youth with Special Health Care Needs(the Standards) as a tool for assisting states to identify and consider those aspects of their Medicaid managed care programs in most need of improvement.

NASHPand AMCHP staff together with other subject matter expertswill provide targeted technical assistancefor seven state teams comprised ofup tofive members. Teams will be composed of representatives from Medicaid, Title V CYSHCN program, Medicaid health plans, families/consumers, provider groups, and others. The Learning Collaborative will beginwith an in-person meetingto be held October 22 – 23, 2017, prior to the NASHP Annual Conference in Portland, Oregon. States participating in the Learning Collaborative will receive support toward travel expenses for five state team members for this in-person meeting. NASHP and AMCHP will convene the Learning Collaborative virtually over the following year and provide targeted technical assistanceand peer-to-peer learning opportunities to state teams as they work towards their identified goals.

Aboutthe National Standards for CYSHCN

In March 2014, AMCHP, with support from the Lucile Packard Foundation for Children’s Health, released a groundbreaking set of standards designed to help communities, states, and the nation build and improve systems of care for CYSHCN. The Standards address the core components of the structure and process of an effective system of care for children with chronic and complex health care needs. They were developed aftera comprehensive review of the literature, guidance from more than 30 key informants, case studies of standards currently in use within selected sites, and with the input and guidance from a national work group comprised of national and state leaders representing the Centers for Medicare and Medicaid Services, the Health Resources and Services Administration, state Title V CYSHCN programs, state Medicaid agencies, pediatric providers, health plans, children’s hospitals, families/consumers, health services researchers, and others. The Standards are intended for use or adaptation by state Medicaid agencies, health plans, Title V CYSHCN programs, provider groups, families and other stakeholders interested in ensuring that health systems meet the unique needs of CYSHCN. In 2017, AMCHP and NASHP released Version 2.0 of the National Standards, which streamline, simplify, and update this work. The Standards are organized into eight core domain areas:

1. Screening, Assessment and Referral
2. Eligibility and Enrollment
3. Access to Care
4. Medical Home, including:

• Medical Home Management
• Pediatric Preventive and Primary Care
• Care Coordination
• Pediatric Specialty Care

1. Community-based Services and Supports, including:

• Respite Care
• Palliative and Hospice Care
• Home-based Services

1. Transition to Adulthood
2. Health Information Technology
3. Quality Assurance and Improvement

Since the development and dissemination of the National Standards, states are using them to make improvements in their health care service delivery systems serving children with chronic and complex health care needs. The landscape in which CYSHCN are served has shifted with more of these children being served in Medicaid managed care. Specifically, states are using the Standards to:

• Build strategic partnerships between key stakeholders(e.g., Medicaid and state Title V CYSHCN programs) to improve how services are delivered
• Identify key standards and related language that can be included in Medicaid contracts with managed care organizations
• Improve the quality of care across systems such as long-term services and supports
• Identify Medicaid data and quality measures that might be aligned with theStandards for quality improvement purposes
• Improving Medicaid managed care delivery systems to best serve children with chronic and complex health care needs

Why States Will Want to Participate and Expected Outcomes

Participating states will receive peer-to-peer and targeted technical assistance to strengthen systems that serve CYSHCN through implementation of the Standards. Support will be tailored to each state’s needs as identified through (1) this Request for Applications form, (2) a goal-setting process that states will complete through development of brief project plans, and (3)project check-in calls with each state. States will have access to targeted and group technical assistance throughout the one-year period.

States may expect some of the following potential outcomesthrough participation in the Learning Collaborative, depending on the priorities identified in their application and project plan:

• Identifying standards and related language for inclusion in Medicaid managed care contracts that address the unique needs of CYSHCN
• Developing plans and strategies for a more robust quality measurement system for CYSHCN enrolled in Medicaid managed care
• Including performance improvement projects for the CYSHCN population in Medicaid managed care contracts
• Improving care coordination for CYSHCN enrolled in Medicaid managed care through strategies such as development of robust shared plans of care and transition plans for CYSHCN into adult health care settings
• Updating Interagency Agreements between Title V and Medicaid to include specific references for CYSHCN enrolled in Medicaid managed care

Learning CollaborativeTimeline

Learning Collaborative (LC) activities will include a day and a half meeting during the NASHP 2017 Conference in Portland, Oregon, and a series of bi-monthly webinars of participating states through September 2018.

Application Guidance

Who is Eligible to Apply?

All states are eligible to apply. Applicants must apply in “state teams” and designate a state team lead. More information about team composition can be found on page four. NASHP recognizes that every state is different, particularly with respect to its leadership, organizational structure, and political environment. This LC will focus on establishing appropriate solutions guided by each state’s unique circumstances.

How Do I Apply?

Please complete the attached RFA Form (pages 5-8). The proposal is due by 5pm ET on August 16, 2017.

How Should the Application be Submitted?

Please direct any questions about the RFA and send completed applications electronically to Anisha Agrawal at .

Request for Applications (RFA) Form

Instructions:Please complete Sections 1-3 and attach relevant documentation. Note that section 2 will need to be answered separately inapproximately three pages.

Section 1: State Teams

Each state team should be comprised of five to seven members. Note that state teams MUST have a representative from five of the required sectors indicated below. Additional team members are encouraged.

1. Medicaid Representative with managed careresponsibilities (*Required)
2. Title V CYSHCN Representative (*Required)
3. Medicaid Health Plan Representative (*Required)
4. A CYSHCN Family Member/Consumer (*Required)
5. Provider Group familiar with the needs of CYSHCN(*Required)
6. Pediatrician or Representative from State AAP Chapter
7. Other (Please Specify Below)

*Please note that NASHP can only cover the cost of travel to the kick-off meeting for five state team members. You will be asked to indicate which team members will be part of the traveling team below. Any additional team members that wish to travel are welcome to attend, but the state will be responsible for covering travel beyond the five required team members.

Each team must also have a designated team leader from either Title V or Medicaid. NASHP recognizes that teams may not be fully formed by the RFA due date, but states must have at least the required five team members (Title V, Medicaid, Family Representative, Provider Group,and Medicaid Health Plan) identified by the RFA Closing Date (August 16th).If optional team members are not yet determined, please leave that section blank and indicate your intention to recruit additional team members.

Please complete the following information for each team member.

Section 2: Application Questions

Please answer the below questions in a separate document and send electronically with the application packet. Please limit responses to no more than three pages total.

1. Briefly describe your state’s system of care for CYSHCN, especially the current and planned extent to whichthis population of children is served in Medicaid managed care.
2. Briefly describe some of the key challenges your state is currently facing in serving CYSHCN through Medicaid managed care.
3. Briefly describe any planned or existing Medicaid managed care quality improvement activities targeted to children with chronic and complex health care needs.
4. How are key partners (e.g., Title V CYSHCN programs, Medicaid, CHIP, health plans, provider groups, families) already working together to improve systems of care for CYSHCN in your state?
5. Briefly describe why and how your state would benefit from participating in the learning collaborative. What do you hope to accomplish through participation in this learning collaborative? What are your expectations?
6. Briefly describe your state’s familiarity with the National Standards. If none, please indicate as such.
7. Please provide any additional background information regarding your state’s health reform efforts, delivery systems, or other initiatives underway that your state would like to align with or build on through this Learning Collaborative, or that would be useful to NASHP/AMCHP’s staff understanding of your current state environment.

Section 3: Commitment to Participate

Commitment: If selected, my state team will agree to:

• Designate a team leader
• Participate in the in-person Learning Collaborativemeeting in Portland, OR
• Actively participate in the development of projectplansto focus and guide work
• Actively participate in all project webinars and calls
• Participate in evaluation of the Learning Collaborative activities
• Be an active participant in follow-up conference calls

____Yes, I have read the application and understand the requirements for participation.

Please sign and date below.

______

Signature

______

Printed Name

______

Date

1