Minutes 05-10-2011 - Laserfiche WebLink

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eligibility standards, benefits packages, payment rates, and program administration. The Social Security Act authorizes multiple waiver and demonstration authorities which allows for flexibility at the state level. Under Section 1915 (b) of the SSA, waivers are granted which allow states to implement managed care delivery systems and restrict consumer choice of providers. These specific waivers often target individuals with mental health and substance abuse issues, although some services are available for people with intellectual/developmental disabilities (I/DD). States may choose to simultaneously operate 1915 (b) and (c) waivers. Medicaid waivers are used to improve access to and quality of services, as well as manage cost. REQUEST FOR APPLICATIONS — 1915(b)(c) Medicaid Waiver Expansion KEY POINTS: • This is the final RFA that will be issued for statewide expansion. • Full expansion is expected to be completed by January 2013. • LMEs applying to operate a waiver must have an unduplicated minimum Medicaid eligible population of 70,000 individuals 3 years and older; a total population size of 300,000 by July 2012, and a total population size of 500,000 by July 2013. [OPC = total population of 227,963; number of Medicaid eligible individuals 3 years and older is 22,372] • A single LME may apply if it meets all minimum requirements. If a single LME does not all minimum requirements it will be expected to merge with one or more other LMEs, with one entity being identified as the lead LME. • Applications must be received by May 20, 2011. • By the date of the RFA application submission, all LMEs must identify which lead LME they will partner with to perform the required Medicaid managed care and LME functions. If LMEs do not identify working partners, then DHHS will assign LME catchment areas. OPTIONS AVAILABLE TO OPC: In February 2010 OPC was approached by PBH, the LME currently operating the 1915(b)(c) pilot project, about the possibility of forming an alliance. With approval of the OPC Area Board negotiations were initiated. In June 2010 legislation was passed which restricted PBH from expanding their geographic region and limited the number of sites for expansion of the Medicaid waiver. OPC's negotiations with PBH were put on hold. Legislative support now exists for removal of the restrictions on PBH, as well as expansion of the waiver, and the OPC Area Board has authorized the Area Director to re-engage in negotiations. OPC AREA BOARD RECOMMENDATION TO BOCC: At their April 11th meeting the OPC Area Board reviewed the RFA and after extensive discussion the following motion was approved by unanimous vote. The OPC Area Board authorizes management of OPC to pursue negotiations with PBH to be identified as the lead LME to operate Medicaid funded services through a 1915 (b)(c) combo waiver for the OPC catchment area; to pursue a merger arrangement with PBH for the provision of services in the Orange, Person and Chatham counties catchment area; and to seek authorization of the Boards of Commissioners of Orange, Person & Chatham counties to proceed with negotiations with PBH towards these ends.