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Bigbypic2By Health and Human Services Secretary Dr. JudyAnn Bigby

Earlier this week, Governor Patrick announced that the federal Centers for Medicare and Medicaid Services (CMS) has renewed Massachusetts’ 1115 Research and Demonstration Waiver Agreement, commonly referred to as the Waiver. Yesterday’s announcement of a $26.75 billion, three-year agreement gives Massachusetts an additional $5.69 billion in spending authority and strongly supports our commitment to promoting integrated systems of care and establishing alternative payment models.  

The milestone agreement also ensures the ongoing success of Massachusetts’ historic health care reform initiative, through which more than 98 percent of the Commonwealth’s residents, and 99.8 percent of children, have health insurance. The waiver fully funds our ongoing health care reform implementation and includes more than $500 million annually in federal support for Commonwealth Care and the Health Safety Net, and more than $300 million annually in other federal support for services to low-income and uninsured populations.

I am pleased to share a few of the important features of the new waiver agreement, which will be active until June 2014. The waiver includes several innovative programs that expand services for certain children, develop integrated systems of care and alternative payment systems, and position the Commonwealth to reduce the cost of medical care and the rate of growth over time.

Under this agreement, we will promote delivery system and payment transformation with the state’s key safety net hospitals. The waiver includes $120 million annually in new federal funding to support the transformation of the hospitals into integrated delivery systems, and envisions transitioning away from fee-for-service payments toward alternative payment arrangements that reward high-quality, efficient and integrated care. This feature of the waiver agreement reflects the principles outlined in the Governor’s comprehensive health care cost containment bill, which he filed earlier this year.  

Massachusetts will also establish a Pediatric Asthma Payment Pilot, which will support a bundled payments to providers for services to improve asthma outcomes in children  not traditionally covered, including home visits by community health workers and supplies for reducing environmental triggers in the home. Efforts like these have been shown to help keep kids with asthma healthy and out of the emergency room with acute asthma exacerbations.   

The waiver also authorizes federal Medicaid reimbursement for medically necessary Applied Behavioral Analysis-based treatment services to children with a diagnosed autistic disorder; these services are provided through the Commonwealth’s Early Intervention program.

We will also initiate an innovative “Express Lane” eligibility program that will streamline procedures for renewing eligibility for parents with children who are enrolled in the Supplemental Nutrition Assistance Program (SNAP) program. We estimate that approximately 140,000 MassHealth members may be eligible for this Express Lane renewal, and by sharing documentation between state agencies, we will ease the administrative burden on both consumers and government and prevent children from losing coverage unnecessarily. 

Some clarification may be necessary when it comes to our duals demonstration project (read my post from last week about this initiative here), independent of the 1115 waiver process. The Commonwealth will move forward with this important initiative. MassHealth and the federal government are working together to design and implement a new care model for individuals aged 21-64 who are eligible for both MassHealth and Medicare, so that they receive all of their benefits in a seamless, integrated manner. When we submitted our draft 1115 waiver renewal overview document in 2010, it appeared that we would need 1115 waiver authority to pursue a duals demonstration. However, in July 2011, CMS released a state Medicaid Director's letter that provided an alternative process for duals demonstrations that does not require 1115 authority. As is mentioned in our 1115 waiver approval letter, we withdrew our request for 1115 authority, given that it is no longer required.  

We look forward to implementing these innovations in Massachusetts and making meaningful steps to improve patient care and control costs for everyone.   

I want to thank Governor Patrick for his leadership on behalf of Massachusetts, as well as our congressional delegation for their strong support. My heartfelt appreciation also goes to the entire MassHealth team for their extraordinary commitment to making this agreement a reality. It was through a lot of hard work and dedication that this agreement was achieved, through which Massachusetts will be able to promote more integrated care while controlling costs.    

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