Public Comment Sought for Proposed Amendments to

CMS Waiver Project Number (11-W-00289/5)

The Alabama Medicaid Agency is seeking public comment on its proposed amendments to the CMS approved 1115 Waiver Project Number (11-W-00289/5). The amendment requests the following modifications:

·         Allow the Agency to phase-in the RCO program on a geographic basis; the phase-in is currently planned to begin on October 1, 2017 in Regions A and C and it is expected that RCOs will begin operations in Regions B, D, and E after October 1, 2017, but by October 1, 2018;

·         Allow the Agency to operate only one RCO on a mandatory enrollment basis in both urban and rural areas;

·         Clarify that if an American Indian chooses to opt into the demonstration, that individual will be subject to standard enrollment and disenrollment procedures until the next open enrollment period.

·         Re-calculate overall budget neutrality fiscal impact to incorporate the regional phase-in of the RCO program. Calculation amendments includes:

o    Re-calculate the “with waiver” expenditure estimates to incorporate the regional phase-in of the RCO program as well as updated RCO capitation rate development.

o    Adjust the Designated State Health Program (DSHP) annual limits for demonstration year 1 and demonstration year 3; the total DSHP limit remains the same.

o    Adjust the Transition Pool annual limits; the total Transition Pool limit remains the same;

•     Adjust the DSHP metrics to account for the phased-in approach to RCO implementation

•     Provide authority for the Agency to distribute Transition Pool payments from demonstration year 1 through demonstration year 5, and allow unused Transition Pool funds to be carried over to the next demonstration year;

•     Clarify that federal financial participation is available for reimbursement to RCOs from the RCO pool for approved start-up costs incurred after January 1, 2015;

•     Clarify that the Integrated Provider System (IPS) program will be implemented on a phased-in basis, based upon when RCOs begin operations in each RCO region;

•     Modify the IPS reporting timeframes and payment dates, and adjust the proportion of the total IPS award that is paid based on the approval of the IPS work plan; and,

•     Not require the Agency to transition the managed care authority to a section 1932(a) state plan amendment or a 1915(b) waiver by the end of the demonstration.

A copy of the proposed changes can be found on the Alabama Medicaid Agency website by clicking here.

The comment period is open until July 2, 2017. Written comments regarding the proposed waiver are welcome and should submitted to: RCOportal@medcaid.alabama.gov or James Hartin, Office of General Counsel, Alabama Medicaid Agency, 501 Dexter Avenue, P.O. Box 5624, Montgomery, Alabama 36103-5624.