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Managed Care

 

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VC provides complete support for States considering or implementing a Medicaid managed care strategy. SVC spearheaded a study of managed care for the disabled and for individuals requiring long-term support services in Indiana and helps states develop, design and implement managed care programs including developing managed care RFPs.  The SVC team leads states through the program development process from policy design, stakeholder communications, waiver development, and identifying operational needs through post-implementation.  This includes identifying policy and program options and facilitating state decision-making. Specifically, SVC develops:

• Requests for Information (RFI) and Requests for Proposals (RFP)

Waiver and State Plan Amendments

• Methods for CMS coordination and negotiation

• MCO and Vendor readiness reviews

Program studies and cost-savings reports

SVC develops Requests for Proposals for different States and led a study of managed care for the State of Indiana. In addition, SVC supports States through the procurement process and implementation as well as preparing the necessary federal waivers and State Plan Amendments. SVC provides Medicaid managed care services to Indiana, Idaho and Iowa.

 

Coverage Expansion

 

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VC has a long history working with States on Medicaid and health policy issues reform. SVC served as the architect of Governor Mitch Daniels' Healthy Indiana Plan (HIP) and has remained directly involved in HIP program policy and operational developments as well as developing the HIP 2.0 program, under Governor Mike Pence. SVC's role with HIP included not only the design but development including creating the Request for Proposal, drafting the initial 1115 waiver, negotiating the waiver special terms and conditions with the Centers for Medicare and Medicaid Services (CMS), managing the implementation, developing the waiver renewal applications and overseeing the evaluation of the plan.

Additionally, SVC has taken the lead on new 1115 waiver development in states such as Iowa, Idaho, Tennessee as they consider Medicaid expansion.  SVC has also worked with many states including Maine, Nebraska and South Carolina on Medicaid strategy and policy evaluation, waiver development, ACA and Exchange issues.  SVC has also worked with counties and local health departments as they consider the impact of the ACA and recent coverage expansions on their programming.  SVC has a firm grasp of the nationwide Medicaid landscape and consistently applies our entire breadth of regulatory knowledge and real world experience to our clients projects no matter the scope.

 

1115 Waivers

 

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VC has been instrumental in innovative 1115 wavier demonstration development for several of our clients. In addition to being the architect of Indiana's Healthy Indiana Plan, SVC developed both of Iowa’s Medicaid Expansion 1115 demonstration proposals and assisted Michigan with program implementation.  SVC brings extensive expertise in designing and creating unique Medicaid programs for our State clients. Our 1115 products share common elements of private market coordination, consumer direction, and incentives for prevention and healthy behaviors, but are specific to each State’s market, politics and unique population needs.

SVC has in depth experience:

  • designing 1115 waiver programs
  • supporting the waiver development and negotiation process with CMS
  • assuring that the proposal is structured appropriately, contains all the required elements and aligns with the state’s political needs
  • leading implementation efforts for waiver programs, including implementing policy, eligibility system changes and developing request for proposals to contracting with managed care companies
  • developing stakeholder education materials
  • ensuring vendor readiness for go-live

 

Medicaid Populations with Special Healthcare Needs - 1915(i)

 

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VC has led many successful analytic research efforts involving special populations (e.g. long-term care, aging and disability, and home and community based services). SVC has assisted State governments in the research, analyses and development of various Medicaid programs that have included vulnerable populations such as those with disabilities and behavioral health challenges. 

SVC led efforts to develop the State of Indiana's Behavioral and Primary Healthcare Coordination (BPHC) program, a Section 1915(i) home and community-based services program specifically designed to maintain Medicaid eligibility for a portion of Indiana's chronic mentally ill population who would have otherwise lost access to coverage for intensive community-based behavioral health services when the State transitioned from 209(b) to 1634 status. SVC's work included identification of the population at risk of losing services, development of policy options for program design, identification of assessment processes and services package design. SVC provided project management and technical support through implementation including developing the State Plan Amendment, administrative rule draft and stakeholder communication materials.

The SVC team was also a key component of the State of Indiana Aged, Blind and Disabled (ABD) Task Force convened to complete a comprehensive review of the current ABD population, expenditures, programming and nationwide trends.  SVC analyzed public input, researched ABD options across the nation and considered Indiana's current managed care landscape in order to create the final Aged, Blind and Disabled Report for the Indiana General Assembly.

 

Cost-containment Strategies

 

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n 2013, Maine's Department of Health and Human Services contracted with SVC, Inc. and Milliman, to provide expertise, research, and data analysis services to the redesign effort and to give a national perspective on Medicaid cost containment strategies in an effort to realize $5.25 million in Medicaid savings. SVC led the Task Force in reviewing the MaineCare program and potential cost containment strategies. Part of this analysis focused on coverage categories, the nature and extent of covered benefits, the cost-sharing requirements, enrollment trends, and analysis of expenditure data. SVC helped facilitate Task Force meetings, prepared analyses and presentations and drafted the final report to be submitted to the State legislature. Recommendations in SVC's report projected total State savings in fiscal years 2013-15 of $35.22 million. Through thorough reviews of strategies nationwide, targeted data analysis, and knowledge of Medicaid program operations, SVC, Inc. was able to help the MaineCare Redesign Taskforce identify and validate strategies to improve care delivery and realize cost savings.

 

 

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