Centennial Care 2.0 1115 Demonstration Waiver Amendment #2

The Human Services Department (HSD), Medical Assistance Division (MAD), invites comments from the public about changes to the Centennial Care 2.0 program that are being considered as part of an amendment that is proposed to be effective July 1, 2021. Comments will be accepted until 5:00pm MST on Sunday, January 31, 2021. Read below to learn more about the Centennial Care 2.0 waiver amendment.

HSD will hold two public hearings to receive comments via teleconference due to the Public Health Emergency (PHE) regarding the draft amendment to the waiver. Please see below information for the public hearings.

All comments will be reviewed and evaluated to inform additional modifications prior to submission of the final waiver amendment application to CMS.

Public Hearings

Tuesday, January 19, 2021

1:00 p.m. – 4:00 p.m.
Medicaid Advisory Committee Meeting
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Thursday, January 28, 2021
9:30 a.m. – 10:30 a.m.
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About Centennial Care 2.0

The New Mexico Human Services Department (HSD) is proposing improvements to the Centennial Care 2.0 program and is seeking input from stakeholders throughout New Mexico for consideration before submitting a final waiver amendment to the federal Centers for Medicare and Medicaid Services (CMS).

HSD has released a draft Section 1115 Demonstration Waiver amendment application for Centennial Care 2.0.The draft amendment outlines HSD’s modifications to improve the program. The draft amendment can be reviewed by clicking here. HSD is seeking federal authority to amend the 1115 Centennial Care 2.0 Waiver (Project Number 11W-00285/6) to make the following changes:

1. Expand the Medicaid program toward a more integrated model of behavioral health care delivery by providing Medicaid reimbursement for extended IMD stays for individuals with Serious Mental Illness/Severe Emotional Disturbance (SMI/SED) in residential and inpatient Institutions for Mental Disease (IMD) settings;
2. Establish High-Fidelity Wraparound (HFW) as an intensive care coordination approach for children and youth who have high intensity needs;
3. Establish a Primary Care Graduate Medical Education (GME) expansion funding mechanism designed to develop new and/or expanded GME programs focusing on the specialists of General Psychiatry, Family Medicine, General Pediatrics, and General Internal Medicine; and
4. Expand coverage of the Coronavirus (COVID-19) vaccines, to the extent not covered by the federal government during the period of Centennial Care 2.0 demonstration and its administration to individuals who have limited benefit plan coverage including Family Planning Category of Eligibility (COE), Emergency Medical Services for Aliens (EMSA), individuals covered under the COVID-19 uninsured population (FFCRA) and also those receiving only Pregnancy – related services.

1. Program Description, Goals, and Objectives
   The state’s goals for the Centennial Care 2.0 demonstration include providing the most effective and efficient health care possible for eligible New Mexicans, as well as continuing the healthcare delivery reforms of Centennial Care. Specifically, the state will further the following goals:

• Assure that Medicaid members in the program receive the right amount of care, delivered at the right time, and in the right setting;
• Ensure that the care and services being provided are measured in terms of their quality and not solely by quantity;
• Slow the growth rate of costs or “bend the cost curve” over time without inappropriate reductions in benefits, eligibility or provider rates; and streamline and modernize the Medicaid program in the state.
• Today, Centennial Care 2.0 features an integrated, comprehensive Medicaid delivery system in which a member’s Managed Care Organization (MCO) is responsible for coordinating his/her full array of services, including acute care (including pharmacy), behavioral health services, institutional services and home and community-based services (HCBS).

The waiver amendment provides the opportunity for the state to continue advancing successful initiatives under the demonstration while continuing to implement new, targeted initiatives to address specific gaps in care and improve healthcare outcomes for Centennial Care members. Key initiatives under the Centennial Care 2.0 program include:

• Refine care coordination to better meet the needs of high-cost, high-need members, especially during transitions in their setting of care;
• Continue to expand access to long-term services and supports (LTSS) and maintain the progress achieved through rebalancing efforts to serve more members in their homes and communities;
• Improve the integration of behavioral and physical health services, with greater emphasis on other social factors that impact population health;
• Expand payment reform through value-based purchasing arrangements to achieve improved quality and better health outcomes;
• Continue the Safety Net Care Pool and time-limited Hospital Quality Improvement Initiative; and

Further simplify administrative complexities and implement refinements in program and benefit design.

As part of the demonstration amendment, the state seeks to strengthen its support to cover New Mexicans through an integrated and comprehensive Medicaid delivery system.

1. Proposed Health Care Delivery System and Eligibility Requirements, Benefit Coverage, and Cost-Sharing
   1. Delivery System & Eligibility Requirements
      Centennial Care 2.0 provides a comprehensive benefit package to eligible populations through an integrated managed care model that includes a number of innovations. The following are descriptions of the current eligible populations and covered benefits:

   Table 1: Eligibility Groups Covered in Centennial Care

   Newborns, infants, and children

   Children’s Health Insurance Program (CHIP)

   Low-income parent(s)/caretaker(s) and families

   Breast and Cervical Cancer

   Transitional Medical Assistance