Common use of PROGRAM DESCRIPTION AND OBJECTIVES Clause in Contracts

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6, 2012, the State of Kansas submitted a Medicaid section 1115 demonstration proposal, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home and Community-Based Services (HCBS) waivers and together provides the authority necessary for the state to require enrollment of almost all Medicaid beneficiaries (including the aged, disabled, and some dual eligibles) across the state into a managed care delivery system to receive state plan and HCBS waiver services. This represents an expansion of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, and to provide incentives to hospitals for programs that result in delivery system reforms that enhance access to health care and improve the quality of care. This five year demonstration will:  Maintain Medicaid state plan eligibility;  Maintain Medicaid state plan benefits;  Allow the state to require eligible individuals to enroll in managed care organizations (MCOs) to receive covered benefits through such MCOs, including individuals on HCBS waivers, except: o American Indian/Alaska Natives will be presumptively enrolled in KanCare but will have the option of affirmatively opting-out of managed care.  Provide benefits, including long-term services and supports (LTSS) and HCBS, via managed care; and  Create a Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsured. The KanCare demonstration will assist the state in its goals to:  Provide integration and coordination of care across the whole spectrum of health to include physical health, behavioral health, mental health, substance use disorders and LTSS.  Improve the quality of care Kansas Medicaid beneficiaries receive through integrated care coordination and financial incentives paid for performance (quality and outcomes);  Control Medicaid costs by emphasizing health, wellness, prevention and early detection as well as integration and coordination of care; and  Establish long-lasting reforms that sustain the improvements in quality of health and wellness for Kansas Medicaid beneficiaries and provide a model for other states for Medicaid payment and delivery system reforms as well. The state’s demonstration evaluation will include an assessment of the following hypotheses: 1. By holding MCOs to outcomes and performance measures, and tying measures to meaningful financial incentives, the state will improve health care quality and reduce costs; 2. The KanCare model will reduce the percentage of beneficiaries in institutional settings by providing additional HCBS and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired; 3. The state will improve quality in Medicaid services by integrating and coordinating services and eliminating the current silos between physical health, behavioral health, mental health, substance use disorder, and LTSS; and 4. KanCare will provide integrated care coordination to individuals with developmental disabilities, which will improve access to health services and improve the health of those individuals.

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6The State’s goal in implementing the Partnership Plan section 1115(a) Demonstration is to improve access to health services and outcomes for low-income New Yorkers by: • improving access to health care for the Medicaid population; • improving the quality of health services delivered; • expanding access to family planning services; and • expanding coverage to additional low-income New Yorkers with resources generated through managed care efficiencies. The demonstration is designed to use a managed care delivery system to deliver benefits to Medicaid recipients, 2012create efficiencies in the Medicaid program and enable the extension of coverage to certain individuals who would otherwise be without health insurance. It was approved in 1997 to enroll most Medicaid recipients into managed care organizations (Medicaid managed care program). As part of the Demonstration’s renewal in 2006, authority to require the disabled and aged populations to enroll in mandatory managed care was transferred to a new demonstration, the Federal-State Health Reform Partnership (F-SHRP). In 2001, the Family Health Plus (FHPlus) program was implemented as an amendment to the Demonstration, providing comprehensive health coverage to low-income uninsured adults, with and without dependent children, who have income greater than Medicaid State plan eligibility standards. FHPlus was further amended in 2007 to implement an employer-sponsored health insurance (ESHI) component. Individuals eligible for FHPlus who have access to cost-effective ESHI are required to enroll in that coverage, with FHPlus providing any wrap-around services necessary to ensure that enrollees get all FHPlus benefits. During this extension period, the State will expand Family Health Plus eligibility for low-income adults with children. In 2002, the Demonstration was expanded to incorporate a family planning benefit under which family planning and family planning-related services are provided to women losing Medicaid eligibility and certain other adults of Kansas submitted a Medicaid section 1115 demonstration proposalchildbearing age (family planning expansion program). In 2010, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home and Community-Based Services Expansion Program (HCBSHCBS expansion program) waivers was added to the Demonstration. It provides cost-effective home and together provides the authority necessary for the state community-based services to require enrollment certain adults with significant medical needs as an alternative to institutional care in a nursing facility. The benefits and program structure mirrors those of almost all Medicaid beneficiaries (including the aged, disabledexisting 1915(c) waiver programs, and some dual eligibles) across strives to provide quality services for individuals in the state into a managed care delivery system to receive state plan community, ensure the well-being and HCBS waiver services. This represents an expansion safety of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, participants and to provide incentives increase opportunities for self-advocacy and self-reliance. As part of this extension, the State is authorized to hospitals for programs that result in delivery system reforms that enhance access develop and implement two new initiatives designed to health care and improve the quality of care. This five year demonstration will:  Maintain Medicaid state plan eligibility;  Maintain Medicaid state plan benefits;  Allow the state care rendered to require eligible individuals to enroll in managed care organizations (MCOs) to receive covered benefits through such MCOs, including individuals on HCBS waivers, except: o American Indian/Alaska Natives will be presumptively enrolled in KanCare but will have the option of affirmatively opting-out of managed care.  Provide benefits, including long-term services and supports (LTSS) and HCBS, via managed care; and  Create a Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsuredPartnership Plan recipients. The KanCare demonstration first, the Hospital- Medical Home (H-MH) project, will assist provide funding and performance incentives to hospital teaching programs in order to improve the state in its goals to:  Provide integration coordination, continuity, and coordination of care across the whole spectrum of health to include physical health, behavioral health, mental health, substance use disorders and LTSS.  Improve the quality of care Kansas Medicaid beneficiaries for individuals receiving primary care in outpatient hospital settings. By the end of the demonstration extension period, the hospital teaching programs which receive through integrated care coordination grants under the H-MH project will have received certification by the National Committee for Quality Assurance as a patient-centered medical home and financial incentives paid for performance (quality and outcomes);  Control Medicaid costs by emphasizing health, wellness, prevention and early detection as well as integration and coordination of care; and  Establish long-lasting reforms that sustain the implemented additional improvements in patient safety and quality of health and wellness for Kansas Medicaid beneficiaries and provide a model for other states for Medicaid payment and delivery system reforms as welloutcomes. The state’s demonstration evaluation will include an assessment second initiative is intended to reduce the rate of preventable readmissions within the Medicaid population, with the related longer-term goal of developing reimbursement policies that provide incentives to help people stay out of the following hypotheses: 1hospital. By holding MCOs to outcomes and performance measures, and tying measures to meaningful financial incentivesUnder the Potentially Preventable Readmissions (PPR) project, the state State will improve health care quality provide funding, on a competitive basis, to hospitals and/or collaborations of hospitals and reduce costs; 2. The KanCare model will other providers for the purpose of developing and implementing strategies to reduce the percentage rate of beneficiaries in institutional settings by providing additional HCBS PPRs for the Medicaid population. Projects will target readmissions related to both medical and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired; 3behavioral health conditions. The state will improve quality in Medicaid services by integrating and coordinating services and eliminating the current silos between physical healthFinally, behavioral health, mental health, substance use disorder, and LTSS; and 4. KanCare CMS will provide integrated funding for the State’s program to address clinic uncompensated care coordination through its Indigent Care Pool. Prior to individuals this extension period, the State has funded (with developmental disabilitiesState dollars only) this program which provides formula-based grants to voluntary, which will improve access non-profit and publicly- sponsored Diagnostic and Treatment Centers (D&TCs) for services delivered to health services and improve the health of those individualsuninsured throughout the State.

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6, 2012, the State of Kansas submitted a Medicaid section 1115 demonstration proposal, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home and Community-Based Services (HCBS) waivers and together provides the authority necessary for the state to require enrollment of almost all Medicaid beneficiaries (including the aged, disabled, and some dual eligibles) across the state into a managed care delivery system to receive state plan and HCBS waiver services. This represents an expansion of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, and to provide incentives to hospitals for programs that result in delivery system reforms that enhance access to health care and improve the quality of care. This five year demonstration will:  • Maintain Medicaid state plan eligibility;  • Maintain Medicaid state plan benefits;  • Allow the state to require eligible individuals to enroll in managed care organizations (MCOs) to receive covered benefits through such MCOs, including individuals on HCBS waivers, except: o American Indian/Alaska Natives will be presumptively enrolled in KanCare but will have the option of affirmatively opting-out of managed care.  • Provide benefits, including long-term services and supports (LTSS) and HCBS, via managed care; and  • Create a Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsured. The KanCare demonstration will assist the state in its goals to:  • Provide integration and coordination of care across the whole spectrum of health to include physical health, behavioral health, mental health, substance use disorders and LTSS.  • Improve the quality of care Kansas Medicaid beneficiaries receive through integrated care coordination and financial incentives paid for performance (quality and outcomes);  • Control Medicaid costs by emphasizing health, wellness, prevention and early detection as well as integration and coordination of care; and  • Establish long-lasting reforms that sustain the improvements in quality of health and wellness for Kansas Medicaid beneficiaries and provide a model for other states for Medicaid payment and delivery system reforms as well. The state’s demonstration evaluation will include an assessment of the following hypotheses: 1. By holding MCOs to outcomes and performance measures, and tying measures to meaningful financial incentives, the state will improve health care quality and reduce costs; 2. The KanCare model will reduce the percentage of beneficiaries in institutional settings by providing additional HCBS and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired; 3. The state will improve quality in Medicaid services by integrating and coordinating services and eliminating the current silos between physical health, behavioral health, mental health, substance use disorder, and LTSS; and 4. KanCare will provide integrated care coordination to individuals with developmental disabilities, which will improve access to health services and improve the health of those individuals.

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6The state‟s goal in implementing the Partnership Plan section 1115(a) Demonstration is to improve access to health services and outcomes for low-income New Yorkers by: • Improving access to health care for the Medicaid population; • Improving the quality of health services delivered; • Expanding access to family planning services; and • Expanding coverage with resources generated through managed care efficiencies to additional low-income New Yorkers. The Demonstration is designed to use a managed care delivery system to deliver benefits to Medicaid recipients, 2012create efficiencies in the Medicaid program, and enable the extension of coverage to certain individuals who would otherwise be without health insurance. It was approved in 1997 to enroll most Medicaid recipients into managed care organizations (MCOs) (Medicaid managed care program). As part of the Demonstration‟s renewal in 2006, authority to require the disabled and aged populations to enroll in mandatory managed care was transferred to a new demonstration, the Federal-State Health Reform Partnership (F-SHRP). In 2001, the Family Health Plus (FHPlus) program was implemented as an amendment to the Demonstration, providing comprehensive health coverage to low-income uninsured adults, with and without dependent children, who have income greater than Medicaid state plan eligibility standards. FHPlus was further amended in 2007 to implement an employer-sponsored health insurance (ESHI) component. Individuals eligible for FHPlus who have access to cost-effective ESHI are required to enroll in that coverage, with FHPlus providing any wrap-around services necessary to ensure that enrollees get all FHPlus benefits. During this extension period, the state will expand Family Health Plus eligibility for low-income adults with children. In 2002, the Demonstration was expanded to incorporate a family planning benefit under which family planning and family planning-related services are provided to women losing Medicaid eligibility and to certain other adults of Kansas submitted a Medicaid section 1115 demonstration proposalchildbearing age (family planning expansion program). In 2010, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home and Community-Based Services Expansion Program (HCBSHCBS expansion program) waivers was added to the Demonstration. It provides cost-effective home and together provides community-based services to certain adults with significant medical needs as an alternative to institutional care in a nursing facility. The benefits and program structure mirrors those of existing section 1915(c) waiver programs, and strives to provide quality services for individuals in the authority necessary community, ensure the well-being and safety of the participants, and increase opportunities for self-advocacy and self-reliance. As part of the 2011 extension, the state is authorized to require enrollment of almost all Medicaid beneficiaries (including the aged, disabled, develop and some dual eligibles) across the state into a managed care delivery system implement two new initiatives designed to receive state plan and HCBS waiver services. This represents an expansion of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, and to provide incentives to hospitals for programs that result in delivery system reforms that enhance access to health care and improve the quality of carecare rendered to Partnership Plan recipients. This five year The first, the Hospital- Medical Home (H-MH) project, will provide funding and performance incentives to hospital teaching programs in order to improve the coordination, continuity, and quality of care for individuals receiving primary care in outpatient hospital settings. By the end of the demonstration will:  Maintain extension period, the hospital teaching programs which receive grants under the H-MH project will have received certification by the National Committee for Quality Assurance as patient-centered medical homes and implemented additional improvements in patient safety and quality outcomes. The second initiative is intended to reduce the rate of preventable readmissions within the Medicaid state plan eligibility;  Maintain Medicaid state plan benefits;  Allow population, with the related longer-term goal of developing reimbursement policies that provide incentives to help people stay out of the hospital. Under the Potentially Preventable Readmissions (PPR) project, the state will provide funding, on a competitive basis, to require hospitals and/or collaborations of hospitals and other providers for the purpose of developing and implementing strategies to reduce the rate of PPRs for the Medicaid population. Projects will target readmissions related to both medical and behavioral health conditions. Finally, CMS will provide funding for the state‟s program to address clinic uncompensated care through its Indigent Care Pool. Prior to this extension period, the state has funded (with state dollars only) this program which provides formula-based grants to voluntary, non-profit, and publicly- sponsored Diagnostic and Treatment Centers (D&TCs) for services delivered to the uninsured throughout the state. In 2012, New York added to the Demonstration an initiative to improve service delivery and coordination of long-term care services and supports for individuals through a managed care model. Under the Managed Long-Term Care (MLTC) program, eligible individuals to enroll in need of more than 120 days of community-based long-term care are enrolled with managed care organizations (MCOs) providers to receive long- term services and supports as well as other ancillary services. Other covered benefits through such MCOs, including individuals services are available on HCBS waivers, except: o American Indian/Alaska Natives will a fee-for-service basis to the extent that New York has not exercised its option to include the individual in the Mainstream Medicaid Managed Care Program (MMMC). Enrollment in MLTC may be presumptively enrolled phased in KanCare but will have the option of affirmatively opting-out of geographically and by group. The state‟s goals specific to managed care.  Provide benefits, including long-term care (MLTC) are as follows: Expanding access to managed long term care for Medicaid enrollees who are in need of long term services and supports (LTSS) ); Improving patient safety and HCBS, via managed care; and  Create a Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsured. The KanCare demonstration will assist the state in its goals to:  Provide integration and coordination of care across the whole spectrum of health to include physical health, behavioral health, mental health, substance use disorders and LTSS.  Improve the quality of care Kansas Medicaid beneficiaries receive through integrated care coordination for enrollees in MLTC plans; Reduce preventable inpatient and financial incentives paid for performance (quality and outcomes);  Control Medicaid costs by emphasizing health, wellness, prevention and early detection as well as integration and coordination of carenursing home admissions; and  Establish long-lasting reforms that sustain the improvements in Improve satisfaction, safety and quality of health and wellness for Kansas Medicaid beneficiaries and provide a model for other states for Medicaid payment and delivery system reforms as well. The state’s demonstration evaluation will include an assessment of the following hypotheses: 1. By holding MCOs to outcomes and performance measures, and tying measures to meaningful financial incentives, the state will improve health care quality and reduce costs; 2. The KanCare model will reduce the percentage of beneficiaries in institutional settings by providing additional HCBS and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired; 3. The state will improve quality in Medicaid services by integrating and coordinating services and eliminating the current silos between physical health, behavioral health, mental health, substance use disorder, and LTSS; and 4. KanCare will provide integrated care coordination to individuals with developmental disabilities, which will improve access to health services and improve the health of those individualslife.

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6The State‟s goal in implementing the Partnership Plan section 1115(a) Demonstration is to improve access to health services and outcomes for low-income New Yorkers by: • improving access to health care for the Medicaid population; • improving the quality of health services delivered; • expanding access to family planning services; and • expanding coverage to additional low-income New Yorkers with resources generated through managed care efficiencies. The demonstration is designed to use a managed care delivery system to deliver benefits to Medicaid recipients, 2012create efficiencies in the Medicaid program and enable the extension of coverage to certain individuals who would otherwise be without health insurance. It was approved in 1997 to enroll most Medicaid recipients into managed care organizations (Medicaid managed care program). As part of the Demonstration‟s renewal in 2006, authority to require the disabled and aged populations to enroll in mandatory managed care was transferred to a new demonstration, the Federal-State Health Reform Partnership (F-SHRP). In 2001, the Family Health Plus (FHPlus) program was implemented as an amendment to the Demonstration, providing comprehensive health coverage to low-income uninsured adults, with and without dependent children, who have income greater than Medicaid State plan eligibility standards. FHPlus was further amended in 2007 to implement an employer-sponsored health insurance (ESHI) component. Individuals eligible for FHPlus who have access to cost-effective ESHI are required to enroll in that coverage, with FHPlus providing any wrap-around services necessary to ensure that enrollees get all FHPlus benefits. During this extension period, the State will expand Family Health Plus eligibility for low-income adults with children. In 2002, the Demonstration was expanded to incorporate a family planning benefit under which family planning and family planning-related services are provided to women losing Medicaid eligibility and certain other adults of Kansas submitted a Medicaid section 1115 demonstration proposalchildbearing age (family planning expansion program). In 2010, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home and Community-Based Services Expansion Program (HCBSHCBS expansion program) waivers was added to the Demonstration. It provides cost-effective home and together provides the authority necessary for the state community-based services to require enrollment certain adults with significant medical needs as an alternative to institutional care in a nursing facility. The benefits and program structure mirrors those of almost all Medicaid beneficiaries (including the aged, disabledexisting 1915(c) waiver programs, and some dual eligibles) across strives to provide quality services for individuals in the state into a managed care delivery system to receive state plan community, ensure the well-being and HCBS waiver services. This represents an expansion safety of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, participants and to provide incentives increase opportunities for self-advocacy and self-reliance. As part of this extension, the State is authorized to hospitals for programs that result in delivery system reforms that enhance access develop and implement two new initiatives designed to health care and improve the quality of care. This five year demonstration will:  Maintain Medicaid state plan eligibility;  Maintain Medicaid state plan benefits;  Allow the state care rendered to require eligible individuals to enroll in managed care organizations (MCOs) to receive covered benefits through such MCOs, including individuals on HCBS waivers, except: o American Indian/Alaska Natives will be presumptively enrolled in KanCare but will have the option of affirmatively opting-out of managed care.  Provide benefits, including long-term services and supports (LTSS) and HCBS, via managed care; and  Create a Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsuredPartnership Plan recipients. The KanCare demonstration first, the Hospital- Medical Home (H-MH) project, will assist provide funding and performance incentives to hospital teaching programs in order to improve the state in its goals to:  Provide integration coordination, continuity, and coordination of care across the whole spectrum of health to include physical health, behavioral health, mental health, substance use disorders and LTSS.  Improve the quality of care Kansas Medicaid beneficiaries for individuals receiving primary care in outpatient hospital settings. By the end of the demonstration extension period, the hospital teaching programs which receive through integrated care coordination grants under the H-MH project will have received certification by the National Committee for Quality Assurance as a patient-centered medical home and financial incentives paid for performance (quality and outcomes);  Control Medicaid costs by emphasizing health, wellness, prevention and early detection as well as integration and coordination of care; and  Establish long-lasting reforms that sustain the implemented additional improvements in patient safety and quality of health and wellness for Kansas Medicaid beneficiaries and provide a model for other states for Medicaid payment and delivery system reforms as welloutcomes. The state’s demonstration evaluation will include an assessment second initiative is intended to reduce the rate of preventable readmissions within the Medicaid population, with the related longer-term goal of developing reimbursement policies that provide incentives to help people stay out of the following hypotheses: 1hospital. By holding MCOs to outcomes and performance measures, and tying measures to meaningful financial incentivesUnder the Potentially Preventable Readmissions (PPR) project, the state State will improve health care quality provide funding, on a competitive basis, to hospitals and/or collaborations of hospitals and reduce costs; 2. The KanCare model will other providers for the purpose of developing and implementing strategies to reduce the percentage rate of beneficiaries in institutional settings by providing additional HCBS PPRs for the Medicaid population. Projects will target readmissions related to both medical and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired; 3behavioral health conditions. The state will improve quality in Medicaid services by integrating and coordinating services and eliminating the current silos between physical healthFinally, behavioral health, mental health, substance use disorder, and LTSS; and 4. KanCare CMS will provide integrated funding for the State‟s program to address clinic uncompensated care coordination through its Indigent Care Pool. Prior to individuals this extension period, the State has funded (with developmental disabilitiesState dollars only) this program which provides formula-based grants to voluntary, which will improve access non-profit and publicly- sponsored Diagnostic and Treatment Centers (D&TCs) for services delivered to health services and improve the health of those individualsuninsured throughout the State.

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6April 24, 2012, the State state of Kansas Nevada submitted a Medicaid section 1115 demonstration proposal, entitled KanCarethe Nevada Comprehensive Care Waiver (NCCW). KanCare Nevada contracts with managed care organizations (MCOs) in urban Xxxxx and Washoe counties; the remainder of the state operates Medicaid as a fee-for-service (FFS) program. Historically, this meant that many Medicaid beneficiaries did not have access to care management services which might be able to both improve quality of care and generate program savings. The NCCW will operate concurrently with implement mandatory care management services throughout the state’s section 1915(c) Home and Communitystate for a subset of high-Based Services cost, high-need beneficiaries not served by the existing MCOs. This subset of beneficiaries will receive care management services from a care management organization (HCBS) waivers and together provides the authority necessary CMO). This entity will support improved quality of care, which is expected to generate savings/efficiencies for the state to require enrollment of almost all Medicaid beneficiaries (including the aged, disabled, and some dual eligibles) across the state into a managed care delivery system to receive state plan and HCBS waiver services. This represents an expansion of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs Enrollment in the CMO is mandatory for Medicaid beneficiaries and demonstration eligible individuals, except for the uninsured, and to provide incentives to hospitals for programs that result in delivery system reforms that enhance access to health care and improve the quality of careAmerican Indian/Alaska Native (AI/AN) population. This five year demonstration will:  Maintain Medicaid state plan eligibility;  Maintain Medicaid state plan benefits;  Allow the state to require eligible individuals to enroll in managed care organizations (MCOs) into the CMO to receive covered benefits through such MCOs, including individuals on HCBS waivers, except: o American Indian/Alaska Natives will be presumptively enrolled in KanCare but will have care management benefits; and  Generate cost efficiencies for the option of affirmatively opting-out of managed care.  Provide benefits, including state to support the long-term services and supports (LTSS) and HCBS, via managed care; and  Create a Safety Net Care Pool to support hospitals that provide uncompensated care to sustainability of the Medicaid beneficiaries and the uninsuredprogram. The KanCare NCCW demonstration will assist the state in its goals to:  Provide integration and coordination of care across the whole spectrum of health management to include physical healthhigh-cost, behavioral health, mental health, substance use disorders and LTSS. high-need Medicaid beneficiaries who receive services on a FFS basis;  Improve the quality of care Kansas that high-cost, high-need Nevada Medicaid beneficiaries in FFS receive through integrated care coordination management and financial incentives paid such as pay for performance (quality and outcomes);  Control Medicaid costs by emphasizing health, wellness, prevention and early detection as well as integration and coordination of care; and  Establish long-lasting reforms that sustain the improvements in the quality of health and wellness for Kansas Nevada Medicaid beneficiaries and provide care in a model for other states for Medicaid payment and delivery system reforms as wellmore cost efficient manner. The state’s demonstration evaluation will include an assessment of the following hypotheses: 1. By holding MCOs Enrollment in a CMO improves the quality of care for Medicaid beneficiaries with a demonstration-qualifying condition compared to outcomes and performance measures, and tying measures to meaningful financial incentives, enrollment in the state will improve health FFS system without the additional care quality and reduce costs;coordination provided by the CMO. 2. The KanCare model will reduce Enrollment in a CMO improves health outcomes for Medicaid beneficiaries with a demonstration-qualifying condition compared to enrollment in the percentage of beneficiaries in institutional settings FFS system without the additional care coordination provided by providing additional HCBS and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired;the CMO. 3. The state will improve quality Enrollment in a CMO reduces the total and per capita costs of providing Medicaid services to Medicaid beneficiaries with a demonstration-qualifying condition compared to enrollment in the FFS system without the additional care coordination provided by integrating and coordinating services and eliminating the current silos between physical health, behavioral health, mental health, substance use disorder, and LTSS; andCMO. 4. KanCare will provide integrated Medicaid beneficiaries enrolled in a CMO are more satisfied with the quality of their health care than beneficiaries in the FFS system without the additional care coordination to individuals with developmental disabilities, which will improve access to health services and improve provided by the health of those individualsCMO.

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6The IowaCare Demonstration was originally approved and began implementation on July 1, 20122005. Under this renewal, the State of Kansas submitted will continue to provide health care services to the Expansion Population and Spend-down Pregnant Women populations. During the renewal period, children with serious emotional disorders will be served under a Medicaid section 1115 demonstration proposal, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home home and Communitycommunity-Based Services (HCBS) waivers based services waiver. Under this Demonstration extension, Iowa expects to achieve the following to promote the objectives of title XIX: • Access: Improve access to and together provides coordination of the authority necessary for most appropriate cost effective care through implementation of a medical home pilot. • Quality: Encourage provision of quality medical services to all enrollees. Encourage quality, continuity, and appropriate medical care. Improve the health status of IowaCare enrollees by improving access to a greater number of beneficiaries by adding additional network providers in underserved areas of the State. • Prevention: Encourage individuals to stay healthy and seek preventive care through care coordination in the medical home pilot. On November 1, 2011, the state of Iowa was approved to require enrollment of almost all Medicaid beneficiaries (including the aged, disabled, and some dual eligibles) across the state into a managed care delivery system to receive state plan and HCBS waiver services. This represents implement an expansion of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net uncompensated care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, and to provide incentives to hospitals for programs that result in delivery system reforms that enhance access to health care and improve the quality of care. This five year demonstration will:  Maintain Medicaid state plan eligibility;  Maintain Medicaid state plan benefits;  Allow the state to require eligible individuals to enroll in managed care organizations (MCOs) to receive covered benefits through such MCOs, including individuals on HCBS waivers, except: o American Indian/Alaska Natives will be presumptively enrolled in KanCare but will have the option of affirmatively opting-out of managed care.  Provide benefits, including long-term services and supports (LTSS) and HCBS, via managed care; and  Create a IowaCare Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsuredor I-SNCP). The KanCare demonstration will assist purpose of the state in its goals to:  Provide integration I-SNCP is to reimburse expenditures incurred by hospitals, clinics, or by other provider types for uncompensated medical care costs of medical services provided to IowaCare members. Allowable expenditures include durable medical equipment and coordination outpatient prescription drugs provided to IowaCare members assigned to Broadlawns as a medical home (above the current 10-day supply of care across the whole spectrum of health prescription medication after an inpatient hospitalization available to include physical health, behavioral health, mental health, substance use disorders and LTSS.  Improve the quality of care Kansas Medicaid beneficiaries receive through integrated care coordination and financial incentives paid for performance (quality and outcomesall IowaCare members);  Control Medicaid costs by emphasizing healthdurable medical equipment, wellness, prevention in-home health care and early detection as well as integration rehabilitation and coordination of caretherapy services after an inpatient stay; and  Establish long-lasting reforms that sustain costs borne by FQHCs for IowaCare members using the improvements in quality of health and wellness for Kansas Medicaid beneficiaries and provide FQHC as a model for other states for Medicaid payment and delivery system reforms as well. The state’s demonstration evaluation will include an assessment of medical home when the following hypotheses: 1. By holding MCOs to outcomes and performance measures, and tying measures to meaningful financial incentives, FQHCs do not have the state will improve health care quality and reduce costs; 2. The KanCare model will reduce the percentage of beneficiaries in institutional settings by providing additional HCBS and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired; 3. The state will improve quality in Medicaid needed laboratory or radiology services by integrating and coordinating services and eliminating the current silos between physical health, behavioral health, mental health, substance use disorder, and LTSS; and 4. KanCare will provide integrated care coordination to individuals with developmental disabilities, which will improve access to health services and improve the health of those individualson site.

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6The state’s goal in implementing the Partnership Plan section 1115(a) demonstration is to improve access to health services and outcomes for low-income New Yorkers by: • Improving access to health care for the Medicaid population; • Improving the quality of health services delivered; • Expanding access to family planning services; and • Expanding coverage with resources generated through managed care efficiencies to additional low-income New Yorkers. The demonstration is designed to use a managed care delivery system to deliver benefits to Medicaid recipients, 2012create efficiencies in the Medicaid program, and enable the extension of coverage to certain individuals who would otherwise be without health insurance. It was approved in 1997 to enroll most Medicaid recipients into managed care organizations (MCOs) (Medicaid managed care program). As part of the demonstration’s renewal in 2006, authority to require the disabled and aged populations to enroll in mandatory managed care was transferred to a new demonstration, the Federal-State Health Reform Partnership (F-SHRP). In 2001, the Family Health Plus (FHPlus) program was implemented as an amendment to the demonstration, providing comprehensive health coverage to low-income uninsured adults, with and without dependent children, who have income greater than Medicaid state plan eligibility standards. FHPlus was further amended in 2007 to implement an employer-sponsored health insurance (ESHI) component. Individuals eligible for FHPlus who have access to cost-effective ESHI are required to enroll in that coverage, with FHPlus providing any wrap-around services necessary to ensure that enrollees get all FHPlus benefits. FHPlus expires on December 31, 2013 and will become a state- only program. In 2002, the demonstration was expanded to incorporate a family planning benefit under which family planning and family planning-related services are provided to women losing Medicaid eligibility and to certain other adults of Kansas submitted childbearing age (family planning expansion program). The family planning expansion program expires on December 31, 2013 and becomes a Medicaid section 1115 demonstration proposalstate plan benefit. In 2010, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home and Community-Based Services Expansion Program (HCBSHCBS expansion program) waivers was added to the demonstration. It provides cost-effective home and together provides community-based services to certain adults with significant medical needs as an alternative to institutional care in a nursing facility. The benefits and program structure mirrors those of existing section 1915(c) waiver programs, and strives to provide quality services for individuals in the authority necessary community, ensure the well-being and safety of the participants, and increase opportunities for self-advocacy and self-reliance. As part of the 2011 extension, the state is authorized to require enrollment of almost all Medicaid beneficiaries (including the aged, disabled, develop and some dual eligibles) across the state into a managed care delivery system implement two new initiatives designed to receive state plan and HCBS waiver services. This represents an expansion of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, and to provide incentives to hospitals for programs that result in delivery system reforms that enhance access to health care and improve the quality of carecare rendered to Partnership Plan recipients. This five year The first, the Hospital- Medical Home (H-MH) project, will provide funding and performance incentives to hospital teaching programs in order to improve the coordination, continuity, and quality of care for individuals receiving primary care in outpatient hospital settings. By the end of the demonstration will:  Maintain extension period, the hospital teaching programs which receive grants under the H-MH project will have received certification by the National Committee for Quality Assurance as patient-centered medical homes and implemented additional improvements in patient safety and quality outcomes. The second initiative is intended to reduce the rate of preventable readmissions within the Medicaid state plan eligibility;  Maintain Medicaid state plan benefits;  Allow population, with the related longer-term goal of developing reimbursement policies that provide incentives to help people stay out of the hospital. Under the Potentially Preventable Readmissions (PPR) project, the state will provide funding, on a competitive basis, to require hospitals and/or collaborations of hospitals and other providers for the purpose of developing and implementing strategies to reduce the rate of PPRs for the Medicaid population. Projects will target readmissions related to both medical and behavioral health conditions. Finally, CMS will provide funding for the state’s program to address clinic uncompensated care through its Indigent Care Pool. Prior to this extension period, the state has funded (with state dollars only) this program which provides formula-based grants to voluntary, non-profit, and publicly- sponsored Diagnostic and Treatment Centers (D&TCs) for services delivered to the uninsured throughout the state. In 2012, New York added to the demonstration an initiative to improve service delivery and coordination of long-term care services and supports for individuals through a managed care model. Under the Managed Long-Term Care (MLTC) program, eligible individuals to enroll in need of more than 120 days of community-based long-term care are enrolled with managed care organizations (MCOs) providers to receive long- term services and supports as well as other ancillary services. Other covered benefits through such MCOs, including individuals services are available on HCBS waivers, except: o American Indian/Alaska Natives will a fee-for-service basis to the extent that New York has not exercised its option to include the individual in the Mainstream Medicaid Managed Care Program (MMMC). Enrollment in MLTC may be presumptively enrolled phased in KanCare but will have the option of affirmatively opting-out of geographically and by group. The state’s goals specific to managed care.  Provide benefits, including long-term care (MLTC) are as follows: • Expanding access to managed long term care for Medicaid enrollees who are in need of long term services and supports (LTSS) ); • Improving patient safety and HCBS, via managed care; and  Create a Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsured. The KanCare demonstration will assist the state in its goals to:  Provide integration and coordination of care across the whole spectrum of health to include physical health, behavioral health, mental health, substance use disorders and LTSS.  Improve the quality of care Kansas for enrollees in MLTC plans; • Reduce preventable inpatient and nursing home admissions; and • Improve satisfaction, safety and quality of life. In April 2013 New York had three amendments approved. The first amendment was a continuation of the state’s goal for transitioning more Medicaid beneficiaries receive into managed care. Under this amendment, the Long-Term Home Health Care Program (LTHHCP) participants are transitioned from New York’s 1915(c) waiver into the 1115 demonstration and into managed care. Second, this amendment eliminates the exclusion from MMMC of, both xxxxxx care children placed by local social service agencies and individuals participating in the Medicaid buy-in program for the working disabled. Additionally the April 2013 amendment approved expenditure authority for New York to claim FFP for expenditures made for certain designated state health programs beginning April 1, 2013 through integrated care coordination and financial incentives paid for performance (quality and outcomes);  Control Medicaid costs by emphasizing healthMarch 31, wellness, prevention and early detection as well as integration and coordination of care; and  Establish long-lasting reforms that sustain the improvements in quality of health and wellness for Kansas Medicaid beneficiaries and provide a model for other states for Medicaid payment and delivery system reforms as well2014. The state’s demonstration evaluation will include an assessment of the following hypotheses: 1. By holding MCOs to outcomes and performance measures, and tying measures to meaningful financial incentivesDuring this period, the state will improve is also required to submit several deliverables to demonstrate that the state is successful in its efforts to transform its health care quality and reduce costs; 2. The KanCare model will reduce the percentage of beneficiaries in institutional settings by providing additional HCBS and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired; 3. The state will improve quality in Medicaid services by integrating and coordinating services and eliminating the current silos between physical health, behavioral health, mental health, substance use disorder, and LTSS; and 4. KanCare will provide integrated care coordination to system for individuals with developmental disabilities. Finally, which will improve access the December 2013 amendment was approved to health services and improve ensure that it reflected changes to the health of those individualsdemonstration that were necessary in order to conform the programs for Affordable Care Act (ACA) implementation beginning January 1, 2014.

PROGRAM DESCRIPTION AND OBJECTIVES. On August 6, 2012, the State of Kansas submitted a Medicaid section 1115 demonstration proposal, entitled KanCare. KanCare will operate concurrently with the state’s section 1915(c) Home and Community-Based Services (HCBS) waivers and together provides the authority necessary for the state to require enrollment of almost all Medicaid beneficiaries (including the aged, disabled, and some dual eligibles) across the state into a managed care delivery system to receive state plan and HCBS waiver services. This represents an expansion of the state’s previous managed care program, which consisted of HealthWave (managed care organization) and HealthConnect Kansas (primary care case management), and provided services to children, pregnant women, and parents in the state’s Medicaid program. KanCare also includes a safety net care pool to support certain hospitals that incur uncompensated care costs for Medicaid beneficiaries and the uninsured, and to provide incentives to hospitals for programs that result in delivery system reforms that enhance access to health care and improve the quality of care. This five year demonstration will:  Maintain Medicaid state plan eligibility;  Maintain Medicaid state plan benefits;  Allow the state to require eligible individuals to enroll in managed care organizations (MCOs) to receive covered benefits through such MCOs, including individuals on HCBS waivers, except: o American Indian/Alaska Natives will be presumptively enrolled in KanCare but will have the option of affirmatively opting-out of managed care.  Provide benefits, including long-term services and supports (LTSS) and HCBS, via managed care; and  Create a Safety Net Care Pool to support hospitals that provide uncompensated care to Medicaid beneficiaries and the uninsured. The KanCare demonstration will assist the state in its goals to:  Provide integration and coordination of care across the whole spectrum of health to include physical health, behavioral health, mental health, substance use disorders and LTSS.  Improve the quality of care Kansas Medicaid beneficiaries receive through integrated care coordination and financial incentives paid for performance (quality and outcomes);  Control Medicaid costs by emphasizing health, wellness, prevention and early detection as well as integration and coordination of care; and and,  Establish long-lasting reforms that sustain the improvements in quality of health and wellness for Kansas Medicaid beneficiaries and provide a model for other states for Medicaid payment and delivery system reforms as well. The state’s demonstration evaluation will include an assessment of the following hypotheses: 1. By holding MCOs to outcomes and performance measures, and tying measures to meaningful financial incentives, the state will improve health care quality and reduce costs; 2. The KanCare model will reduce the percentage of beneficiaries in institutional settings by providing additional HCBS and supports to beneficiaries that allow them to move out of an institutional setting when appropriate and desired; 3. The state will improve quality in Medicaid services by integrating and coordinating services and eliminating the current silos between physical health, behavioral health, mental health, substance use disorder, and LTSS; and, 4. KanCare will provide integrated care coordination to individuals with developmental disabilities, which will improve access to health services and improve the health of those individuals.