Supporting Your Reentry Section 1115 Demonstration

Medicaid Disproportionate Share Hospital (DSH)

January 2019

Reentry Section 1115 Demonstration Services

We help our clients work through the Reentry Section 1115 Demonstration waiver application development process and post-approval requirements.

Budget Neutrality Workbook – Due prior to CMS waiver approval

CMS requires demonstrations to be “budget neutral” – the federal costs of the state’s Medicaid program with the demonstration cannot exceed what the federal government’s Medicaid costs in that state likely would have been without the demonstration.

How we can help: Our financial advisory services are tailored to ensure that your Reentry Demonstration meets CMS approval and maintains budget neutrality while maximizing federal funding opportunities.

  • We provide detailed financial models and simulations to predict financial outcomes and ensure compliance with federal cost-neutrality requirements.
  • We guide our clients through the process of identifying allowable costs, projecting savings, and documenting financial metrics to support CMS reporting requirements.

Implementation Plan – Due to CMS within 120 days post-approval

Implementation Plan outlines achievement towards 5 program milestones:

  1. Increasing Medicaid and CHIP coverage for the reentering population.
  2. Covering and ensuring access to pre-release services to improve care transitions upon return to the community.
  3. Promoting continuity of care.
  4. Connecting to services available post-release to meet the needs of the reentering population.
  5. Ensuring cross-system collaboration.

How we can help: Myers and Stauffer provides comprehensive Reentry waiver implementation planning services that align with both the goals of SMD# 23-003 and the specific needs of your state.

  • Strategic Planning Services
  • Stakeholder Engagement
  • Care Coordination Process Development
  • Implementation Plan Development
  • Resource Optimization

Provider Readiness Assessment

Participating providers must have experience and appropriate training prior to furnishing 1115 pre-release services. The Readiness Assessment must include the following:

  • Pre-release Medicaid and CHIP application and enrollment processes;
  • Screen beneficiary qualifications;
  • Coordinate with partnered entities to furnish Health-Related Social Needs (HRSN);
  • Pre-release care management and assistance with care transitions to the community;
  • Data exchange to support reentry activities;
  • Data reporting to inform 1115 oversight;
  • Project management support to Correctional partners providing pre-release services.

How we can help: Myers and Stauffer consultants facilitate detailed readiness assessments, help in setting up pilot projects, and support full-scale program rollouts, ensuring that every phase of implementation is planned meticulously to meet expected outcomes.

Monitoring Protocol – Due 120 – 150 days of the demonstration approval; Monitoring Reports due quarterly

An outline of the state’s approach to reporting progress on ensuring program integrity, oversight, and monitoring to performance metrics through three quarterly and one annual report each year.

  • Includes specification of a selection of quality of care and health outcomes metrics and population stratifications based on CMS’s upcoming guidance on the Health Equity Measure Slate.
  • For milestones and measure targets at medium to high risk of not being achieved, states must submit to CMS for approval modifications to the Monitoring Protocol for reducing such risks.
  • How we can help: Myers and Stauffer data analysis and quality measure consultants evaluate the impact of the Reentry 1115 Demonstration.
    • We design and implement evaluation frameworks that not only satisfy CMS’s requirements but also provide your team with actionable insights to continually refine and enhance program outcomes.
    • Myers and Stauffer leverages both quantitative and qualitative research methods to assess the effectiveness of health interventions and ensure continuous improvement based on empirical data.
  • Performance Measure Development
  • Data System Enhancements
  • Quality of Care and Health Outcomes
  • Reporting and Compliance
  • Managed Care Plan Integration
  • Collaborative Strategy Development
  • Proactive Adjustments and Strategy Refinement

Evaluation Design Framework – Due 180 days of the demonstration approval

How we can help: Myers and Stauffer data analysis and quality measure consultants are experienced at evaluating the impact of Medicaid 1115 Demonstrations.

  • Evaluation Design and Implementation
  • Outcome Measurement Framework
  • Hypothesis Development and Testing Beyond Minimum Benefits
  • Comprehensive Cost Analysis and Efficiency Planning
  • Budget Optimization

Reinvestment Plan – Due within 120 days post-approval, within the Implementation Plan

Expected to be included in the implementation, states must develop a reinvestment plan that outlines the aggregate amount of federal matching funds that is being requested for services already covered by the carceral facility or authority and where reinvestments will be made throughout the demonstration period to reinvest those federal dollars. Some permissible uses for reinvestment:

  • Optimizing Healthcare Access and Quality: Our consulting services can help you develop a comprehensive Reinvestment Plan that details how your state will:
    • Increase access to healthcare services: We’ll guide you in outlining strategies to expand healthcare availability for underserved populations, including incarcerated individuals (both current and soon-to-be released), recently released individuals, and those at risk of criminal justice involvement due to behavioral health issues.
    • Improve healthcare quality: We’ll assist you in defining methods to enhance the quality of healthcare services provided to these populations.
  • Reinvestment Plan Development and Funding: We can support you in crafting a robust reinvestment plan as part of your overall implementation strategy. This plan will clearly outline:
    • The total amount of federal matching funds your state expects to receive and what portion needs to be reinvested.
    • How these funds will be allocated to achieve the goals outlined in the Reinvestment Plan.
  • Aligning with Reentry Section 1115 Demonstration Opportunity Goals: Our expertise can ensure your Reinvestment Plan seamlessly aligns with the objectives of the Reentry Section 1115 Demonstration Opportunity. This ensures your plan effectively addresses the specific needs of these populations and maximizes the impact of your reinvestment efforts.

By leveraging our consulting services, you can develop a well-defined Reinvestment Plan that improves healthcare access and quality for vulnerable populations while effectively utilizing available federal funding.

How we can help: Our expert consultants will develop your Reinvestment Plan to align with the goals of the Reentry Section 1115 Demonstration opportunity.

Mid-Point Assessment Report – Due at the end of Demonstration Year 3

Conducted by an independent entity to assess the following:

  • Progress toward meeting each milestone and timeframe approved in the Implementation Plan;
  • Progress toward meeting performance metrics as approved in the Monitoring Protocol;
  • Factors that affected achievement on the milestones and progress;
  • Factors likely to affect future performance in meeting milestones and targets not yet met and information about the risk of possibly missing those milestones and performance targets;
  • For milestones or targets at medium to high risk of not being met, recommendations for adjustments in the Implementation Plan or to pertinent factors that the state can influence that will support improvement.

How we can help: Myers and Stauffer’s has extensive experience as a Medicaid 1115 waiver Independent Assessor. We have developed assessment tools to efficiently and effectively perform the following:

  • We design and implement evaluation frameworks that not only satisfy CMS’s requirements but also provide your team with actionable insights to continually refine and enhance program outcomes.
  • Myers and Stauffer leverages both quantitative and qualitative research methods to assess the effectiveness of health interventions and ensure continuous improvement based on empirical data.

Comprehensive Program Development, Infrastructure Design, and Operations Deployment

Developing the necessary infrastructure to support the pre-release benefit package is crucial. We specialize in designing systems that integrate enhanced case management, Medication-Assisted Treatment (MAT), and medication management systems effectively within existing healthcare frameworks.

How we can help: Our clients leverage our expertise to design health care programs that address the full spectrum of needs for justice-involved individuals, from mental health and substance use disorder treatment to chronic disease management.

  • We help states craft policies that enhance access to care, improve treatment continuity, and reduce the health-related barriers to successful reentry.
  • Our operational support extends to developing IT solutions that ensure seamless data sharing and coordination between correctional facilities and community healthcare providers, crucial for the continuity of care.
  • Comprehensive Project Management
  • Expert Technical Assistance and Advisory
  • Advanced Infrastructure and Health IT Solutions
  • Coordination for Comprehensive Care Delivery

For More Information:

Jerry Dubberly, PharmD
PH 404.524.9519
Kelly Gonzalez
PH 404.524.0775
Bobby Courtney, JD, MPH
PH 317.815.5475
Tara Clark, CPA
PH 888.749.5799