Washington State
Medicare/Medicaid Integration Project

Project Overview

General Approach: The Washington State Medicare-Medicaid Integration Project (WMMIP) continues to make progress in promoting and developing health care models that integrate medical and long-term care services for dual eligible seniors. These activities include updating the integrated Medicare-Medicaid database, expanding PACE and developing both small and large-scale demonstration projects that link medical management with long-term care services (chronic care coordination).

Current Status

WMMIP negotiated a data use agreement with the Centers for Medicare and Medicaid Services (CMS) to facilitate use, data linking and updating of the Medicare-Medicaid database from 1997 to present.

WMMIP successfully transitioned Providence ElderPlace-Seattle (PEPS) from PACE demonstration site to permanent Medicare Provider status. PEPS was the third site in the country to achieve this status in July 2002. WMMIP also secured a grant from the National PACE Association for the "Accelerating State Access to PACE" (ASAP) project. The ASAP project intends to strengthen and expand the current PACE site and to develop at least one new PACE site.

In April 2002, the WMMIP was adopted and accelerated as a priority initiative of the Secretary of the host department (Washington State Department of Social and Health Services). The mission of the WMMIP now includes transformation of the Medicaid program from specialized and fragmented silo programs to integrated health care. The state intends to develop cost-effective, outcome-based models of managed care to slow the progression of illness and disability among Medicaid clients with multiple complex needs. The goal is to improve the effectiveness of Medicaid service delivery and achieve budget savings by reducing unnecessary expenditures on medical and nursing home care.

In response to a Request for Information (RFI) in July, WMMIP has identified providers, provider networks and organized health plans (both local and national) that are prepared to partner with the state to implement innovative models of integrated care. Small-scale pilot projects will bundle long-term care services and coordinate with primary care physicians via an intensive model of case management called "chronic care coordination". The state will also introduce a nursing facility medical care management strategy that uses dedicated geriatric physicians and nurse practitioners to dramatically improve preventive medical care for nursing home residents. The strategy will target pneumonia, urinary tract infection, skin care and dementia with the goal of preventing unnecessary hospitalization.

WMMIP will use a formal Request for Proposal (RFP) to secure partners for large-scale Medicaid transformation to managed health care. Several projects will be implemented across the state with the goal of fully integrating health services for the Medicaid aged and disabled population. These projects, operating under risk contracts, will be expected to employ chronic care coordination strategies to seamlessly link the primary, acute, long-term care and mental health services included in the comprehensive Medicaid benefit package. As soon as may be feasible, the WMMIP and its partners will secure federal waivers to fully integrate complementary Medicare benefits and financing for those clients who are dually eligible.

Next Steps

• Implement small-scale, community-based pilot programs as soon as possible
• Procure partners for nursing facility medical care management as soon as possible
• Progressively develop, update and analyze Medicare-Medicaid database
• Develop RFP for large-scale integrated care projects not later than June 2003
• Secure state and federal authority/waivers for implementation by January 2004

Contact Information

Ken Cameron, Strategic Planning Coordinator
DSHS Aging and Adult Services Administration
P.O. Box 45600
Olympia, WA 98504-5600
Phone: (360) 725-2571
FAX: (360) 407-0304
E-mail: CAMERKJ@dshs.wa.gov
Website: http://www.wa.gov/dshs/