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Wyoming – Medical Homes
/in Policy Wyoming Cost, Payment, and Delivery Reform, Health System Costs, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Medical HomesWyoming’s 2013 Supplemental Budget included a $300,000 earmark to “[develop] a primary care medical home network in Wyoming.” The Wyoming Department of Health, which administers the state’s Medicaid program, leveraged a $14 million Health Care Innovation Award led by the Wyoming Institute for Population Health to help achieve this goal. The Department of Health allocated $250,000 of the earmarked funds to increase the number of practices receiving TransforMED support through the Innovation Award.
As a pilot, The Wyoming Department of Health began making enhanced payments ($3.00 per-member per-month) to four NCQA-recognized medical homes participating in WyHealth, a care management program for Medicaid enrollees. Beginning April 10, 2015, the Wyoming Department of Health will make enhanced payments to any WyHealth-participating primary care practice that completes a PCMH attestation form. The attestation form is built off of NCQA PCMH standards, but practices will not be required to achieve NCQA PCMH recognition to receive the enhanced payments.
Last updated: March 2015
| Forming Partnerships | The Wyoming Department of Health has partnered with the Wyoming Institute of Population Health, a division of Cheyenne Regional Medical Center. |
| Defining & Recognizing a Medical Home | Recognition: The Wyoming Department of Health developed an attestation form built on NCQA PCMH standards; however, practices are not required to receive NCQA recognition in order to receive payment. |
| Aligning Reimbursement & Purchasing | Beginning in April 2015, The Wyoming Department of Health will pay medical homes an extra $3 per-member per-month. In order to receive payment, practices must:
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| Supporting Practices | The Wyoming Department of Health provided $250,000 in funding to increase the number of practices receiving support from TransforMED through a Health Care Innovation Award led by the Wyoming Institute for Population Health. |
| Measuring Results | The Wyoming Department of Health selected nine clinical quality measures that practices are required to report in 2015:
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Wyoming
/in Policy Wyoming /by NASHPIn Wyoming:
- All Medicaid behavioral health, mental health, and dental service services are delivered entirely on a fee-for-service basis through EqualityCare, the state Medicaid program. There were a total of 69,947 beneficiaries enrolled in Wyoming Medicaid as of July 2011.
- Wyoming also delivers home and community based services including care coordination, youth and family training and support, and respite care, through a 1915(i) Home and Community Based Services State Plan Amendment.
As of 2013, 59,992 individuals were eligible for Health Check (the Early and Periodic Screening, Diagnostic, and Treatment, or EPSDT, benefit) through Wyoming’s Medicaid program. According to CMS data from 2013, Wyoming achieved an EPSDT screening ratio of 63% and a participation ratio of 45%. 23,541 children received dental services of any kind, with 21,296 receiving preventive dental services.
Last updated June 2014
| Medical Necessity |
Wyoming Rules and Regulations define Medical Necessity for the Health Check program as follows:
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| Initiatives to Improve Access |
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| Reporting & Data Collection | |
| Behavioral Health |
The target population for the Care Management Entities created under the Wyoming CHIPRA Quality Demonstration Grant includes Medicaid-enrolled children and south with serious emotional disturbance, as well as children in Psychiatric Residential Treatment Facilities (or at risk of such a placement). Medicaid-enrolled children whose use of prescription drugs does not conform to state prescribing guidelines are also targeted under the grant.
The children that meet these criteria, and live in the southeastern part of the state (the focus area for the pilots), are eligible to be treated by a Care Management Entity (CME). The CME is an organizational entity that serves as a centralized accountable hub to coordinate all care for youth with complex behavioral health needs and who are receiving care in multiple systems. The authority Wyoming uses to run the CMEs is its 1915(i) State plan Home and Community-Based Services benefit, which was approved in July 2013.
Wyoming also offers ongoing case management for Medicaid beneficiaries under age 21 with a behavioral health disorder. This includes linking beneficiaries to needed services; monitoring and follow-up; referrals; other advocacy on behalf of the beneficiary; and crisis intervention.
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| Support to Providers and Families | The Wyoming Health Check website has information for families about the EPSDT benefit, a provider list, and newsletters about EPSDT. |
| Care Coordination |
Wyoming, in partnership with Maryland and Georgia, received a CHIPRA Quality Demonstration Grant in 2010 to implement and/or expand a Care Management Entity (CME) provider model using high fidelity wraparound and intensive care coordination. Through this grant Wyoming seeks to improve clinical, functional, and cost outcomes, access to home and community-based services, and youth and family resiliency of Medicaid children and youth with serious behavioral health challenges.
The coordination services the CMEs offer include:
Wyoming believes that this program will demonstrate improved access, reduced use of restrictive services, improved clinical and financial outcomes for children in the target population, reductions in disproportional use of restricted services by racial and ethnic minorities, and improved quality of care.
Wyoming’s 1915(i) State Plan Amendment also establishes that Family Care Coordinators will work to coordinate care and secure wraparound services for children. Care Management Entities and primary care physicians are expected to work together to track EPSDT requirements and coordinate care.
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| Oral Health |
All children in Wyoming Health Check receive dental services on a fee-for-service basis. The Health Check brochure details which services are covered by age group. Other dental services are provided as deemed medically necessary.
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Wyoming
/in Policy Wyoming /by NASHPNASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@oldsite.nashp.org.
Last updated: October 2012
CHIP Dental Coverage: An Examination of State Oral Health Benefit Changes as a Result of CHIPRA
/in Policy Reports Health Coverage and Access /by Leigha Basini and Jennifer DolatshahiOral health remains a serious concern for the health and well being of children, especially those who are low-income. However, with the passage of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), all children enrolled in the Children’s Health Insurance Program (CHIP) will have a base level of dental coverage included in their benefit package. This brief provides a summary of the CHIP dental benefit changes under CHIPRA and examines the states that had voluntarily sought federal approval of current benefits, or made changes to their CHIP dental benefits as of September 2011.
Additionally, NASHP wrote a blog post about the dental brief and CHIPRA dental benefit, which is on the Georgetown Center for Children and Families’ Say Ahhh! blog.
Blog: Children’s Dental Health
By Leigha Basini
Jennifer Dolatshahi
Leigha Basini, Former Program Manager
December 2011
| Attachment | Size |
|---|---|
| NMOHPC.CHIPRA.dental.12.11.pdf | 1.64 MB |
Wyoming
/in Policy Wyoming /by EBPHIT_AdminNo HIE Strategic Plan available yet.
Wyoming
/in Policy Wyoming /by NASHP StaffThe Wyoming State Legislature passed a bill (Senate File 0113) during the 2005 session requiring all licensed healthcare facilities in the state to report any occurrence of a defined set of patient safety events. The purpose of this law is to provide the Wyoming Department of Health (WDH) with information that can be used to identify trends in healthcare facility safety events. This information can then be used to assist healthcare facilities in reducing the severity and incidence of safety events.
At the end of each year, the WDH will prepare an aggregate report, without facility or facility employee names, on medical safety events in the state, and will make any necessary recommendations to reduce such events.
| Authorizing statutes or regulations | Code of Wyoming Regulations, Department of Health, Health Care Facilities, Chapter 2 (Document 7299) | |
| Authorizing statutes or regulations | Wyoming Statues, Title 35, Chapter 2, Article 912 (scroll to bottom of page) | |
| Lists or clarifications of reportable events | Instructions for Health Care Facility Safety Event Reporting Form | |
| Public reports | Annual Reports | |
| Public reports | Annual Report – December 2008 | |
| Reportable event forms | Health Care Facility Safety Event Reporting Form | |
| State website | Wyoming Department of Health, Health Care Facility Safety Event Reporting |
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