The Utah Department of Health (UDOH) is pleased to invite comment regarding a new Accountable Care Organization Section 1115 Waiver demonstration initiative Utah will submit a draft waiver for review by the Centers for Medicare and Medicaid Services (CMS). The formal waiver request will be submitted after public comment is received.

In response to the recently passed S.B. 180, Medicaid Reform, UDOH is submitting a Section 1115 Demonstration Waiver authorized by Title XIX of the Social Security Act. The waiver, if approved, will establish Accountable Care Organizations (ACO) in Utah, Salt Lake, Weber, and Davis counties.

The waiver will allow the State to convert its current managed care contracts to an ACO model. The ACO model will better align financial incentives to control costs and to deliver appropriate care to clients. The model eliminates incentives to provide surplus care while at the same time maintaining and increasing the quality of service.

The reimbursement for ACO services will be through prospective rate setting based on the health status of individuals, while allowing flexibility in the delivery of appropriate care. This reimbursement structure customizes risk adjustment models that are consistent with historical expenditures of statewide averages modified by categories of risk.

To ensure the quality of care, each ACO will have a medical home component. This component will customize, coordinate and facilitate care. Further, the ACO must meet quality of care and access to care standards monitored by external, and nationally recognized, professional entities whose entire focus is monitoring the quality of medical care services.

UDOH anticipates that there will be no decrease in the current level of Medicaid expenditures. Rather, the waiver is intended to reduce the rate of increase in future Medicaid appropriations.

UDOH is committed to an extensive public process. UDOH wants the public to have an opportunity to see the waiver amendment, understand the concepts, and offer comments. The waiver application will be available for review and comment on June 1, 2011, at: http://health.utah.gov/medicaid/stplan/1115%20Waivers.htm. It will also be available at local health departments.

UDOH will provide two public forums for comments. The first will be from 10:00 a.m. to 12:00 (noon) on June 7, 2011, at the Cannon Health Building, 288 N 1460 W, Room No. 125, Salt Lake City, Utah. The second will be during the Medical Care Advisory Committee meeting from 4:00 p.m. to 6:00 p.m. on June 9, 2011, at the Cannon Health Building, 288 N 1460 W, Room No. 125, Salt Lake City, Utah.

UDOH invites your comments and questions by June 20, 2011.

The public may direct comments to the Utah Department of Health, Division of Medicaid and Health Financing, PO Box 143102, Salt Lake City, Utah 84114-3102.