Medicaid Pathway

The Medicaid Pathway accelerates payment and delivery system reform for Medicaid Specialized Services and Providers (mental health, substance use, developmental disabilities, and long term services and supports). These providers and services are not subject to the proposed financial caps of the All-Payer Model where the primary focus is hospital and physician services.  The goals of the Medicaid Pathway include (excerpts from document posted here):

  • Foster integrated service delivery for Medicaid beneficiaries across the care continuum.
  • Support flexibility to allow individuals and providers to decide on necessary services based on a person’s unique treatment and/or support plan needs and social determinants of health, including use of home-and community-based services.
  • Reduce payment silos and fragmentation across provider and service types.
  • Connect payments with quality in service delivery and health of Medicaid beneficiaries.
  • Provide data and feedback to providers delivering care to support accountability for quality and cost.
  • Create a foundation for program oversight, provider monitoring, provider reporting, corrective action and quality improvement planning that assesses accountability for delivering contracted services; appropriateness of care based on best practice and State standards; and outcomes.
  • Transition payments in a manner that is operationally feasible for both the State and providers.

The Medicaid Pathway is a planning process led by the AHS-Central Office in partnership with the Agency of Administration. These planning efforts are designed to systematically review payment models and delivery system expectations across the AHS Medicaid program to refine State and local operations to better support the integration of physical health, long-term services and supports, mental health, and substance use disorder treatment.

Medicaid Pathway delivery system changes are guided by Vermont’s Model of Care and supported by payment reform with the goal of achieving better outcomes for Vermonters. The Model of Care has been agreed upon by stakeholders as foundational to reform efforts. Vermont’s Model of Care emerged over the course of several years and many discussions with a broad set of stakeholders. Discussions began as part of the “Dual Eligible Project” work groups from 2011-2014 and continued to be refined by the VHCIP Disability and Long Term Services and Supports Work Group. It was adopted by the VHCIP Practice Transformation Work Group and utilized to inform learning collaborative activities and training curriculums.

As part of the Medicaid Pathway process, AHS has convened the following stakeholder groups, each focusing on a specific set of Medicaid Specialized Services:

DA/SSA/DS Medicaid Pathway ˗ services provided by Designated Agencies, Specialized Service Agencies, and Preferred Providers for mental health, substance use, and developmental disabilities. It incorporates previous work to initiate a feasibility assessment of current mental health and substance abuse spending within the Agency of Human Services (Value Based Purchasing Project).

LTSS/CFC Medicaid Pathway ˗ whose focus is on delivery system integration and payment reform for long term services and supports, including the Choices for Care program. Vermont’s Choices for Care Program is a nationally recognized Medicaid program that serves both nursing home residents and those receiving home- and community-based services. Although this program has been very successful, there are opportunities for improvement. These include better coordination among providers, increased flexibility of service provision, a shift away from fee-for-service payments, and improved integration of services.

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