February 6, 2019 Washington DC

1. Department of Health Care Finance (DHCF) and Deputy Mayor for Health and Human Services (DMHHS) Fiscal Year 2018-19 Performance Oversight Hearings Presentation Before theCommittee on HealthCouncil of the District of ColumbiaThe Honorable Vincent Gray, Chairperson February 6, 2019 Washington DC

2. Presentation Outline • Introduction • Agency Mission and Challenges • Focus of DHCF’s FY2018 Oversight and Program Reforms • Key Activities for the Office of DMHHS • Conclusion 

3. Presentation Will Address Oversight Issues For DHCF and DMHSS • Thank you Mr. Chairman for the invitation to speak to the Committee on Health about the activities executed under my charge for the administration of Mayor Muriel Bowser • Remarks today will cover oversight and program reform activities, first for DHCF, then DMHHS • Honored to have served in a dual role since September of 2018 • Weighty responsibilities associated with both DMHHS and DHCF • Very grateful for assistance from: • Executive team at DHCF • Jay Melder, the very capable Chief of Staff for DMHHS; and, • Outstanding operational and line staff at both agencies

4. Presentation Outline • Introduction • Agency Mission and Challenges • Focus of DHCF’s FY2018 Oversight and Program Reforms • Key Activities for the Office of DMHHS • Conclusion 

5. DHCF Is A Mission Driven Public Health Insurance Agency • Goal of DHCF remains to improve health outcomes – • Access • Sound Reimbursement • Focus on quality and improving health outcomes • Program Focus – • Medicaid • Children’s Health Insurance Program (CHIP) • Alliance • Immigrant Children’s Program

6. Public Health Programs Administered By DHCF Remain A Key Factor In Coverage Success For The District District of Columbia Residents On Public Health Programs N = 702,455 61% No 39% Yes 87% 6% 7% Medicaid CHIP Alliance Notes: Enrollment as of September 2018. Immigrant children numbers included. CHIP is Children’s Health Insurance Source: Enrollment data from DHCF’s Medicaid Management Information System.

7. More Than Three-Fourths of Medicaid Enrollees Are In The Managed Care Program DC Medicaid Enrollment by Coverage Type, FY2009-2017 76% 63% Source: DHCF staff analysis of data extracted from the agency’s Medicaid Management Information System

8. DHCF’s Program of Long-Term Care Supports Has, And Will Continue To Require Significant Policy Attention Moving Forward Medicaid Enrollees 271,462 *FFS and No Long-Term Care Supports 18% 6% Managed Care Members 76% *FFS & Receiving Long-Term Care Supports Note: *FFS denotes Fee-for-Service program Source: Data extracted from MMIS, reflecting unique enrollment and claims paid during through September 2018

9. Presentation Outline • Introduction • Agency Mission and Challenges • Focus of DHCF’s FY2018 Oversight and Program Reforms • Key Activities for the Office of DMHHS • Conclusion 

10. Focus Of Hearing • Mr. Chairman the written testimony provides detailed testimony on eight of our key projects. In the interest of time, I will discuss four of these projects in this presentation. • I refer the Committee to my more detailed written testimony for information on our My Health GPS program, PACE, our work with Telehealth grants, and our improvements in fraud detection This presentation covers - • Status of DHCF’s $1 billion managed care procurement; • Current endeavor to recalibrate provider rates for four major provider groups; • Efforts to reform DHCF’s long-term care system of supports; and • Developing a comprehensive mental health and substance use treatment programs

11. The Protest Filed By MedStar Of DHCF’s Managed Care Solicitation Has Concluded And We Are Executing A New Procurement • CAB Orders District To Terminate Renewal Years of MCO contracts. The CAB ordered the District to not renew or exercise the option periods of the contract awards to Amerigroup, AmeriHealth, and Trusted; instead, instructing the District to conduct an orderly, timely, and competitive new procurement for these services. This process is well underway. Action 5 • DHCF Initiates A New Procurement. In August 2018, DHCF launched a new procurement for the managed care program. This process is well underway and the agency hopes to announce the winning bidders by no later than April 2019. The new contract will have a contracted base year and four option years. • Action 5 11

12. DHCF Has Made Significant Progress In Rebasing Reimbursement Rates For Several Of Our Major Provider Groups

13. Major Steps Have Been Taken To Reform The Operations Of DHCF’s System Of Long-Term Care Supports • During the past 15 months, DHCF pursued three key initiatives to improve long-term care services: • Implemented a new assessment tool; • Adopted a new case management system; and • Hired a new long-term service and supports (LTSS) assessment vendor • The new assessment tool offers several benefits - • Nationally recognized, validated, and standardized assessment • Ensures a more correct match of services with beneficiary need • Improves access to patient level of care need data • DHCF also established a new case management system - • Integrated with the new assessment tool and associated data • Provides greater insight into the care planning process • Staff acquires better understanding of beneficiary support needs • Ultimately, will improve monitoring of care transitions

14. Work Underway To Submit A Waiver For A Comprehensive Mental Health And Substance Use Disorder Program • DHCF is in the early stages of planning a mental health and substance use disorder (SUD) waiver that will hopefully win CMS approval • Waiver will – • Afford DHCF and the DBH the opportunity to collaborate on the design and implementation of a comprehensive continuum of care • Secure more federal Medicaid funding for adult mental health stays in Institutes for Mental Disease (IMD) • In FY17, at least 2,400 Medicaid beneficiaries had SUDs or mental health conditions that resulted in IMD stays • Cost the District more than $8 million in locally funded payments • Missed opportunities for treatment and disaggregation of residential treatment from other community services • Residential behavioral health needs especially acute for FFS beneficiaries not in waivers • More than half have some mental illness diagnosis • One-quarter presenting with problems of drug or alcohol addiction • Many are homeless, and need for a treatment option residential setting • Medicaid reimbursement for these services is critical

15. Presentation Outline • Introduction • Agency Mission and Challenges • Focus of DHCF’s FY2018 Oversight and Program Reforms • Key Activities for the Office of DMHHS • Conclusion 

16. Key Goals For DMHHS Create an Integrated Health System East of the River Improve Health Outcomes for Infants and Mothers Make DC an Ever-Easier Place to Grow Older Close DC General & Open Short-Term family Housing Reduce Opioid Use, Misuse, & Related Deaths by 50% by 2020 Rehouse all Seniors Displaced by Arthur Capper Fire Protect Access to Affordable Health Coverage Make Homelessness Rare, Brief and Nonrecurring Coordinate Encampment Response and Engagement

17. Efforts Continue To Create A New Health Care System East Of The River But Challenges Exist • We signed LOI with GW Hospital on August 10 • Negotiations ongoing • Impacts of East End Health Equity Bill has put the agreement at risk • Despite the serious setback, we will continue to work within the legislation to resume negotiations with GW Hospital while seriously investigating opportunities for Howard within this venture

18. Homeward DC Continues To Demonstrate Efficacy In Combating Homelessness Across The City • Overall homelessness is down 17% since 2016 • Family homelessness is down 40% since 2016 • Homelessness among Veterans is down 12% since 2016

19. Preventing Homelessness Remains A Key Priority • In the Last Four Years, we have: • Built a robust homelessness prevention program for at-risk families, preventing a shelter stay in over 5,000 cases. • Building on lessons learned in the family system, designed and launched a new Rapid Exit program for single adults • This year, we will: • Begin scaling our prevention programming for single adults • Continue working with feeder systems to help slow inflow into the shelter system

20. Creating Safe, Dignified, Service-Enriched Short-Term Housing Remains a Focus • In the Last Four Years, we have: • Created year-round shelter access to ensure families in crisis have a safe place to be • Closed DC General once and for all • Opened Short-term Family Housingin the first three wards, with four more projects delivering through 2019 and 2020 • This year, we will: • Redevelop the 801 East Men’s Shelter • Open a new Downtown Day Services Center for single adults

21. Ultimate Goal: Ensuring All District Residents Have a Safe & Stable Place to Call Home • In the Last Four Years, we have: • Helped more than 4,600 families exit the homeless services system to permanent housing • Helped more than 4,800 single adultsexit the homeless services system to permanent housing • Launched a Landlord Partnership Fund to increase access to private rental units • This year, we will: • Continue to make historic investments in PermanentSupportive Housing

22. Progress Against The Problem Of Family Homelessness Trend For Families In Shelters 47% Decrease 14% Decrease Source: Office of the Deputy Mayor For Health and Human Services

23. Presentation Outline • Introduction • Agency Mission and Challenges • Focus of DHCF’s FY2018 Oversight and Program Reforms • Key Activities for the Office of DMHHS • Conclusion 

24. Conclusion • Mr. Chairman this concludes my remarks for today’s hearing. • As the Office of the Deputy Mayor and DHCF move into the remainder of this fiscal year and the next, we look forward to working with you and your very capable team on many of these important initiatives. • My team will provide updates on the progress of our efforts throughout the year. • Now I, and members of both DHCF and the Office of the Deputy Mayor, are happy to receive your questions from the Committee. 

25. Questions and Comments