Five Key Standard Terms and Conditions of the Washington 1115 Medicaid Waiver

On January 9, 2017 the Washington Healthcare Authority (HCA) reached a pivotal milestone in their partnership with the Centers for Medicare and Medicaid (CMS) to transform the delivery and quality of care served to their Medicaid population. The two parties finalized the Standard Terms and Conditions (STCs) of the 1115 Medicaid waiver, making the waiver officially approved, which up until that point had only been agreed-in-principle at the federal level. The STCs are an essential document as they outline the fundamental rules and regulations that HCA, the regional Accountable Communities of Health (ACHs) and providers throughout the state will have to follow as they begin to implement the transformation elements outlined in the waiver.

Over the coming months, HCA will develop the remaining governing documents of the waiver known as the protocols (or attachments to the STCs) and work to gain approval of these from CMS. These documents are critical as they will further define items such as:

• Project valuation and the funds flow formula that will allocate the maximum dollars each ACH can earn through demonstrated performance
• The semi-annual reporting requirements needed to demonstrate performance
• Expectations around the collection and reporting of clinical quality outcomes
• A number of other key governing regulations.

While the STCs are not complete until all of the protocols are developed and approved, this Health Insights piece will focus on five key terms outlined in the STCs related to the DSRIP program and offer suggestions as to things ACHs and community providers should begin to consider as they prepare for the implementation requirements of waiver participation. This piece is not intended to prescribe waiver next steps or compare other waiver programs; COPE Health Solutions has developed other thought leadership pieces that explain these elements of the Washington waiver and those articles are linked at the bottom of this piece.