PHPG has provided consulting services to state legislatures and Medicaid agencies to identify viable options for delivering cost-effective, accessible, high-quality services. Our team of consultants have extensive experience to support state government operations, policy development initiatives, compliance solutions and design for federal specifications and requirements, program implementation, data analysis and program/contractor performance evaluations. A featured selection of clients and recent project work we have performed on their behalf is described below.
PHPG provided technical assistance with regard to the evaluation and planning for implementation of coordinated care models as part of the Senate Bill 74, which authorized comprehensive reform of Alaska’s Medicaid program. Assistance included evaluation of care coordination models; development of core components for care coordination models; drafting of a request for information (RFI) and request for proposals RFP; development of proposal evaluation criteria and strategies; review and discussion of proposal evaluation criteria and strategies; and review and evaluation of RFI and RFP responses.
PHPG provided assistance to the Alaska Department of Administration regarding Medicaid-specific considerations concerning the proposed development of a Health Care Authority. Study tasks included evaluation of various Alaska-based state and public-private organizational authority models; potential coordinated purchasing strategies; and assessment of potential administrative activities that may be performed by a single entity for state-funded health care.
PHPG has served as a consultant to the Arizona Health Care Cost Containment System (AHCCCS) since 1994, where it first assisted the state with operational reviews of AHCCCS plans, including networks/accessibility, care management systems and quality improvement. PHPG also has participated in the development and implementation of the Arizona Long Term Care System (ALTCS), the state’s managed care model for frail elders and persons with physical and/or intellectual disabilities; assistance with monitoring the physical and behavioral health contractor quality; and development of clinical assessment instruments for determining eligibility for the long-term care program.
Examples of recent projects include the following: Our team was instrumental in the development of Medicaid (MAGI and long-term care) eligibility business rules for Arizona’s automated eligibility determination system (Health-e-Arizona Plus), including drafting of policies and procedures for Arizona’s eligibility policy manual; planning and development of remote identity proofing and authentication system applications; test case scenario development; and ongoing testing of the Health-e-Arizona Plus system. PHPG also researched national trends with respect to managed long-term care programs and assisted the state in updating its contractual standards in advance of its recent managed care procurement, for which PHPG assisted in the proposal evaluation.
PHPG assisted the State of Colorado in its efforts to create a model for forecasting the utilization of residential support services for persons who have a developmental disability. Activities included the preparation of an overall project plan, including survey elements, distribution and data collection methodologies targeting residential and host home care providers who currently service persons under the State's Medicaid 1915(c) HCBS waiver, and development of a utilization and expenditure forecast model that enables the State to test the impact of alternative coverage and reimbursement strategies.
PHPG is participating in the evaluation of New Mexico's Centennial Care Section 1115 waiver program. Under Centennial Care, New Mexico has contracted with private managed care organizations to deliver health services to all Medicaid beneficiaries. PHPG is responsible for evaluating managed care organizations' performance with respect to service accessibility, quality of care and implementation of performance-based payment models.
Since 2011, PHPG has provided program integrity review project assistance to the New York State Department of Health. Our work has included auditing and reporting eligibility findings for both the Medicaid and CHIP programs under the federal Payment Error Rate Measurement (PERM). PHPG developed an application and database to facilitate the PERM eligibility process, review training materials, policies and procedures for conducting reviews, quality control mechanisms and a formal decision resolution process with local districts in compliance with mandatory state quality control reviews.
PHPG was originally retained by the Oklahoma Legislature in 1994 to develop strategies for restructuring Oklahoma’s nearly insolvent Medicaid program and to advise on options for enhancing the program’s cost-effectiveness. Based on our recommendations, the legislature directed the establishment of a new Single State Agency – the Oklahoma Health Care Authority (OHCA) – and directed the agency to undertake a series of reforms, including development of rural and urban managed care systems and targeting program fraud and abuse, particularly within the behavioral health sector. PHPG provided formative Section 1115 Research and Demonstration waiver assistance to the OHCA for its Medicaid (“SoonerCare”) program; design and implementation of a special “partial capitation” model in rural Oklahoma; and evaluation and implementation planning related to multi-payer health initiatives and re-organization of public agencies. We have also worked on a variety of projects for the Oklahoma legislature.
More recently, PHPG has assisted Oklahoma with the following initiatives:
SoonerCare Health Management Program and Chronic Care Unit, under which the state has contracted with a private care management organization to provide health coaching and care coordination to Medicaid beneficiaries with complex/chronic conditions.
Evaluating the feasibility of contracting with private managed care organizations to enroll and serve Medicaid ABD beneficiaries.
SoonerRide, the state’s non-emergency medical transportation (NET) program.
Since 1994, PHPG has assisted the State with a broad array of policy analysis, program development, implementation activities and major program reforms. PHPG has also provided groundwork development and implementation assistance for the Vermont Health Access Plan (VHAP), Choices for Care and the Global Commitment to Health Section 1115 Medicaid Demonstration waivers. PHPG also was retained as the independent evaluator for the Global Commitment Section 1115 Medicaid Demonstration for the five-year period from 2017 through 2021.
Other recent project work also includes:
Several evaluations of Vermont’s statewide, specialized mental health and developmental disability service delivery system.
Identifying opportunities to streamline and standardize data collection and reporting requirements for Medicaid-funded LTSS and other specialized state programs.
Performing an interim evaluation of the Vermont Premium Assistance Program, the state’s marketplace subsidy program, one element in the larger Global Commitment framework and has provided financial modeling and consultative services related to the sustainability of the Vermont Designated Agency system.