COMMONWEALTH COORDINATED CARE PLUS. A Managed Long Term Services and Supports Program
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1 COMMONWEALTH COORDINATED CARE PLUS A Managed Long Term Services and Supports Program
2 Agenda Background and Key Facts Populations Services Regional Launch CCC Plus Enrollment 2
3 Overview of Commonwealth Coordinated Care Plus (CCC Plus) Primary goal is to improve health outcomes New statewide Medicaid managed care program beginning Aug 2017 for over 216,000 individuals Participation is required for qualifying populations Integrated delivery model that includes medical services, behavioral health services and long term services and supports (LTSS) Care coordination and person centered care with an interdisciplinary team approach 3
4 Medicaid Expenditures Enrollment vs. Expenditures Older adults and individuals with disabilities 23% of the Medicaid population = 66% of expenditures 4
5 Virginia Legislative Mandates General Assembly directed DMAS to transition individuals from the Fee-For-Service delivery model into the Managed Care Model to achieve high quality care and budget predictability
6 6 Health Plans Contracted Statewide Aetna Better Health of Virginia Anthem HealthKeepers Plus Magellan Complete Care of Virginia Optima Health United Healthcare Virginia Premier Health Plan A list of CCC Plus regions by locality is available at: 6
7 CCC Plus Enrollment by Region & Launch Date Date Regions Regional Launch All Populations Aug 1, 2017 Tidewater 20,846 46,811 September 1, 2017 Central 23,368 52,698 October 1, 2017 Charlottesville/Western 17,266 30,114 November 1, 2017 Roanoke/Alleghany 11,169 26,014 November 1, 2017 Southwest 12,769 21,767 December 1, 2017 Northern/Winchester 26,450 39,447 January 2018 January 2018 CCC Demonstration (Transition plan determined with CMS) Persons who are Aged, Blind, Disabled (ABD) (Transitioning from Medallion 3.0) 28,205 76,778 Total All Regions 216, ,851 Source: VAMMIS Data; totals are based on CCC Plus target population data as of May 31,
8 CCC Plus Program Regional Launch Aug 1, 2017 Jan 1, 2018 Tidewater Assign 6/18/17 Central Assign 7/18/17 Charlottesville Assign 8/18/17 Roanoke, Alleghany & Southwest Assign 9/18/17 Northern & Winchester Assign 10/18/17 CCC & M3.0 ABD Assign 11/18/17 June July Aug Sept Oct Nov Dec 8 Go Live Tidewater Effective 8/1/17 Assignment happens on the 18th of each month; CCC Plus enrollment is effective first of the next month following assignment; around 45 days after initial assignment Central Effective 9/1/17 Charlottesville Effective 10/1/17 Roanoke Alleghany & Southwest Effective 11/1/17 Northern & Winchester Effective 12/1/17 CCC and ABD effective 1/1/18
9 CCC Plus Member Benefits Person centered, individualized support plan Same standard Medicaid services provided Choice between health plans Care coordinator for each individual Team of health care professionals working together Assistance connecting to housing, food and community resources Possible additional benefits offered by health plans 9
10 CCC Plus Populations 65 and older Adults and children living with disabilities Individuals living in Nursing Facilities (NFs) Individuals in the CCC Plus Waiver (formerly the Tech Assisted Waiver and EDCD Waiver) Individuals in the 3 waivers serving the DD populations for their acute and primary services *CCC and Medallion 3 ABD populations transition to CCC Plus 10
11 Excluded Populations Limited Coverage Groups Governor s Access Plan (GAP) Family Planning Qualified Medicare Beneficiaries only Special Low-Income Medicare Beneficiaries Qualified Disabled Working Individuals Other Programs Members of Medicaid Medallion and FAMIS managed care PACE (Program of All Inclusive Care for the Elderly) Money Follows the Person (MFP) Alzheimer s Assisted Living Waiver (AAL) Health Insurance Premium Payment (HIPP) 11
12 Excluded Populations Specialized Settings Intermediate Care Facilities for Individuals with Intellectual Disability Veterans Nursing Facilities VA Home Psychiatric Residential Treatment Facilities State facilities: Piedmont, Catawba and Hancock CCC Plus Local Government-Owned Nursing Facilities Bedford County Nursing Home Birmingham Green Dogwood Village of Orange County Health and Rehabilitation Lake Taylor Transitional Care Hospital Lucy Corr Nursing Home Special Conditions Hospice if a hospice provider has submitted paperwork to indicate hospice election prior to enrollment, the member will be excluded. CCC Plus enrolled individuals who elect hospice will remain CCC Plus enrolled 12
13 Carved Out Services Services for CCC Plus enrolled individuals that are paid for through feefor-service. Dental Services (Smiles for Children) School Health Services Preadmission Screening Therapeutic Group Home (formerly Level A and B Group Home) Treatment Foster Care Developmental Disabilities (DD) Waivers Carve out includes waiver services, related transportation, case management and support coordination. Also includes waiver-like EPSDT services for DD Waiver enrolled individuals. 13 (DD Waiver services covered through EPSDT includes: Private duty nursing, Personal care, and Assistive Technology.) Non-waiver services are covered under CCC Plus program.
14 Carved Out Services Community Mental Health Rehabilitation Services will be carved out until Jan 1, These services will be covered by Magellan, the behavioral health services contractor for DMAS. Services include: Mental Health Case Management Therapeutic Day Treatment (TDT) for Children Day Treatment/ Partial Hospitalization for Adults Crisis Intervention and Stabilization Intensive Community Treatment Mental Health Skill-building Services (MHSS) Intensive In-Home Psychosocial Rehab Behavioral Therapy Mental Health Peer Supports 14
15 Transportation CCC Plus Reservations Phone Number Type of Transportation Aetna Better Health of Virginia (800) Option 1 All ages and all levels of service Anthem HealthKeepers (855) All ages and all levels of service Magellan Complete Care of Virginia (877) All ages and all levels of service Optima Health (855) All ages and all levels of service United Healthcare Regions 2,4,5 (855) All ages and all levels of service United Healthcare Regions 1,3,6 (888) All ages and all levels of service Virginia Premier (877) All ages and all levels of service Additional information, including phone numbers for ride assistance, is available at: 15
16 Member Materials Provided by Health Plans Care Coordinator Contact Information Ø CCC Plus Members are assigned a Care Coordinator to personally assist members and their treating providers Ø For assistance identifying a member s Care Coordinator, please contact the assigned health plan directly at: Magellan UnitedHealthCare Anthem Aetna VA Premier Optima Press # press #1 and ask for CC select option for Care Management OR Toll Free
17 Enrollee Protections During the continuity of care period of up to 90 days, MCOs have to pay existing providers MCO must go out of network to provide a service that they don t have in network Individuals in Nursing Facility (NF) at the time of enrollment will not be moved even if the NF does not choose to participate. NF will be paid as an out of network provider. 17
18 Thank You! For More Information... Additional CCC Plus information is available at: Provider call schedule is on the CCC Plus Meetings webpage (look for the Behavioral Health Call) CCC Plus Provider Q and A Conference Call Schedule NEW Send CCC Plus questions, comments, and suggestions to: CCCPlusCMHRS@dmas.virginia.gov 18
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P-01242 (03/2016) 1 Table of Contents Executive Summary... 3 Introduction... 5 Public and Stakeholder Engagement... 5 Ongoing Consumer and Stakeholder Engagement in Family Care/IRIS 2.0... 6 Guiding Principles...