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1 Integrating Care for Dual Eligible Beneficiaries National Conference of State Legislatures Fall Forum: Changing Roles of States in Long Term Services and Supports December 3, 2013 Sarah Barth, JD Welcome and Introductions Sarah Barth, JD Director, Long Term Services Center for Health Care Strategies 2 1
2 Agenda I. Move to Managed Care for Integrated Care II. Building State Capacity III. MLTSS State Experience IV. Readiness Reviews V. Working Together 3 Move to Managed Care for Integrated Care Financial Alignment Capitated Models Administrative Dual Demonstration Model (MN) Dual Eligible Special Needs Plan Platforms (AZ) Stepped Approach Medicaid Managed Long Term Services and Supports (NJ) 4 2
3 Move to Managed Care for Integrated Care Develop a communications plan and engage stakeholders during design, implementation and ongoing program oversight Beneficiary Protections (Ombudsman; Consumer Advisory Councils; Grievances and Appeals) Clearly outline MCO responsibilities and expectations in contracts while building strong relationships that promote innovation Create strong state infrastructure for program monitoring Create LTSS specific quality measures 5 Agenda I. Move to Managed Care for Integrated Care II. Building State Capacity III. MLTSS State Experience IV. Readiness Reviews V. Working Together 6 3
4 Building State Capacity Organizational capacity Leadership Staffing needs Knowledge of Medicare Stakeholder outreach and communication Beneficiaries Health plans Providers 7 Building State Capacity Contracting expertise Development Compliance monitoring Oversight Medicare Advantage requirements Data analysis and information systems Ratesetting and quality measurement Communications expertise 8 4
5 Building State Capacity States can train and/or hire staff with expertise Reorganize/engagesister agenciesto bring expertise supporting seniors and people with mental health and substance abuse Assessment and care coordination Community supports Quality measurement States may need budget resources for building capacity 9 Agenda I. Move to Managed Care for Integrated Care II. III. Building State Capacity MLTSS State Experience IV. Readiness Reviews V. Working Together 10 5
6 MLTSS State Experience MLTSS programs doubled from 8 to 17 between By 2014, 26 states are projected to have MLTSS programs Currently, 9 states have mandatory enrollment, 7 voluntary, and 1 has both Number of MCOs in the MLTSS market has expanded accordingly Consumer directed options offered in 13 of the 17 states with MLTSS* 11 States with MLTSS Programs Arizona California Delaware Florida Hawaii Kansas Massachusetts Michigan Minnesota New York New Mexico North Carolina Pennsylvania Tennessee Texas Washington Wisconsin 12 6
7 Promoting Rebalancing and Choice of MLTSS Mechanism Plans responsible for NF and HCBS under blended capitation rate (full risk, full profit) Plans responsible for NF and HCBS under blended capitation rate (risk and profit shared with state) HCBS available as an entitlement (enrollment not capped) for NF level of care Higher rate for HCBS services Transition allowance benefit Plans required to work with consumers who want to transition Performance measures require service timelines for sentinel events Performance measure with penalty for NF utilization State MN, NJ, WI AZ, HI, TN TN, TX, WI MN TN HI, MN, TN, TX AZ,TN, TX Source: Mildred Consulting -- Flexible Accounting for Long-Term Care Services: State Budgeting Practices that Increase Access to Home- and Community- Based Services -- Recommendations for California TX 13 Opportunity to Address MLTSS Challenges Access to Medicare data to coordinate benefits/services Coordination of care across acute, primary, bh behavioral health and long term services and supports Extent to which financial incentives can be built into rates to coordinate across programs Beneficiary confusion navigating two programs 14 7
8 Agenda I. Move to Managed Care for Integrated Care II. Building State Capacity III. MLTSS State Experience IV. Readiness Reviews V. Working Together 15 Spotlight: Readiness Reviews Major Areas of Review AssessmentProcess Care Coordination Enrollee Protections Monitoring of First Tier, Down Stream, and Related Entities Organizational Structure and Staffing Provider Networks Enrollee & Provider Communications Enrollment Systems Testing Utilization Management Focus Areas: LTSS & BH 16 8
9 Readiness Reviews Top Areas of Interest Person Centered Care/Self Directed Services Reaching the Hard to Serve Adequate Provider Networks & Credentialing Care Coordination/Care Transitions 17 Agenda I. Move to Managed Care for Integrated Care II. Building State Capacity III. MLTSS State Experience IV. Readiness Reviews V. Working Together 18 9
10 States and CMS are Working Together to: Engage stakeholders at every level in design and implementation Build on existing relationships between state Medicaid agencies, providers, and beneficiaries Ensure beneficiary protections under Medicare Include quality standards and rigorous evaluations Establishpayment strategiesthatencourageproviderthat encourage participation and create potential state and federal savings The Integrated Care Resource Center (ICRC): Established by CMS to help states advance integrated care delivery for dual eligibles. CHCS, with Mathematica Policy Research, coordinates state technical assistance and online resources. Visit 19 States Working Together Implementing New Systems of Integration for Dual Eligibles (INSIDE) Supported by The SCAN Foundation and The Commonwealth Fund Brings together 16 states implementing programs of integrated care through group learning and innovation sharing, as well as opportunities to work with federal partners Arizona, Arkansas, California, Colorado, Idaho, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Rhode Island, South Carolina, Texas, Virginia, and Washington 20 10
11 Community Based Health Plans Working Together Promoting Integrated Care for Dual Eligibles (PRIDE) Supported by The Commonwealth Fund Brings together seven integrated health plans to work to enhance their scale, long term viability, and impact on service delivery through a learning, innovation and information dissemination platform PRIDE Consortium membership: CareSource (OH) icare (WI) Commonwealth Care Alliance (MA) Health Plan of San Mateo (CA) UCare (MN) Together 4 Health (IL) VNSNY Choice (NY) 21 Resources Building State Capacity to Implement Integrated Care Programs for Medicare Medicaid Enrollees. M. Herman Soper, Center for Health Care Strategies, July Developing Provider Nt Networks for Mdi Medicaid idmanaged dcare Long Term Services and Supports Programs: Considerations for States. J. Klebonis and Sarah Barth, Center for Health Care Strategies, July _.pdf Three State s Paths to Medicaid Managed Long Term Care; Florida, New Jersey and Virginia. S. Barth and B. Ensslin, Center for Health Care Strategies, July _.pdf Innovations in Integration: ti State t Approaches to Improving Care for Mdi Medicare Medicaid Mdi id Enrollees. M. Herman Soper, B. Ensslin, Center for Health Care Strategies, February State Trends and Innovations in Long Term Services and Supports. S. Barth, B. Ensslin and N. Archibald, Center for Health Care Strategies, December _FINAL.pdf 22 11
12 Thank you! 12
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3+ 3+ N = 155, 442 3+ R 2 =.32 < < < 3+ N = 149, 685 3+ R 2 =.27 < < < 3+ N = 99, 752 3+ R 2 =.4 < < < 3+ N = 98, 887 3+ R 2 =.6 < < < 3+ N = 52, 624 3+ R 2 =.28 < < < 3+ N = 36, 281 3+ R 2 =.5 < < < 7+
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