Commonwealth Coordinated Care 10/14/2014 ' PROGRAM OVERVIEW
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1 ' PROGRAM OVERVIEW Commonwealth Coordinated Care CCC is a new integrated care initiative for individuals who are currently served by both Medicare and Medicaid & meet certain eligibility requirements. Is designed to coordinate the delivery of primary, preventive, behavioral, and long-term services & supports. CCC goals include: - improved quality and health outcomes, - streamlined Medicare and Medicaid requirements, - increased accountability, - reduced burden for enrollees and providers, - providin& care in each individual's setting of choice, and - reduced avoidable services. Supplementary benefits will include care coordination, interdisciplinary care teams, and person-centered care plans. 1
2 10/14/l014 CCC Highlights Throe-" > tonijaci between CMS, DMAS, and he hh plans ~ l referred to IS MMPs (MedtC&td-Medtcare Plans) Rcunburseroent - Blended. ns.l. adjusted rate based on -~ Mcchaul Mochcon:, and.!focb<ore Adnn~a&< clala W Htgh q.wuy, person-<eni<t<d we for!he 0..1 Ebg~blc!hat 15 focused on Lhetr needs and preferences Bcha\aoral Hcllth Homes created mputner'shtp "'lh CSBs for mdmduals "'lh Scnous Mcrtl>l lllncss (SMI) Ht:'.. lt h.._~t-pt"l\ ThelhreeMMPsforCCC IW Hullr.J"~ '.or-.;!flfol Pff'flll..l Who is Eligible for CCC? Full benefit Medicare-Medicaid Enrollees (entitled to benefits under Medicare Pan A and enrolled under Medicare Pans Band D, and receiving full Medtcaid benefits) Participants m the Elderly or Disabled with Consumer Direction Waiver Residents of nursing facilities Age 21 and Over Live in destgnated regtons (Northern VA, Tidewater, Rtchmond/Cenrral, Charlottesville, and Roanoke) Who is not Eligible for CCC? Individuals not eligible include those m - ID, DD, Day Support, Alzhetmer's, Technology Assisted HCBS Watvefs - MHIID facilities - ICF/IDs - PACE (although they can opt m) - Long Stay Hospitals - Money Follows the Person (MFP) program - Hosp1ce - Other Comprehens1ve Coverage (TPL) 2
3 Beneficiary Choice Ifan individual is unhappy with a chosen health plan, he/she may, at any time, request reassignment to another health plan or opt out of the program and return to traditional Medicare and Medicaid (changes will be made the first of the month) Beneficiary Choice cont'd Opt-out decision rests with the beneficiary and their authorized designee (POA or family member) Opt-outs accepted by telephone through MAXI MUS As always, it is critical to honor beneficiary right to privacy. Think twice before sending PHI! Beneficiary Choice is a Hallmark of CCC and woven into the core of the program structure! Enrollee Benefits ~ ~ ~ One system to coordinate care OneiDurcl for all care 24(71ocal ull center w1th 1ccessto btnefiaary ~ UnWitd appeals process C\ PeBOncentered ca,. coordination L:;;) Expanded Benefits ~'- '-....'"" ' 3
4 Supplement21 Benefits and Supports Varies by MMP May include: -Dental -Vision, to include eyeglasses - Podiatry -Gym (wellness) memberships -Hearingexams, to include hearing aides A New Partner in Town: MMPs Medicare Medicaid Plan (MMP) is a payer and provider of care Signed three-way contracts wi th CMS/DMAS Responsible for Care Coordination Panners to quantify outcomes Provide Supplemental Services in addition to what IS currently ava1lable to beneficiaries Care Coordination Unique to CCC No extra cost Help with arranging appoint ments and services Care Manager gets to know member and helps to develop the care plan ~ ~c...o ~~~-JIIIe ;, 4
5 Cost to Beneficiary No deductibles, premiums or co-pays for doctor or specialist (; - visits Some co-pays for prescriptions No co-pays or premiums for extra benefits Continue to pay long-term care patient pays Continuity ofcare Keep Providers that are In-Network Care continues with current providers for up-to 180 days Afterwards, will need to choose In Network providers During transition providers bill the MMP, not Medicare~ &Medicaid. ~ea.. MHIIilllt l ti ~~- fiu l' Enroll in a Plan Members may enroll by calling this number. NO PAPERWORK required for enrollment! Coverage begins 1" of month ~~t!~ 5
6 Beneficiary Notification Eligible individuals are identified by a joint process in DMAS and CMS information s~ems Mb5tffi tffin4j! illjibicj( 1. A letter introducmg CCC 2. A 60 day letter mformongthe ondovidual he/she will be signed up by a specific date unless he/she opts out 3 A 30 day letter onformong the ondovodual he/she woll be signed up by a specofic date unless he/she opts out 4 A welcome package from the health plan providong coverage for the ondovodual Behavioral Health All Community MH Services are included Targeted Case Management is carved out -Still conducted by CSBs CSBs are working with CCC Health Plans to develop behavioral health homes Implementation Update:. WHERE ARE WE NOW? 6
7 Implementation Timeline. October 2014 Charlol:tes\ilk. Stptcmbcr and Roonol.e 2014 Reg~ons. CentraJ AutormiJc: lui) 201~ eo,. nage VJtt~ru Tide\\ atcr Autom.atJ.c Effccti\C AutomiiiUC Co\erage EO'oetm~ Much-June Co' '"ie Opt-In Effoct.~, e Enrollment phased in November 2014 Nonh<m Vugtrua Automattc co, er.age EITce1n e Update on CCC Networks Mediare Medteaid Plan tmmp) participation hn been updatedfor the fouow nc loulrttes Roanob fteeton -city of Radford Is now open to automattcasslgnment. Henf)' County and City of Martinsville now available for opt~ in. The fouowin& k>calit~ have 1 MMP approved Elt&tble benefiaanes 111 these l~httes c.1n opt '" to CCC but wtll not be automattulty assiened while there rs onlv one plan ~Hable. Western/Charlonesville Reston Cities of Harrtsonburaand Staunton please Note In Northern Wythe County V"lf'lwua.Culp~pH, Pnnce W1lham Northern Virginta Rt(K)n and Crty of Manassas h~ve at least ocity of Alexandria 2 MMPs available and will mo'lle Arkncton forward With automatte ocrty andcounty of Fairfu asscnment as scheduled for C tv of Falls Church November 1, 2014, Fauqu ~ r loudoun Manassas Park C tv How the CCC Twn is tndun' ompl<mtnl>rlon MONITORING AND EVALUATION " 7
8 VICAP & Ombudsman Partnership for outreach Sharing beneficiary concerns & trends Contract Monitoring Team Weekly Contract Monitoring Team (CMT) Meetings with each health plan to review: - Marketmg Matenals - Dashboard - MMP Staffing -Claims & -Complamts Processing Time - Provider Traming & - Customer Serv1ce Feedback Lme - Network Review I Evaluation Evaluation Advisory Committee: - 12 members representmg agmg, physical disab1hty, nursing facility, 10/00, hospital, and health plan communities DMAS/George Mason biweekly team meetings Interviews to collect data and develop in-depth understanding of the CCC Program - DMAS, Providers, MMPs - site visits: AAA, AD, CSB, Townhalls - Observattons of MMP Care Management Acttvtttes Enrollee Survey Questionnaire Evaluation Notes from the Field reports posted to DMAS webpage http'ljwww.dmas.virgm1a gov/content pgs/ccc eval aspx 8
9 ~ Coordinated Core \X,~ -og l~for,.. Eduatlon & Outruch Continues OUTREACH " Ongoing Outreach... ~...'-' CCC UPDATE CAUS (Wry Tu.s y 12:J0.1:)Qpm and fridlyl i:mm-u m MoM.y~ Calh(UlS) JrW.y~4erC.Itt To jolnthenl di., l..j S771 Adull O.w 1:l0-2p Holplllb.,..., 11 11:JO m hu C06e CoN«~el-...~ Cclnf r PIC L I 166-&4257~ PfKtiCft li6-141h19 Conltfe"'':e'oM Coflferen(.ecod.t 1U JI(i920S _.. ""01\alc... 2-l:.lOp 1Ll0ant-11P"'I HorMH.tlllttll CoM -l... Conl«-.el "" t Great forum! -facol,nolon ConlettfiCitcocit Conftnnce code o1Ui,.4 Stakeholders ask UC>Jp their questions and racm!ih CoNitot.-rw:tl '9 DMAS/MMPs learn CoftltfltftCICO!Mii 714lHt20S '- con du~ln& 7 \... /... '" about beneficiary & provider experiences with CCC ~,zcl ~~ Ongoing presentations bv request MMPs worked together to combine provider training 9
10 10/14/2u14 On the Web Providers Background documents Provid er Reference Manual MMP Contacts Beneficiaries & Stakeholders Upcoming events CCC Overview information Comparison charts - Department leads (Provider Copies of beneficiary letters Re lations, Auth, etc) Evaluation Information - Regional Care M1n11er leads THANK YOU! ANY QUESTIONS? ~===~ 10
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