True Blue Special Needs Plan A Medicare/Medicaid Coordinated Plan
|
|
- Gregory Fletcher
- 6 years ago
- Views:
Transcription
1 True Blue Special Needs Plan A Medicare/Medicaid Coordinated Plan 06/01/ An Independent Licensee of the Blue Cross and Blue Shield Association
2 Idaho Dual Eligibles Age 21 and older Receives Full Medicaid coverage Enrolled in Medicare Part A & Part B Live within 42 eligible counties 27,200 *Current ESRD diagnosis are prohibited from enrollment 2
3 50%+ below FPL 5+ Chronic Conditions Rural Region Living Limitations Lack high school diploma Institution/Nursing Home Mental Illness More hospital stays/ readmissions More Women Dual Eligibles 1/3 African-American or Hispanic
4 Fiscally Responsible The National Commission on Fiscal Responsibility and Reform estimated that enrolling Dual Eligibles in Medicaid managed care plans would save... $12 billion through
5 Why have MMCP? Medicaid Medicare Blue Cross of Idaho Care Coordination 5
6 True Blue Special Needs Plan True Blue Special Needs Plan provides services for full-benefit, dual-eligible Medicare & Idaho Medicaid beneficiaries. The plan is available in all Idaho counties except Franklin and Lemhi. Plan enrollment is voluntary for all participants Provides coverage for A & D Waiver Services Home and Community Based Services (HCBS) Long Term Services and Supports (LTSS) Ensures necessary services; including primary and acute care, pharmacy, behavioral health, and long-term services and supports are provided, coordinated, and managed. Developmentally Disabled Waiver (D & D) 6
7 Member Benefits Hospital Medical Prescription Drugs Dental Behavioral health Aged & Disabled Waiver Personal Care Services Developmental Disability Targeted Service Coordination Nursing Home and ICF/ID Community Based Rehabilitation Services *Non-Emergent medical transportation must be arranged through Veyo and IS NOT a Waiver Benefit. This benefit is available to all MMCP enrollees. 7
8 Member s Favorite Benefits Blue Cross of Idaho Member Card Access to the True Blue Network Nurse Line Customer Service Fitness Center Benefit Vision Care Coordination 8
9 New Member Enrollment UAI or ISP/SSP requested from IDHW Authorizations are entered once received if applicable through redetermination (UAI) or plan end date (ISP). Long Term Care (LTC) Authorizations are created once Blue Cross of Idaho identifies where enrollees resides. Care Management Episode auto-created in Blue Cross of Idaho s authorization system (JIVA) on all enrollees Care Coordinator is assigned within 14 days once effective Expanded Mental Health (LMSW,LMFT,LPC, TCM and CBRS) No prospective data sent to BCI to identify these services Providers must request authorization to continue services Providers need to include a copy of the Optum Authorization and description of service when requesting authorization. 9
10 Transition Member s benefits and providers remain the same for 90 days from the effective date of enrollment. 10
11 Tips to Know Eligibility for clients who have enrolled/converted to the True Blue Special Needs Plan (MMCP) can be verified on the Blue Cross of Idaho Web Portal by conducting a Member Search within Eligibility & Claims. After the Universal Assessment Instrument (UAI) is received from Health and Welfare, it gets entered into the Blue Cross of Idaho system and the Notice of Decision (NOD) is sent to respective servicing providers. The UAI is good through the redetermination date (re-dat). Every member is assigned a Care Coordinator and offered a Face-to-Face visit within the first 90 days. Alpha prefix to assist in identifying member is XMX A Share of Cost may apply to Waiver Services (HCBS & LTSS), which is located on the Blue Cross of Idaho web portal, under eligibility and claims. 11
12 Tips to Know (cont.) $0 Premium, $0 Part D Deductible & $0 copay for medical services How do providers know if the Medicaid rate changes? Rates may change depending on the provider type. Some rates may change at the re-dat date or others may change when Medicaid changes the facility rate. (i.e., LTC) Some rates are determined by the State and usually change with the new plan year. Other rates may change if the State changes the rates during the year. 12
13 Care Plan Member s Care Plan is made available upon request to enrollee s identified interdisciplinary team on the Blue Cross of Idaho provider portal. Primary Care Physician Care Coordinator Targeted Service Coordinator (when applicable) The primary care physician is informed what services each member receives and has ongoing communication with care coordinator. 13
14 Interdisciplinary Care Team (ICT) Care Coordinator Mental Health Family Member Nursing Home Primary Care Physician Home Care 14
15 Care Plan (cont.) The ultimate purpose of the care plan is to guide all who are involved in the care of the member to provide appropriate treatment to ensure optimal outcome in their healthcare setting. Any caregiver unfamiliar with the member should be able to find all the information needed to care for them in their Care Plan. MMCP Care Plans are available on the Blue Cross of Idaho provider portal. 15
16 Elements of the Care Plan Health status Diagnosis Functional limitations Supports (natural and paid caregivers) Educational and vocational opportunities Goals Target Dates Participant requested services Participant preferences 16
17 Why Care Coordination? Patient Education Medication Monitoring & Adherence Care Setting Transition Physicians are better informed and patients are more engaged and results in better outcomes of care Gaps in care are filled, patient volume increases and the cost of delivering care can be more accurately quantified Increased preventative care leads to higher quality and more efficient coordinated care The nation benefits from reduced healthcare costs, better disease management and a generally healthier population 17
18 Agency Requests Home Community Based Services (HCBS) Agencies receive a copy of the UAI when they are chosen to provide services. If a request for the UAI, Negotiated Service Agreement (NSA)/Care Plan is made, please direct to Blue Cross of to request a copy of the care plan. Agencies must notify Blue Cross of Idaho when enrollee changes agencies, is admitted or discharged, moves, or has significant changes in care etc. Notification of Change Form Used when an member changes agencies. Blue Cross of Idaho must receive form on or before the 25th of the current month for changes to be effective by the 1st. The form is available on the Blue Cross of Idaho Web Portal under Home and Community Based Services Provider Administrative Policy HCBS303. Significant Change Form Used when an agency would like to request a change in authorized time/units due to change in member s condition. Available on bcidaho.com found under Home and Community Based Services Provider Administrative Policy HCBS302. Forms can be ed to MMCP-MQM@bcidaho.com 18
19 Long Term Care (Institutionalized) Enhanced LTC (Long Term Care/Institutionalized): Member lives in an Extended Care Nursing Facility Considered Custodial Level of Care Blue Cross of Idaho responsible for payment of claims When billing for LTC on our Direct Claim Entry tool: Place of Service = 99 CPT/HCPCS = T5999 Additional Claim Information Field = Enter admit date of 07/01/2014 or later along with rev code (rev 0100). 19
20 Expanded Mental Health Available to all members based on Medical Necessity and requires prior authorization. Includes: Community Based Rehabilitation Services (CBRS), Targeted Case Management (TCM), Treatment Plan Development, Psychotherapy (services may require prior authorization based on provider credentials; please contact Blue Cross of Idaho Medical Quality Management for additional information). Provider Administrative Policy HCBS300 on the Blue Cross of Idaho web portal provides further information on Prior Authorization for Expanded Mental Health Services. Peer Support services covered as of
21 Community Based Rehab Services (CBRS) Authorization Requirements Authorization Requirements Requester Information Enrollee Information CPT Code(s) Date span requested, units requested Reason for request Attach Optum authorization Attach care plan Fax to or to 21
22 Targeted Case Management (TCM) Authorization Requirements Authorization Requirements Requester Information Enrollee Information CPT Code(s) (Typically G9002 and G9007) You must bill a Face-to-Face Targeted Service Coordination (G9002) visit with an SC modifier. This modifier represents the targeted service coordinator s acknowledgement that the visit with the member occurred face-to-face. Date span requested, units requested Reason for request (i.e., Individual Support Plan (ISP) Fax to or to MMCP-MQM@bcidaho.com 22
23 Provider Responsibilities True Blue Special Needs Plan (MMCP) eligibility can be verified on the Blue Cross of Idaho Web Portal by conducting a Member Search within Eligibility & Claims. Required Mandatory Annual Training On Web Portal Cultural Competency, Fraud Waste and Abuse, Discrimination and Model of Care All providers must document care for their patients the same way documentation has been done for the State of Idaho Health and Welfare. 23
24 Member Enrollment is Easy Customer Service Staff at (888) Apply online at Ask Blue of Idaho or Medicaid for an application to be mailed Outreach Staff Phone or in-person Monique Johns, or
25 Contacts Member Line Dual Special Needs Plan Waiver Providers Support Line Care Coordinator Line All Requests FAX : MMCP-MQM@bcidaho.com Provider Enrollment All Medicare Advantage medical provider types (i.e., hospitals, physicians, behavioral health, facilities, clinics, etc.) Statewide Lauri Rowell ext Lauri.rowell@bcidaho.com Provider Enrollment Medicare Medicaid Coordinated Plan (MMCP): HCBS, Expanded Mental Health, ICF/Long Term Care, Certified Family Homes Statewide. Sheila Habblett ext Sheila.habblett@bcidaho.com 25
26 Mandatory Training Contacts Angie McCormick, CPC, CPC-P, CRC ext Contacts for Training ext Kathy Brock, CPC-P ext ext Web Site Training Leah Hulse CPC ext Counties: Benewah, Bonner, Boundary, Clearwater, Idaho, Kootenai, Latah, Lewis, Nez Perce and Shoshone Jamie Hunihan ext Counties: Adams, Boise, Canyon, Gem, Owyhee, Payette, Valley and Washington Heidi Lowman ext Cities: Boise and Meridian Jenn Lucy CPC ext Counties: Bannock, Bear Lake, Bingham, Blaine, Bonneville, Butte, Camas, Caribou, Cassia, Clark, Custer, Franklin, Freemont, Gooding, Jefferson, Jerome, Lemhi, Lincoln, Madison, Minidoka, Oneida, Power, and Teton 26 Kylee Williams ext Cities: Eagle, Garden City, Kuna, and Star
27 Questions? 27
Idaho Medicare Medicaid Coordinated Plan (MMCP) FEBRUARY 2018
Idaho Medicare Medicaid Coordinated Plan (MMCP) FEBRUARY 2018 DISCUSSION TOPICS MMCP Overview Who is Dual Eligible MMCP Benefits MMCP Vendors Eligible Counties Oversight Questions & Answers The MMCP is
More informationSecure Blue (PPO) 2015 Evidence of Coverage. January 1 December 31, Your Medicare Health Benefits and Services Coverage as a Member of
Secure Blue (PPO) 2015 Evidence of Coverage January 1 December 31, 2015 Your Medicare Health Benefits and Services Coverage as a Member of Secure Blue (PPO) This booklet gives you the details about your
More information2018 EMERGENCY SOLUTIONS GRANT
IDAHO HOUSING AND FINANCE ASSOCIATION 2018 EMERGENCY SOLUTIONS GRANT PROJECT SOLICITATION Please submit application to snap@ihfa.org no later than 5 pm MT, Friday, August 17, 2018. Table of Contents INTRODUCTION:...
More informationMedicare Advantage Plans. True Blue Special Needs Plan (HMO SNP) Member Handbook. Plan includes dental and vision! H1350_009_MK (11-14)
Medicare Advantage Plans True Blue Special Needs Plan (HMO SNP) Member Handbook Plan includes dental and vision! 16-560 (11-14) H1350_009_MK15144 Blue Cross of Idaho Care Plus is a HMO SNP health plan
More informationone one Three Ways to Identify a Medicare Advantage Plan Member Reminder to Sign Up for EFT Direct Data Entry Now at Blue Cross of Idaho
SPRING 2014 Reminder to Sign Up for EFT We still have offices who have not signed up for Electronic Funds Transfer (EFT) through the Blue Cross of Idaho provider website at bcidaho.com/provider. Enrollment
More informationAre your patients up to date?
SUMMER 2014 Are your patients up to date? As your patients physician, you can play a big part in keeping them on track for preventive screenings. You have a stronger influence on the health of your patients
More informationTrue Blue Special Needs Plan (HMO SNP)
True Blue Special Needs Plan (HMO SNP) 2012 Summary of Benefits You think about finding the perfect health insurance plan. We think about providing you with seamless service and affordable benefits. Serving
More informationWorking with Anthem Subject Specific Webinar Series
Working with Anthem Subject Specific Webinar Series Special Session 2015 Medicare Advantage Dual Eligible Special Needs Plans Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference
More informationMedicare Advantage Plans. True Blue Special Needs Plan (HMO SNP) Member Handbook. Form No (09-17) H1350_009_MK18042
Medicare Advantage Plans True Blue Special Needs Plan (HMO SNP) Member Handbook H1350_009_MK18042 Form No. 16-560 (09-17) True Blue Special Needs Plan (HMO SNP) is a health plan with a Medicare and Idaho
More informationBINGO RAFFLE ANNUAL REPORT. October 16, October 15, 2014
BINGO RAFFLE ANNUAL REPORT October 16, 2013 - October 15, 2014 December 19, 2014 Dear Friends, Twenty-five years ago, when the Idaho Lottery was created, one of the key discussion points was ensuring
More informationMedicare Advantage Plans True Blue Special Needs Plan (HMO SNP) Member Handbook. Form No (09-16) H1350_009_MK17081
Medicare Advantage Plans True Blue Special Needs Plan (HMO SNP) Member Handbook H1350_009_MK17081 Form No. 16-560 (09-16) True Blue Special Needs Plan (HMO SNP) is a health plan with a Medicare and Idaho
More informationTrue Blue Special Needs Plan (HMO SNP)
Medicare Advantage Plans True Blue Special Needs Plan (HMO SNP) True Blue Special Needs Plan (HMO SNP) 2014 Summary of Benefits and Addendum 16-562 (04-14) H1350_MK 14483 05/13/2014 Addendum to the True
More informationParticipant Eligibility. Why should you check eligibility? To verify a participant has Medicaid coverage on actual date of service
Eligibility Overview Importance of checking eligibility Define the eligibility receipt Review examples of eligibility responses Review benefit plans and coverage Identify resources available to check benefit
More informationIntroduction for New Mexico Providers. Corporate Provider Network Management
Introduction for New Mexico Providers Corporate Provider Network Management Overview New Mexico snapshot. Who we are. Why Medicaid managed care? Why AmeriHealth Caritas? Why partner with us? Medical Management
More informationVIRGINIA S MEDICARE AND MEDICAID INTEGRATION EXPERIENCE 12/2/2016
VIRGINIA S MEDICARE AND MEDICAID INTEGRATION EXPERIENCE The Honorable Dr. William Hazel Secretary of Health and Human Resources Commonwealth of Virginia Why Is It Important to Integrate Medicare and Medicaid
More informationMolina Healthcare MyCare Ohio Prior Authorizations
Molina Healthcare MyCare Ohio Prior Authorizations Agenda Eligibility Medicare Passive Enrollment Transition of Care Definition Submission Time Frame Standard vs. Urgent How to Submit a Prior Authorization
More informationProviders who see Empire Medicare Advantage HMO members also are considered contractually eligible to see Empire D-SNP members.
Empire BlueCross BlueShield FAQs for 2017 D-SNP Plans Introduction: Empire BlueCross BlueShield is offering Special Needs Plans (SNPs) to people who are eligible for both Medicare and Medicaid benefits
More informationAnthem HealthKeepers Medicare-Medicaid Plan (MMP), a Commonwealth Coordinated Care plan, provider orientation presentation
Anthem HealthKeepers Medicare-Medicaid Plan (MMP), a Commonwealth Coordinated Care plan, provider orientation presentation Anthem HealthKeepers MMP HealthKeepers, Inc. participates in the Virginia Commonwealth
More information9/10/2013. The Session s Focus. Status of the NYS FIDA Initiative
Leading Age NY Financial Manager s Conference, September 10-12, 2013 The Otesaga Resort Hotel, Cooperstown NY Paul Tenan VCC, Inc. FIDA: An Overview and Update The Session s Focus Overview of CMS national
More informationModel of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018
Model of Care Model of Care 2018 Learning Objectives Program participants will be able to: List two differences between the Complex Care Management (CCM), and Special Needs Program (SNP) programs. Identify
More informationMaryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012
Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint
More informationLong-Term Care Improvements under the Affordable Care Act (ACA)
Long-Term Care Improvements under the Affordable Care Act (ACA) South Carolina Health Care Implementation Coalition September 17, 2010 JoAnn Lamphere, DrPH Director, State Government Relations Health &
More informationMedicare Medicaid Alignment Initiative (MMAI) November 14, 2014
Medicare Medicaid Alignment Initiative (MMAI) November 14, 2014 MMW work is supported by grants from: The Chicago Community Trust Michael Reese Health Trust The Retirement Research Foundation Who We Are:
More informationAlaska Mental Health Trust Authority. Medicaid
Alaska Mental Health Trust Authority Medicaid November 20, 2014 Background Why focus on Medicaid? Trust result desired in working on Medicaid policy issues and in implementing several of our focus area
More informationArkansas LTSS Reform Update
Arkansas LTSS Reform Update Division of Aging, Adult, and Behavioral Health Services (DAABH) Mark White, Deputy Director Division of Provider Services and Quality Assurance (DPSQA) Craig Cloud, Director
More informationA Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Agenda Introductions Power of Purpose Considerations
More informationThe Patient Protection and Affordable Care Act (Public Law )
Policy Brief No. 2 March 2010 A Summary of the Patient Protection and Affordable Care Act (P.L. 111-148) and Modifications by the On March 23, 2010, President Obama signed into law the Patient Protection
More informationIntroduction for Texas Providers. AmeriHealth Caritas Corporate Provider Network Management
Introduction for Texas Providers AmeriHealth Caritas Corporate Provider Network Management Texas snapshot. Who we are. Why AmeriHealth Caritas? Overview Why partner with us? Medical management. Quality
More informationSummary Of Benefits. IDAHO Ada, Bannock, Bingham, Bonner, Bonneville, Canyon, Kootenai, Nez Perce, and Twin Falls
Summary Of Benefits IDAHO Ada, Bannock, Bingham, Bonner, Bonneville, Canyon, Kootenai, Nez Perce, and Twin Falls 2018 Molina Medicare Options Plus (HMO SNP) (844) 239-4913, TTY/TDD 711 7 days a week, 8
More informationHealthcare Service Delivery and Purchasing Reform in Connecticut
Healthcare Service Delivery and Purchasing Reform in Connecticut Presentation to National Association of Medicaid Directors November 9, 2011 Mark Schaefer Director, Medical Care Administration Health Purchasing
More informationHealth Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10
Health Care Reform Provisions Affecting Older Adults and Persons with Special Needs 3/30/10 On March 23, 2010, President Obama signed a comprehensive health care reform bill (H.R. 3590) into law. On March
More informationMedicare Advantage. Financial Alignment: Medicare and Medicaid 08/19/2015. Types of SNPs
Medicare Advantage Other Medicare Plans September, 2015 Types of SNPs SNPs may be any type of Medicare Advantage Coordinated Care Plan, including local or regional preferred provider organization (PPO)
More informationCalifornia s Coordinated Care Initiative
California s Coordinated Care Initiative Sarah Arnquist Harbage Consulting Presentation on 4/22/13 2 Overview Federal and State Movement toward Coordinated Care Update on California s Coordinated Care
More informationTRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED CARE Frequently Asked Questions March 2015
ANDREW M. CUOMO Governor HOWARD A. ZUCKER, M.D., J.D. Acting Commissioner SALLY DRESLIN, M.S., R.N. Executive Deputy Commissioner TRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED
More informationProvider Relations Training
Cal MediConnect Provider Relations Training Presented by Victor Gonzalez and George Scolari Provider Relations Training Agenda Overview of Cal MediConnect Eligibility & Exclusions Enrollment & Disenrollment
More information5/30/2012
The Affordable Care Act Background Coverage Long-term Care Home and Community Based Services Payment Delivery Care Transitions Assuring Quality Supreme Court 5/30/2012 www.nasuad.org BACKGROUND Health
More informationprograms and briefly describes North Carolina Medicaid s preliminary
State Experiences with Managed Long-term Care in Medicaid* Brian Burwell Vice President, Chronic Care and Disability Medstat Abstract: Across the country, state Medicaid programs are expressing renewed
More informationCONTRACT YEAR 2011 MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLAN MODEL TERMS AND CONDITIONS OF PAYMENT
CONTRACT YEAR 2011 MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLAN MODEL TERMS AND CONDITIONS OF PAYMENT Table of Contents 1. Introduction 2. When a provider is deemed to accept Flexi Blue PFFS terms and
More informationMedicaid 101: The Basics
Medicaid 101: The Basics April 9, 2018 Miranda Motter President and CEO Gretchen Blazer Thompson Director of Govt. Affairs Angela Weaver Director of Regulatory Affairs OAHP Overview Who We Are: The Ohio
More informationMMW Webinar Medicare & MMAI/MLTSS Updates December 14, 2016
MMW Webinar Medicare & MMAI/MLTSS Updates December 14, 2016 Webinar Logistics: Audio: Listen through your computer speakers or call in using a telephone. To get call-in information, click telephone under
More informationWhere the Money Goes
Published FY 2015 Where the Money Goes The true benefit of a Lottery is measured only in the meaningful contributions they provide for their good causes and beneficiaries. During their 25th anniversary
More informationUPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS
UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS November 18, 2013 NYS OMH Behavioral Health Transition 2 Key MRT initiative to move fee-for-service populations and services into managed
More informationDual Eligible Special Needs Plans For 2015
Dual Eligible Special Needs Plans For 2015 Introduction: Amerigroup Community Care is offering Dual Eligible Special Needs Plans (D-SNPs) to people who are eligible for both Medicare and Medicaid benefits
More informationMedicaid 201: Home and Community Based Services
Medicaid 201: Home and Community Based Services Kathy Poisal Division of Long Term Services and Supports Disabled and Elderly Health Programs Group Center for Medicaid and CHIP Services Centers for Medicare
More informationCoordinated Care Initiative Frequently Asked Questions for Physicians
What is the Coordinated Care Initiative? California's Coordinated Care Initiative (CCI) changes the focus and delivery of health care for seniors and people with disabilities. Coordinated care offers participants
More informationSpecial Needs Plan (SNP) Model of Care Training 2018
Special Needs Plan (SNP) Model of Care Training 2018 Table of Contents Training Overview Pg. 1 Denver Health Medical Plan s (HMO SNP) MOC Annual Training Pg. 2 Special Needs Plans (SNPs) Pg. 2 Special
More informationLeveraging Care Coordination Organizations in Medicaid Health Homes: The Washington Way
Exploring Medicaid Health Homes Leveraging Care Coordination Organizations in Medicaid Health Homes: The Washington Way September 12, 2013; 2:00 3:00PM (ET) For audio, dial: 1-800-273-7043; Access code
More informationBenefits Why AmeriHealth Caritas VIP Care Plus Was Created
Benefits Benefits Why AmeriHealth Caritas VIP Care Plus Was Created The Medicare Medicaid Plan, AmeriHealth Caritas VIP Care Plus, was created to coordinate Medicare and Medicaid services, simplify the
More informationCAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team. Physician Group Webinar Series
CAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team Physician Group Webinar Series Today s Webinar This webinar is part of a series designed specifically for physicians.
More informationCoordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012
Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Table of Contents CARE COORDINATION GENERAL REQUIREMENTS...4 RISK STRATIFICATION AND HEALTH ASSESSMENT PROCESS...6
More informationProvider orientation. HealthKeepers, Inc. for Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus)
Provider orientation HealthKeepers, Inc. for Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) Professional, facility, behavioral health providers Agenda Who we are Provider
More informationSunflower Health Plan
Key Components for Successful LTSS Integration: Case Studies of Ten Exemplar Programs Sunflower Health Plan Jennifer Windh September 2016 Long- term services and supports (LTSS) integration is the integration
More informationImproving the Continuum of Care: Progress on Selected Provisions of the Affordable Care Act One Year Post-Passage
Improving the Continuum of Care: Progress on Selected Provisions of the Affordable Care Act One Year Post-Passage March 23, 2011 marks the oneyear anniversary of the signing of the Patient Protection and
More information2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP), Chronic Special Needs Plan ESRD (CSNP ESRD) & Model of Care (MOC) Overview
2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP), Chronic Special Needs Plan ESRD (CSNP ESRD) & Model of Care (MOC) Overview Medicare Advantage (MA) Program Part C Medicare Advantage Medicare
More informationFIDA. Care Management for ALL
Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative
More informationHealth Homes: Perspectives from the Leaders
Health Homes: Perspectives from the Leaders February 26, 2014 We strongly encourage you join the call by receiving a call back. If you choose to dial in, please be sure to use your attendee # found under
More informationIllinois Medicaid. updated August 2016 AgeOptions All rights reserved.
Illinois Medicaid updated August 2016 AgeOptions 2016. All rights reserved. 1 What We Will Cover Today What is Medicaid? Medicaid Eligibility Categories of Medicaid Coverage Medicaid Waiver Programs Medicare
More informationStatewide Senior Action Conference. Mark Kissinger. Division of Long Term Care Office of Health Insurance Programs.
Statewide Senior Action Conference Mark Kissinger Division of Long Term Care Office of Health Insurance Programs October 10, 2012 Plan released on the MRT website Care Management for All is a key element
More informationSpecial Needs Plan Model of Care Chinese Community Health Plan
Special Needs Plan Model of Care 2017 2017 Chinese Community Health Plan Elements of CCHP SNP Model of Care Special Needs Plan (SNP) Goals CCHP Dual Eligible SNP Enrollment & Eligibility Vulnerable Beneficiaries
More informationNorth Carolina Medicaid Reform
North Carolina Medicaid Reform Sandy Terrell Director, Clinical Policy Health and Human Services NC Health Care History c.1952 Good Health Act 1965 Medicare & Medicaid c.1972 Office of Rural Health 1877
More informationMedicare: 2017 Model of Care Training 12/14/201 7
Medicare: 2017 Model of Care Training 12/14/201 7 What is the Model of Care? The Model of Care (MOC) is Allwell s plan for delivering our integrated care management program for members with special needs.
More informationFlorida Medicaid. Statewide Inpatient Psychiatric Program Coverage Policy
Florida Medicaid Statewide Inpatient Psychiatric Program Coverage Policy Agency for Health Care Administration December 2015 Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority...
More information2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP) & Model of Care (MOC) Overview
2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP) & Model of Care (MOC) Overview Medicare Advantage (MA) Program Part C Medicare Advantage Medicare Part A and B benefits are administered
More informationImplementing the Affordable Care Act:
Implementing the Affordable Care Act: Making it Easier For Individuals to Navigate Their Health and Long Term Care 26 th National Home and Community Based Services Conference Tuesday, September 28, 2010
More informationNew York Children s Health and Behavioral Health Benefits
New York Children s Health and Behavioral Health Benefits DRAFT Transition Plan for the Children s Medicaid System Transformation August 15, 2017 DRAFT Transition Plan for the Children s Medicaid System
More informationA Snapshot of the Connecticut LTSS Rebalancing Agenda
A Snapshot of the Connecticut LTSS Rebalancing Agenda Agenda Medicaid context and vision State Rebalancing Plan Major elements of rebalancing agenda Money Follows the Person, Nursing Home Rightsizing,
More informationAnthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training
Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training Anthem Blue Cross Cal MediConnect Plan Effective January 1, 2015, Anthem Blue Cross
More informationBending the Health Care Cost Curve in New York State:
Bending the Health Care Cost Curve in New York State: Integrating Care for Dual Eligibles October 2010 Prepared by The Lewin Group Acknowledgements Kathy Kuhmerker and Jim Teisl of The Lewin Group led
More informationIllinois Medicaid Integrated Care Program August 2013
Illinois Medicaid Integrated Care Program August 2013 What We Will Cover Today Background of Illinois Managed Care Transitions Integrated Care Program (ICP) Service Packages 1, 2, and 3 Enrollment Implementation
More informationFrom Fragmentation to Integration: Bringing Medical Care and HCBS Together. Jessica Briefer French Senior Research Scientist
From Fragmentation to Integration: Bringing Medical Care and HCBS Together Jessica Briefer French Senior Research Scientist 1 Integration: The Holy Grail? An act or instance of combining into an integral
More informationLessons Learned from MLTSS Implementation in Florida Where Have We Been and Where Are We Going?
Lessons Learned from MLTSS Implementation in Florida Where Have We Been and Where Are We Going? David Rogers Assistant Deputy Secretary for Medicaid Operations Agency for Health Care Administration 2016
More informationSubtitle E New Options for States to Provide Long-Term Services and Supports
LONG TERM CARE (SECTION-BY-SECTION ANALYSIS) (Information compiled from the Democratic Policy Committee (DPC) Report on The Patient Protection and Affordable Care Act and the Health Care and Education
More information2014 Model of Care. Provider Training. Molina Medicare _rev_8-14_cab
2014 Model of Care Provider Training Molina Medicare 2014 5-2013_rev_8-14_cab Course Overview The Model of Care (MOC) is Molina Healthcare s documentation of the CMS directed plan for delivering coordinated
More informationComing Changes for Adults Who Have Medicare and Medi-Cal
Coming Changes for Adults Who Have Medicare and Medi-Cal California Coordinated Care Initiative and the Cal MediConnect Program 1 Coming Changes for People with Medicare and Medi-Cal California Coordinated
More informationGenerations Advantage Focus DC (HMO SNP) Diabetes Care Special Needs Plan GENERAL MODEL OF CARE (MOC) TRAINING
Generations Advantage Focus DC (HMO SNP) Diabetes Care Special Needs Plan GENERAL MODEL OF CARE (MOC) TRAINING Through this training you will learn: What is a SNP? What is Martin s Point Generations Advantage
More informationRoadmap for Transforming America s Health Care System
Roadmap for Transforming America s Health Care System America s health care system requires transformational change to provide all health care participants with broader access and choice, improved quality
More informationCal MediConnect (CMC) Model of Care
Cal MediConnect (CMC) Model of Care CMC MOC Annual Training Presentation for Providers and Health Net Associates Presentation by Health Net Medical Management Training Department Herminia Escobedo Health
More informationManaged Care Transitions
Managed Care Transitions New York State Health Facilities Association Mid-Winter Education Conference Carla R. Williams, MPA Cornelius R. Murray, Esq. January 14, 2014 Medicaid Redesign Update Medicaid:
More informationThe Future of the Valley: Do we actually know what to expect?
From the SelectedWorks of Jacobus J. "Jaap" Vos July, 2014 The Future of the Valley: Do we actually know what to expect? Jaap Vos Available at: https://works.bepress.com/jaap_vos/28/ The Future of the
More informationBlue Medicare Private-Fee-For-Service SM (PFFS) 2008 Medicare Advantage Terms and Conditions
Blue Medicare Private-Fee-For-Service SM (PFFS) 2008 Medicare Advantage Terms and Conditions Medicare Advantage Table of Contents Page Plan Highlights...2 Provider Participation The Deeming Process...2
More informationSHP_ Adult Foster Care & Assisted Living (AL)
SHP_2015891 Adult Foster Care & Assisted Living (AL) Who is Superior HealthPlan? A subsidiary of Centene Corporation located in St. Louis, MO. Has held a contract with HHSC since December 1999. Provides
More informationFor Profit Managed Care for Long Term Supports & Services Lessons Learned
For Profit Managed Care for Long Term Supports & Services Lessons Learned Mike Chittenden, The Arc Nebraska Kevin Fish, The Arc of Sedgwick County Carrie Hobbs Guiden, The Arc Tennessee John Nash, The
More informationBig Brothers Big Sisters of the Inland Northwest Kootenai County receives grant from Idaho Community Foundation
BIG BROTHERS BIG SISTERS of the Inland Northwest 222 W MISSION STE 210 Phone (509) 328-8310 Fax (509) 328-2068 FOR IMMEDIATE RELEASE: 6/14/06 Pull date: June 20 Contact: Brusan Wells Development Director
More informationH.R. 3962, the Affordable Health Care for America Act: Issues Affecting Long Term Care November 3, Changes to LTC-Related Funding
H.R. 3962, the Affordable Health Care for America Act: Issues Affecting Long Term Care November 3, 2009 Below is a summary of the provisions of the Affordable Health Care for America Act (H.R. 3962) affecting
More informationProgram of All-inclusive Care for the Elderly (PACE) Summary and Recommendations
Program of All-inclusive Care for the Elderly (PACE) PACE Policy Summit Summary and Recommendations PACE Policy Summit On December 6, 2010, the National PACE Association (NPA) convened a policy summit
More informationLow-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees
TECHNICAL ASSISTANCE BRIEF J UNE 2 0 1 2 Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees I ndividuals eligible for both Medicare and Medicaid (Medicare-Medicaid
More information2012 ANNUAL OPERATING PLAN GATEWAY INTERAGENCY FIRE FRONT
2012 ANNUAL OPERATING PLAN GATEWAY INTERAGENCY FIRE FRONT This document serves as the Annual Operating Plan (AOP) as provided for in the Cooperative Fire Protection Agreement (CFPA), dated December 2009,
More informationFACT SHEET Low Income Assistance: Cal MediConnect (E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect (E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is one of 12 states that has signed a Memorandum of Understanding
More informationDual Eligibles: Integrating Medicare and Medicaid A Briefing Paper
Dual Eligibles: Integrating Medicare and Medicaid A Briefing Paper Although almost all older Americans are covered through Medicare, forty-five percent of Medicare beneficiaries (16 million) are poor or
More informationSelectHealth Plan. A Health Maintenance Organization (high and standard option) Member Services FEHB
SelectHealth Plan www.selecthealth.org/fehb Member Services 844-345-FEHB 2017 A Health Maintenance Organization (high and standard option) This plan's health coverage qualifies as minimum essential coverage
More informationDentaQuest/Superior Health Plan Training 2018 STAR Health (Foster Care) STAR + PLUS STAR Value Added Services
DentaQuest/Superior Health Plan Training 2018 STAR Health (Foster Care) STAR + PLUS STAR Value Added Services Agenda STAR Health (Foster Care) STAR + PLUS STAR Pregnant Women Value Added Service (VAS)
More informationBest Practices. SNP Alliance. October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees
SNP Alliance Best Practices October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees Commonwealth Care Alliance is a Massachusetts-based non-profit,
More informationProvider Frequently Asked Questions
Provider Frequently Asked Questions Strengthening Clinical Processes Training CASE MANAGEMENT: Q1: Does Optum allow Case Managers to bill for services provided when the Member is not present? A1: Optum
More informationMedicaid and CHIP Managed Care Final Rule MLTSS
Medicaid and CHIP Managed Care Final Rule MLTSS John Giles, Technical Director Division of Quality and Health Outcomes Children and Adult Health Programs Group Debbie Anderson, Deputy Director Division
More informationSummary of California s Dual Eligible Demonstration Memorandum of Understanding
April 2013 Summary of California s Dual Eligible Demonstration Memorandum of Understanding The Nation s Largest, Most Aggressive Plan for Integration On March 27, 2013, the Centers for Medicare and Medicaid
More informationMedicaid and You Yesterday and Tomorrow: How Medicaid and Payment Reforms Impact Assisted Living Providers
Medicaid and You Yesterday and Tomorrow: How Medicaid and Payment Reforms Impact Assisted Living Providers Ohio Assisted Living Association November 5, 2012 Suzanne J. Scrutton Vorys, Sater, Seymour and
More informationFACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6
FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is 1 of 15 states that has signed a Memorandum of Understanding
More informationSPECIAL NEEDS PLANS. Medicaid Managed Care Congress June 4-6, 2006 Mary B Kennedy, Vice President,State Public Policy
SPECIAL NEEDS PLANS Medicaid Managed Care Congress June 4-6, 2006 Mary B Kennedy, Vice President,State Public Policy Presentation Overview Background on the Evercare Model Transition to Special Needs Plans
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationDay Activity Health Services (DAHS)
Day Activity Health Services (DAHS) Training Last Updated June 2015 SHP_2015891 Who is Superior HealthPlan? A subsidiary of Centene Corporation located in St. Louis, MO. Has held a contract with HHSC since
More information