michael fiore, director division of plan policy centers for medicare and medicaid services june 6,...

Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care Innovations in Medicare Managed Care for Dual Eligible Individuals for Dual Eligible Individuals Special Needs Plans:

Upload: bridget-quinn

Post on 24-Dec-2015

213 views

Category:

Documents

0 download

Report

Download

Tags:

Embed Size (px):

TRANSCRIPT

Michael Fiore, DirectorDivision of Plan PolicyCenters for Medicare and Medicaid ServicesJune 6, 2006

Innovations in Medicare Managed Care Innovations in Medicare Managed Care for Dual Eligible Individualsfor Dual Eligible Individuals

Special Needs Plans:

Page 2: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

Types of MA Plans

Coordinated Care Plans

HMO

PSO

Local PPO

Regional PPO

SNP

Page 3: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

Other MA Plans

Private Fee-for-Service

Medical Savings Account (MSA)

Page 4: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

What do MA Plans Offer?

Provide the full Medicare Part A and Part B benefits

May offer additional benefits to beneficiaries or lower premiums and cost sharing

Each Medicare Advantage Organization (MAO) must offer one MA-PD in each service area

Page 5: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

Access to MA Plans

Beginning January 2006, 98% of all Medicare beneficiaries have access to an MA plan

Page 6: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

Special Needs Plans (SNPs)

MMA of 2003 created new type of Medicare coordinated care plan

Allows a SNP to restrict enrollment for certain categories of special needs individuals Dual Eligibles

Institutionalized Individuals

Severe or Disabling Chronic Conditions

Page 7: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNPs

Dual Eligibles

All Dual Eligibles may be enrolled in a SNP

A Subset of Dual Eligibles may be enrolled, such as Full Dual Eligibles, but not other subsets such as just SLMBs

Page 8: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNPs

Institutionalized Individuals

Reside or expected to reside continuously for 90 days or longer in SNF/NF

Requiring institutional level of care, but living in the community

Page 9: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNPs

Severe or Disabling Chronic Conditions

Case-by-case basis—No specific Federal definition

Appropriateness of target population

Existence of Clinical programs and special expertise

Non-discrimination against sicker members

Page 10: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNPs

Approved Chronic Care SNPs

DM - COPD

CHF - Cancer

ESRD - Cardiomyopathy

CAD - Stroke

Mentally ill - HIV/AIDS

Page 11: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNPs

Disproportionate Percentage

May enroll a greater percentage of the target population while include non-targeted Medicare beneficiaries

Must enroll target members at a percentage greater than occur nationally in the Medicare population

Page 12: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNPs

Be affiliated with or be an MA plan

Offer all MA services, plus Part D drugs

Provide services tailored to target group

Follow MA plan marketing requirements

Meet all Federal MA plan application requirements

Page 13: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNPs

Set to expire December 31, 2008, But expect/hope for Congressional remedy

Evaluation Report on SNPs due to Congress by December 31, 2007

Assess impact on cost savings

Assess impact on quality of services

Page 14: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNP Concerns

Dual Eligible SNPs

Integration with State efforts

Different Medicare vs. Medicaid enrollment periods

On/off the Medicaid roles

Page 15: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNP Concerns

Institutionalized

Restricting enrollment to designated facilities

Steerage of sicker vs. health individuals

Medicaid medically needy issues

Marketing barriers

Page 16: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNP Concerns

Chronic Care

Inclusion of multiple co-morbidity conditions

Ensuring access to non-institutional care

Page 17: Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible

SNP Concerns

How are they providing superior quality?

More open formularies? Fewer restrictions on access?

Which Medicaid services can be provided under the SNP benefit package?

Medicare and Medicaid $

Data Analysis Brief Medicare-Medicaid Dual Enrollment from ... · Data Analysis Brief Medicare-Medicaid Dual Enrollment from 2006 through 2011 Prepared by Medicare-Medicaid Coordination

Module: 10 Medicare and Medicaid Fraud Prevention · PDF fileModule: 10 Medicare and Medicaid Fraud Prevention . Inside Front Cover . i Module 10: MEDICARE & MEDICAID FRAUD PREVENTION

C MEDICARE MEDICAID SERVICES

Transitions from Medicare-Only to Medicare-Medicaid EnrolleeMME Medicare-Medicaid Enrollee SNF Skilled Nursing Facility SSI Supplemental Security Income 1 INTRODUCTION Medicare-Medicaid

Navigating Medicare...Medicare & Medicaid (Dual) • Called “Dual-eligible” or “Duals” • Medicare costs are covered • Medicare pays first, Medicaid second, IHS last *unless

Medicare Advantage and Dual Medicare-Medicaid Plans

Medicaid Coverage of Medicare Beneficiaries (Dual ...learning.rxassist.org/.../medicare_beneficiaries_dual_eligibles_at... · Medicaid Coverage of Medicare Beneficiaries (Dual Eligibles)

March 1, 2014 Center for Medicare and Medicaid Innovation · Deputy Administrator for Innovation and Quality Center for Medicare and Medicaid Innovation Centers for Medicare and Medicaid

Hearing from Medicare-Medicaid Enrollees: Findings from 2011 Focus Groups Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services

Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid...Presenting a live 90‐minute webinar with interactive Q&A Medicare and Medicaid

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare You 2010

Medicare-Medicaid Network Analysis

The lessons in this module, “Medicare and Medicaid Fraud ... · The lessons in this module, “Medicare and Medicaid Fraud and Abuse Prevention,” explain Medicare and Medicaid

MAGI Medicaid-to- Medicare TransitionsMAGI Medicaid-to-Medicare transitions Transitions from MAGI Medicaid to Medicare will often look different from transitions for those with traditional

Of MEDICARE & MEDICAID - Centers for Medicare and Medicaid ... · Of . MEDICARE & MEDICAID . ... Responsibility for administering the Medicare and Medicaid programs was entrusted

Medicare, Medicaid and Private Health Insurer Liens …media.straffordpub.com/products/medicare-medicaid-and...Medicare, Medicaid and Private Health Insurer Liens in Personal Injury

CMS Medicare Manual System - Centers for Medicare & Medicaid

Medicare, Medicaid, and CHIP · Medicare, Medicaid, and CHIP April 2013 CMS National Training Program . 1. Introduction to Medicare 2. Medicaid and new eligibility group 3. Children’s

Integrating Care for Individuals Eligible for Medicare and Medicaid Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services June

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare You · CENTERS FOR MEDICARE & MEDICAID SERVICES & Medicare. Y. ou. 2012. This is the official U.S. government . Medicare handbook:

Pathways to Medicare Medicaid Eligibility: A Literature · PDF filePathways to Medicare‐Medicaid Eligibility: A Literature Review ... Pathways to Medicare-Medicaid eligibility: A

Medicare & Medicaid EHR Incentive Program Final Rule · Medicare & Medicaid EHR Incentive Program Final Rule. ... What is in the Medicare & Medicaid EHR Incentive Program Final Rule?

Medicare and Medicaid Audit Sampling Strategiesmedia.straffordpub.com/products/medicare-and-medicaid-audit-sam… · Medicare and Medicaid Audit Sampling Strategies Tuesday, August

Medicare and Medicaid

Improving Care for Medicare-Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 19, 2015

Medicare and Medicaid Repayments and Disclosuresmedia.straffordpub.com/products/medicare-and-medicaid-repayments... · Medicare and Medicaid Repayments and Disclosures ... Robert

Medicare + Medicaid 2014

Centers for Medicare & Medicaid Services, Medicaid ... · Centers for Medicare & Medicaid Services Medicaid Integrity Program . Annual Summary Report . of . Comprehensive Program

Centers for Medicare & Medicaid Services OUTREACH … · Centers for Medicare & Medicaid Services OUTREACH TO DATA ... 2 series of the Centers for Medicare & Medicaid Services

Centers for Medicare & Medicaid Services - Medicaid Education

Centers for Medicare & Medicaid Services Center for Medicare

Medicare-Medicaid Plan (MMP) Marketing Training · Medicare-Medicaid Plan (MMP) Marketing Training Medicare-Medicaid Coordination Office. Centers for Medicare & Medicaid Services

Integrating Care for Medicare- Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services November 2011

Medicare & Medicaid

michael fiore, director division of plan policy centers for medicare and medicaid services june 6,...

Documents

ma plan slide

slmbs slide

community slide

snps dual eligibles

ma services

chronic care snps

noninstitutional care

service area slide