Sarah Broughton, MSW: Outreach and Education CoordinatorPatti Davidson, MSW: Program AnalystElizabeth Smith, RN: Program AnalystVirginia Department of Medical Assistance Services

Virginia Medicaid Waiver NetworkJanuary 23, 2014

http://dmasva.dmas.virginia.gov

Department of Medical Assistance Services

Overview2Current structure Medicare/ Medicaid Introduction to Commonwealth Coordinated Care (CCC)EligibilityEnrollmentSpecific Benefits of CCC

2Medicare-Medicaid Enrollees?3Receive both full benefit Medicare and Medicaid coverage58.8% age 65 or older41.2% under age 65Often have multiple, complex health care needs.

Over 9 million Americans are eligible for Medicare and Medicaid (known as Medicare-Medicaid enrollees)

Medicare-Medicaid Coordination Office. Data Analysis Brief: Medicare-Medicaid Dual Enrollment from 2006-2011. February 2013.

3Who Pays for Services in Virginia? 4MEDICAREHospital carePhysician & ancillary servicesSkilled nursing facility (SNF) care (up to 100 days)Home health careHospicePrescription drugsDurable medical equipmentMEDICAIDNursing facility (once Medicare benefits exhausted)Home- and community-based services (HCBS)Hospital once Medicare benefits exhaustedOptional services: personal care, select home health care, rehabilitative services, some behavioral healthSome prescription drugs not covered by MedicareDurable medical equipment not covered by Medicare

4What does care look like for Medicare-Medicaid enrollees now?5WITHOUT COORDINATED CARE INDIVIDUALS MAY HAVE:Three ID cards: Medicare, Medicaid, and prescription drugsThree different sets of benefitsMultiple providers with limited means of coordination Health care decisions that are not coordinated and not made from the person-centered perspective 5

Fragmented Not CoordinatedComplicated Difficult to NavigateNot Focused on the IndividualGaps in Care

What Does the Medicare-Medicaid Benefit Look Like Now?Like navigating a traffic circle.6A Better Path to Health; Sally and Ednas Story7The Voices for Better Health program at Community Catalyst has released a new video that highlights the challenges of our current health care system for dual eligibles and how integrated care has changed the lives of one older adult and her daughter. http://vimeo.com/77063796

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Commonwealth Coordinated Care8Provides high-quality, person-centered care for Medicare-Medicaid enrollees that is focused on their needs and preferences CCC provides the same benefits currently available under Medicaid and Medicare Creates a single program to coordinate delivery of primary, preventive, acute, behavioral, and long-term services and supports

Commonwealth Coordinated Care9CCC also provides care coordination for beneficiariesPromotes the use of home- and community-based behavioral and long-term services and supportsPromotes improved transitions between acute and long-term facilities

Who is eligible for CCC? 10Full benefit Medicare-Medicaid Enrollees (entitled to benefits under Medicare Part A and enrolled under Medicare Parts B and D, and receiving full Medicaid benefits) Participants in the Elderly or Disabled with Consumer Direction WaiverResidents of nursing facilities Age 21 and OverLive in designated regions (Northern VA, Tidewater, Richmond/Central, Charlottesville, and Roanoke)

10 11Approximately 78,600 Medicare-Medicaid Enrollees

Who is eligible for CCC? Region Nursing FacilityEDCD WaiverCommunity Non-waiverTotalCentral VA4,4303,76216,13524,327Northern VA1,9351,76612,95216,653Tidewater3,0312,49212,57518,098Charlottesville1,4778424,4276,747Roanoke2,8331,3558,58312,771Total13,70610,21754,67278,59611Who is not eligible for CCC?12Individuals not eligible include those in:ID, DD, Day Support, Alzheimer's, Technology Assisted HCBS WaiversMH/ID facilitiesICF/IDsPACE (although they can opt in)Long Stay HospitalsMoney Follows the Person (MFP) program Hospice

Enrollment13Enrollment in CCC will be in five regions of the Commonwealth:Central Virginia/RichmondTidewaterNorthern VirginiaRoanoke areaCharlottesville area

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Virginias Service Regions

Enrollment15Enrollment will be in two phases:The first phase is called voluntary enrollment where an individual proactively enrolls in the program The second phase is called passive enrollment (also known as automatic enrollment) where the individual is automatically enrolled into the CCC program. Individuals will be automatically enrolled after considering the individuals previous enrollment with the health plans, or the health plan network that includes their current adult day health provider or nursing facility (if applicable).

Enrollment16Most importantly, if an individual is unhappy with a chosen health plan, he/she may request reassignment to another health plan or opt out of the program and return to traditional Medicare and Medicaid

Commonwealth Coordinated Care Enrollment Timeline17Tidewater area

March 2014: Voluntary enrollment beginsApril 2014: Coverage beginsMay 2014: Automatic enrollment begins July 2014: Coverage for those automatically enrolled begins

Commonwealth Coordinated Care Enrollment Timeline18Central Virginia/Richmond area

March 2014: Voluntary enrollment beginsApril 2014: Coverage beginsJune 2014: Automatic enrollment beginsAugust 2014: Coverage for those automatically enrolled begins

Commonwealth Coordinated Care Enrollment Timeline19Northern Virginia, Roanoke, Charlottesville areas

May 2014: Voluntary enrollment beginsJune 2014: Coverage beginsAugust 2014: Automatic enrollment beginsOctober 2014: Coverage for those automatically enrolled begins

CCC Benefits for Individuals and their Families20One system of coordinated carePerson-centered care coordinationOne ID card for all care24 hour/7 days a week, toll free number for assistanceUnified appeals process

Additional CCC Benefits21Supplemental Services and Supports in addition to current Medicare and Medicaid coverage (Varies according to health plan)Expanded Telehealth Services (Varies according to health plan)Behavioral Health Homes NEW partnership between the health plans and the CSBs. Provides behavioral and physical health services in one system of care Health Risk Assessments comprehensive assessment of the beneficiarys medical psychosocial, cognitive and functional status

Health Risk Assessment (HRA)22A key component of CCC is a health risk assessment for each Enrollee, completed by the Health Plans care coordination teamHRA- assists in determining medical, behavioral health, long-term supports and services (LTSS), and social needsEach HRA results in a person-centered plan of care, including: the Enrollees strengths and goals, any needed specialists and the plan for care coordination

Commonwealth Coordinated Care: Key Partnerships23CCC Enrollment Facilitator is MaximusVICAPOffice of Long-Term Care OmbudsmanHealth Plans providing coverage under CCC:

HealthkeepersHumanaVirginia Premier

Contact Information24Office of Coordinated CareVirginia Department of Medical Assistance Services600 E. Broad Street, Suite 1300Richmond, VA 23219CCC@dmas.virginia.gov