Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst Virginia Department of Medical Assistance Services LTC Medicaid Subcommittee February 27, 2014 http:// dmasva.dmas.virginia.go 1 Department of Medical Assistance Services
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Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst
Department of Medical Assistance Services. Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst Virginia Department of Medical Assistance Services LTC Medicaid Subcommittee February 27, 2014. http://dmasva.dmas.virginia.gov. 1. 3. 2. 1. Overview. - PowerPoint PPT Presentation
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Sarah Broughton, MSW Outreach and Education CoordinatorPatti Davidson, MSW Program Analyst
Virginia Department of Medical Assistance Services
LTC Medicaid SubcommitteeFebruary 27, 2014
http://dmasva.dmas.virginia.gov 1
Department of Medical Assistance Services
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1Commonwealth Coordinated Care: Program Highlights
Eligibility and Enrollment
Important Contact Information
Overview
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1High-quality, person-centered care for the Dual Eligible that is focused on their needs and preferences
2All the same benefits currently available under Medicaid and Medicare
3Single program with built-in Care Coordination for primary, preventive, acute, behavioral, and long-term services and supports
4Promotes improved transitions between acute and long-term facilities
5Reimbursement – Blended, risk adjusted rate based on Medicaid, Medicare, and Medicare Advantage data
CCC Highlights
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1Three-way contract between CMS, DMAS, and health plans referred to as MMPs (Medicaid-Medicare Plans).
2Same fiscal agent for consumer-directed services to ensure continuity of care
3Extended transition period for previously authorized services
4Behavioral Health Homes created in partnership with CSBs for individuals with Serious Mental Illness (SMI)
5The three MMPs for CCC
CCC Highlights
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Healthkeepers
HumanaVirginia Premier
Who is eligible for CCC?
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• Full 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 Waiver
• Residents of nursing facilities
• Age 21 and Over
• Live in designated regions (Northern VA, Tidewater, Richmond/Central, Western/Charlottesville, and Roanoke)
Who is not eligible for CCC?
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Individuals 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 HospiceOther Comprehensive Coverage (TPL)
Enrollment
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Enrollment in CCC will be in five regions of the Commonwealth:Central Virginia/RichmondTidewaterNorthern VirginiaRoanoke areaWestern/Charlottesville area
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Virginia’s Service Regions
Enrollment
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Enrollment 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 automatic enrollment where the
individual is automatically enrolled into the CCC program. Intelligent Assignment will consider previous enrollment with the
health plans or the health plan network that includes the current adult day health provider or nursing facility (if applicable).
Intelligent Assignment
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Individuals will be automatically enrolled after considering:The Health Plan network that includes their current adult
day health provider The network that includes the enrollee’s nursing facility
(if applicable) An enrollee’s previous enrollment with the health plans
Beneficiary Choice
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Most importantly, if an 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)
1One system
to coordinate
care
2One ID card for all care
3Designated
Care Manager
424/7 local call
center with access to
beneficiary records
5Person-
centered care
coordination
6Unified appeals process
Enrollee Benefits
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Supplemental Benefits and Supports
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Varies by health planMay include:
DentalVision, to include eyeglassesPodiatryHearing exams, to include hearing aides
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CCC Ready for Launch
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March April
May
June July Aug
Oct
2014 Implementation Timeline
CCC is Different From Medallion IICCC is for those who are eligible for BOTH
Medicare and MedicaidEnrollees with Medicare are NOT eligible for
Medallion IIIncludes Nursing Facility residents and
individuals in the EDCD waiver
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Overview of Enrollment ProcessVaMMIS identifies a list of CCC eligible Medicaid
recipients and this file is sent to CMSCMS runs VaMMIS list through Infocrossing and identifies
individuals who are not CCC eligible from the Medicare side:ESRDHospiceMedicare A/B/D issues and sends back.
Those who remain “eligible” are loaded into VaMMIS (by DMAS) with an “E”.
Individuals eligible for CCC may:Opt-inOr will eventually be automatically enrolled if no choice is
made
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Overview of Enrollment Process cont’dEligible Virginians will receive numerous
letters informing them of their eligibility and providing information on the CCC program
MAXIMUS is the third party enrollment broker
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Important CCC Contact Information
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Phone: 1-855-889-5243 Monday-Friday 8:30-6:00
starting March 3, 2014or
Website: www.virginiaccc.com
Important CCC Contact Information
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Questions about CLAIMS should be referred back to the Medicare-Medicaid
Plan (MMP)
Important CCC Contact Information
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Providers and advocacy groups should send CCC questions and presentation requests to:
Office of Coordinated CareVirginia Department of Medical Assistance