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Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst Virginia Department of Medical Assistance Services LTC Medicaid.

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Presentation on theme: "Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst Virginia Department of Medical Assistance Services LTC Medicaid."— Presentation transcript:

1 Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst Virginia Department of Medical Assistance Services LTC Medicaid Subcommittee February 27, Department of Medical Assistance Services

2 321 Commonwealth Coordinated Care: Program Highlights Eligibility and Enrollment Important Contact Information Overview 2

3 1 High-quality, person-centered care for the Dual Eligible that is focused on their needs and preferences 2 All the same benefits currently available under Medicaid and Medicare 3 Single program with built-in Care Coordination for primary, preventive, acute, behavioral, and long-term services and supports 4 Promotes improved transitions between acute and long-term facilities 5 Reimbursement – Blended, risk adjusted rate based on Medicaid, Medicare, and Medicare Advantage data CCC Highlights 3

4 1 Three-way contract between CMS, DMAS, and health plans referred to as MMPs (Medicaid-Medicare Plans). 2 Same fiscal agent for consumer-directed services to ensure continuity of care 3 Extended transition period for previously authorized services 4 Behavioral Health Homes created in partnership with CSBs for individuals with Serious Mental Illness (SMI) 5 The three MMPs for CCC CCC Highlights 4 Healthkeepers Humana Virginia Premier

5 Who is eligible for CCC? 5 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)

6 Who is not eligible for CCC? 6 Individuals not eligible include those in: ID, DD, Day Support, Alzheimer's, Technology Assisted HCBS Waivers MH/ID facilities ICF/IDs PACE (although they can opt in) Long Stay Hospitals Money Follows the Person (MFP) program Hospice Other Comprehensive Coverage (TPL)

7 Enrollment 7 Enrollment in CCC will be in five regions of the Commonwealth: Central Virginia/Richmond Tidewater Northern Virginia Roanoke area Western/Charlottesville area

8 8 Virginia’s Service Regions

9 Enrollment 9 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).

10 Intelligent Assignment 10 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

11 Beneficiary Choice 11 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)

12 1 One system to coordinate care 2 One ID card for all care 3 Designated Care Manager 4 24/7 local call center with access to beneficiary records 5 Person- centered care coordination 6 Unified appeals process Enrollee Benefits 12

13 Supplemental Benefits and Supports 13 Varies by health plan May include: Dental Vision, to include eyeglasses Podiatry Hearing exams, to include hearing aides

14 14 Competitive process for MMP selection Summer-Fall 2013 Multiple-step readiness reviews October- December 2013 Ensure adequate provider networks December February 2014 Extensive systems testing Ongoing Community Education and Outreach CCC Ready for Launch

15 15 Phase I Opt-in Enrollment Phase I Coverage Begins Tidewater Automatic Enrollment and Phase II Opt-in Enrollment Central Automatic Enrollment and Phase II Opt-in Coverage Begins Tidewater Automatic Coverage Begins Central Automatic Coverage Begins and Phase II Automatic Enrollment Phase II Automatic Coverage Begins MarchAprilMayJuneJulyAugOct 2014 Implementation Timeline

16 CCC is Different From Medallion II CCC is for those who are eligible for BOTH Medicare and Medicaid Enrollees with Medicare are NOT eligible for Medallion II Includes Nursing Facility residents and individuals in the EDCD waiver 16

17 Overview of Enrollment Process VaMMIS identifies a list of CCC eligible Medicaid recipients and this file is sent to CMS CMS runs VaMMIS list through Infocrossing and identifies individuals who are not CCC eligible from the Medicare side: ESRD Hospice Medicare 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-in Or will eventually be automatically enrolled if no choice is made 17

18 Overview of Enrollment Process cont’d Eligible Virginians will receive numerous letters informing them of their eligibility and providing information on the CCC program MAXIMUS is the third party enrollment broker 18

19 Important CCC Contact Information 19 Phone: Monday-Friday 8:30-6:00 starting March 3, 2014 or Website:

20 Important CCC Contact Information 20 Questions about CLAIMS should be referred back to the Medicare-Medicaid Plan (MMP)

21 Important CCC Contact Information 21 Providers and advocacy groups should send CCC questions and presentation requests to: Office of Coordinated Care Virginia Department of Medical Assistance Services 600 E. Broad Street, Suite 1300 Richmond, VA


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