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Updates Michigan Department of Community Health Leading Age of Michigan HFA Regulatory Day Lansing, Michigan October 29, 2014
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Today’s Objectives Overview of the MI Health Link program PACE Program
Description of the Program Key Implementation Targets and the Associated Timeline PACE Program Current status Developing programs Current MDCH Initiatives Managed Care Rebid State Innovations Model Home Help Program MI Choice
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What is MI Health Link? Demonstration program for Medicare-Medicaid dual eligibles in partnership with the Centers for Medicare and Medicaid Services All Medicare and Medicaid benefits, rules, and funding unified into a single coordinated health care delivery system To be implemented in four regions of Michigan
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Program Goals Seamless access to all services and supports
Person-centered care coordination model Streamlined administrative processes Elimination of barriers to use of home and community based services Quality services focused in enrollee satisfaction Realignment of financial incentives
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MI Health Link Management
New division within Medicaid program to manage MI Health Link CMS and state oversight through a contract management team Steering Committee comprised of MDCH leadership MI Health Link Advisory Committee MI Health Link Ombudsman created
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MI Health Link Management
Managed care entities called Integrated Care Organizations (ICOs) Upper Peninsula: Upper Peninsula Health Plan Southwest: Aetna Better Health (CoventryCares) and Meridian Health Plan Macomb & Wayne: Aetna Better Health, AmeriHealth, Fidelis, Midwest, Molina, United
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MI Health Link Management
ICOs responsible for providing Medical services including primary and acute Pharmacy (Part D) Nursing Facility Services (skilled and custodial) Home and Community Based Services Pre-paid Inpatient Health Plans (PIHPs) to manage all Behavioral Health Services Northcare Southwest Behavioral Health Detroit-Wayne Behavioral Health Macomb Behavioral Health
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Coordinating Mental & Physical Health
All ICOs will contract with a PIHP to manage Medicare behavioral health benefits PIHP supports coordinators and the well-established PIHP provider networks will ensure high quality behavioral health care delivery ICO care coordinators will work with the PIHP through integrated care teams ensuring coordination and responsiveness
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Enrollment Michigan ENROLLS will serve as the enrollment broker for MI Health Link The Demonstration will begin with an opt-in period in which eligible individuals can voluntarily enroll All eligible individuals will receive a letter from Michigan ENROLLS with the option to enroll with either an enclosed paper form or by telephone Michigan Medicare Medicaid Assistance Program (MMAP) will provide enrollment assistance Outreach by the state will begin in October ICOs begin marketing in December for UP and Southwest counties Enrollees may change plans or opt out on a monthly basis 9
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Implementation Timeline
Phase I – UP & SW Michigan Phase II – Wayne & Macomb November – Eligible individuals receive opt-in letter December 1, 2014 – Enrollment period starts for voluntary enrollees January 1, 2015 – Services begin for voluntary enrollees February 1 & March 1, 2015 – Eligible individuals receive 60 and 30 day notices for passive enrollment April 1, 2015 – Services begin for individuals who are passively enrolled March 2015 – Eligible individuals receive opt-in letter April 1, 2015 – Enrollment period starts for voluntary enrollees May 1, 2015 – Services begin for voluntary enrollees May 1 & June 1, 2015 – Eligible individuals receive 60 and 30 day notices for passive enrollment July 1, 2015 – Services begin for individuals who are passively enrolled
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Informing Beneficiaries on Choices
DCH will contract with the State Long Term Care Ombudsman to provide specialized outreach to nursing home, homes for the aged and adult foster care residents about MI Health Link These specialized Ombudsmen can provide information and answer staff questions regarding MI Health Link
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Transitioning to MI Health Link
ICOs will be held to transition requirements to ensure continuity of care for enrollees Nursing home residents have the right to remain in the facilities in which they currently reside at the time of enrollment Nursing facilities not in an ICO’s network can sign single case agreements New CMS Home and Community Based Rule impacts residents of HFAs and AFCs
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Payments to ICOs Integrated Care Organizations (ICOs) will receive 3 monthly capitation payments Medicare Parts A and B Medicare Part D Medicaid The Medicaid monthly capitation payment is based on level of care (LOC), setting, region, and age of each enrollee Tier 1A Nursing Facility LOC – Privately owned Nursing Facility & Hospital Long Term Care Unit Tier 1B Nursing Facility LOC – County Medical Care Facility Tier 2 Nursing Facility LOC – Community Tier 3 Community
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Payments to ICOs – Tier 1 A Tier 1 (A or B) payment requires the individual to meet nursing facility level of care and reside in a dually certified bed Three day required acute hospital stay prior to Medicare authorized skilled nursing stay is waived Medicaid capitation payment includes funds for all Medicaid covered nursing facility services, including the Quality Assurance Supplement (QAS)
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Payments to ICOs – Tier 1 All provider payments made by the ICO
Nursing facilities will continue to collect patient pay amounts Nursing facilities will continue to receive QAS payments for “Medicaid” days and will pay the provider tax to the state for those days ICOs will pay nursing facilities the Medicaid fee-for-service rate (including QAS), unless an alternative rate is negotiated by the nursing facility and ICO, and approved by DCH
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Quality and Performance Evaluation
94 Quality Measures monitored by DCH & CMS 40 waiver performance measures Independent review of outcomes across states by a national research agency (RTI International) Quality Management Workgroup led by DCH with input from beneficiaries MI Health Link Advisory Committee MI Health Link Ombudsman
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Quality Withhold In the 1st Demonstration year, DCH and CMS will apply a 1% quality withhold; payment will depend on ICO performance in 6 quality measures that skew toward structure and process The quality withhold will increase to 2% in the 2nd year and 3% in the 3rd year; payment will depend on ICO performance in 13 more clinically-oriented quality measures
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Program of All-Inclusive Care for the Elderly (PACE)
Medicaid State Plan covered benefit Community-based care model for frail elderly (people age 55 and above) who meet Nursing Facility Level of Care Provides all Medicare and Medicaid covered services (primary, therapeutic, home-based services, pharmacy and institutional) PACE receives separate capitation payments from both Medicare and Medicaid Most services are provided in the PACE center
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Program of All-Inclusive Care for the Elderly (PACE)
Name Location Enrollment Center for Senior Independence -Northwest location -Rivertown Detroit 159 – opened 1994 124 – opened 2013 Care Resources Grand Rapids 186 – opened 2006 LifeCircles Muskegon 220 – opened 2009 CentraCare -Calhoun County -Kalamazoo County Battle Creek Kalamazoo 140 – opened 2009 24 – opened 2013 PACE of Southwest Michigan St. Joseph/Benton Harbor 65 – opened 2012 Huron Valley Ypsilanti Opened February 2014 Total Enrollment 918
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Developing PACE Projects
Organization Location Anticipated Start Date Anticipated Full Enrollment Genesys Health Systems Flint Spring 2015 225 A&D Charitable Foundation (Great Lakes PACE) Saginaw Winter/Spring 2015 Volunteers of America Senior CommUnity Care Lansing Summer 2015 250 United Methodist Retirement Communities Jackson FY 2016 Grand Traverse Pavillions Traverse City
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Current MDCH Initiatives
Healthy Michigan Update Enrollment over 380,000 MI Health Account and healthy behavioral protocols approved State began collecting cost share based on PA 107 starting 10/1/14 State Innovation Model (SIM) Planning phase complete Proposal to test model has been submitted to CMS Focus on primary care and care coordination Concept focuses on Accountable Systems of Care (ASC) Managed Care Re-bid Initiating process to procure new Medicaid Health Plans
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Current MDCH Initiatives
Managed Care Re-bid Initiating process to procure new Medicaid Health Plans RFP to be released after the first of the year Procurement will focus on pillars that include Population health management Value-focused payment Integration of care Structural transformation Stakeholder survey will be released soon Home Help Background check policy Agency provider
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Questions or Comments?
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Contact Information MAIL Integrated Care Medical Services Administration PO Box Lansing, MI WEBSITE
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