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Commonwealth Coordinated Care

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Presentation on theme: "Commonwealth Coordinated Care"— Presentation transcript:

1 Commonwealth Coordinated Care
BPRO May 2015

2 What is Commonwealth Coordinated Care?
Blending of Medicare and Medicaid MMP’s (Medicare-Medicaid Plans) Anthem Healthkeepers Humana Virginia Premier CCC is an enhancement over regular Medicare/Medicaid

3 21 and Older Who is eligible for CCC?
Full Benefit Medicare (A,B,D) & Medicaid EDCD & Nursing Home Residents 21 and Older

4 Who is not eligible? Other Medicaid Long-Term Care Waivers Hospice
Other Comprehensive Insurance

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

6 Care Coordination Unique to CCC No extra cost
Help with arranging appointments and services Care Manager gets to know member and helps to develop the care plan

7 COSTS No deductibles, premiums or co-pays for doctor or specialist visits Some co-pays for prescriptions No co-pays or premiums for extra benefits Continue to pay long-term care patient pays No balance billing patients

8 Do I Have to Change Providers?
Keep Providers that are In-Network Care continues with current providers for up to 180 days Afterwards, will need to choose In-Network providers During transition providers bill the MMP, not Medicare & Medicaid

9 Frequently Asked Questions
My clients ask me questions about CCC, but I don’t feel comfortable answering their CCC questions. Who should I refer them to? What notifications do beneficiaries receive? My client didn’t realize they got enrolled, how did this happen? A client came to me to complain about an issue obtaining medications and they are in CCC, where should they turn? I suspect someone has opted my client out of CCC without their knowledge, who can I inform? My client didn’t opt out of CCC but they were dropped, why? What if I’m in CCC and my ID/DD waiver slot comes available? How can I identify the MMP in VaMMIS? Helpful to have an authorized

10 For CCC Questions, refer beneficiaries to VICAP 1-800-552-3402
Assist VICAP Coordinators & Counselors Information, education, and guidance, to CCC-eligible individuals. Helping to increase the confidence of beneficiaries and their families in their Medicare and Medicaid supports Collaborates with DMAS Enhancing educational opportunities at venues serving Virginia’s five service regions Add phone number Serves as Liaison Serving as a liaison between the AAA’s, VICAP Coordinators and DMAS

11 All Roads Lead to MAXIMUS
Individuals call their trusted source for insurance information-VICAP! VICAP Coordinators have three options when individuals call requesting assistance with CCC enrollment 1 Refer & connect Individual with MAXIMUS 2 Refer Individual to VICAP Educator for personalized assistance 3 Review MMPs in Plan Finder with Individual VICAP Educator connects Individual with MAXIMUS Connect Individual with MAXIMUS All Roads Lead to MAXIMUS

12 What notifications do beneficiaries receive?
Eligibility is determined by a joint process in DMAS and CMS information systems Eligible Individuals Receive Notification by Mail A 60 day letter informing the individual he/she will be signed up by a specific date unless he/she opts out 2. A 30 day letter informing the individual he/she will be signed up by a specific date unless he/she opts out 3. A welcome package from the health plan providing coverage for the individual

13 For Access to Care issues, refer to LTC OMBUDSMAN 1-800-552-3402
Beneficiary Rights & Problem Solving Assistance understanding enrollee rights, responsibilities and benefits; investigate complaints and resolve beneficiary problems with their CCC health plan or services Assist individuals in nursing facilities and assisted living facilities as well as persons receiving community-based services at home. Coordinated Care Advocates assist individuals in the community. Enrollment and disenrollment, continuity of care, accessibility and information, timeliness of plan responses to beneficiary inquiries, covered services and appeals and grievances Assistance Resolving CCC Issues Resource for members & their Advocates

14 Beneficiary Enrollment
Choice Maintaining Eligibility Opt-out decision rests with the beneficiary and their authorized designee (POA or family member) Opt-outs accepted by telephone through MAXIMUS (written opt-outs not accepted) To opt-out or change health plans, the member calls MAXIMUS Access to care issues may result from a break in eligibility. No retroactive enrollment Contact the CCC team with any suggestions for preventing coverage breaks

15 Waiting for ID/DD Waivers
If a beneficiary receives an ID/DD waiver slot and is in CCC: They will enroll with the waiver and their waiver services will begin right away. Use the existing process for waiver enrollment and service authorization. They will stay in the CCC program through the end of the month and then transition back to regular (often called Fee-for-Service) Medicaid. Medical services, pharmacy, etc will be covered by CCC until disenrollment.

16 Identifying MMPs in MMIS
You can identify which MMP a beneficiary is in by locating the Provider ID on the Eligibility or Managed Care screens in MMIS. Anthem Healthkeepers Medicare-Medicaid Plan Humana Gold Integrated Plus Virginia Premier Complete Care

17 Office of Coordinated Care

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