Sarah Broughton, MSW: Outreach and Education Coordinator Patti Davidson, MSW: Program Analyst

1. Department of Medical Assistance Services Sarah Broughton, MSW: Outreach and Education Coordinator Patti Davidson, MSW: Program Analyst Elizabeth Smith, RN: Program Analyst Virginia Department of Medical Assistance Services Virginia Medicaid Waiver Network January 23, 2014 http://dmasva.dmas.virginia.gov

2. Overview • Current structure Medicare/ Medicaid • Introduction to Commonwealth Coordinated Care (CCC) • Eligibility • Enrollment • Specific Benefits of CCC

3. Medicare-Medicaid Enrollees? • Receive both full benefit Medicare and Medicaid coverage • 58.8% age 65 or older • 41.2% under age 65 • Often have multiple, complex health care needs. Over 9 million Americans are eligible for Medicare and Medicaid (known as Medicare-Medicaid enrollees)

4. Who Pays for Services in Virginia? MEDICARE • Hospital care • Physician & ancillary services • Skilled nursing facility (SNF) care (up to 100 days) • Home health care • Hospice • Prescription drugs • Durable medical equipment MEDICAID • Nursing facility (once Medicare benefits exhausted) • Home- and community-based services (HCBS) • Hospital once Medicare benefits exhausted • Optional services: personal care, select home health care, rehabilitative services, some behavioral health • Some prescription drugs not covered by Medicare • Durable medical equipment not covered by Medicare

5. What does care look like for Medicare-Medicaid enrollees now?

6. What Does the Medicare-Medicaid Benefit Look Like Now? Like navigating a traffic circle…. • Fragmented • Not Coordinated • Complicated • Difficult to Navigate • Not Focused on the Individual • Gaps in Care

7. A  Better Path to Health; Sally and Edna’s Story • The 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

8. Commonwealth Coordinated Care • Provides 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

9. Commonwealth Coordinated Care • CCC also provides care coordination for beneficiaries • Promotes the use of home- and community-based behavioral and long-term services and supports • Promotes improved transitions between acute and long-term facilities

10. Who is eligible for CCC? • 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, Charlottesville, and Roanoke)

11. Who is eligible for CCC? Approximately 78,600 Medicare-Medicaid Enrollees

12. Who is not eligible for CCC? • 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

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

14. Virginia’s Service Regions

15. Enrollment • 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 “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 individual’s previous enrollment with the health plans, or the health plan network that includes their current adult day health provider or nursing facility (if applicable).

16. Enrollment Most 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

17. Commonwealth Coordinated Care Enrollment Timeline Tidewater area • March 2014: Voluntary enrollment begins • April 2014: Coverage begins • May 2014: Automatic enrollment begins • July 2014: Coverage for those automatically enrolled begins

18. Commonwealth Coordinated Care Enrollment Timeline Central Virginia/Richmond area • March 2014: Voluntary enrollment begins • April 2014: Coverage begins • June 2014: Automatic enrollment begins • August 2014: Coverage for those automatically enrolled begins

19. Commonwealth Coordinated Care Enrollment Timeline Northern Virginia, Roanoke, Charlottesville areas • May 2014: Voluntary enrollment begins • June 2014: Coverage begins • August 2014: Automatic enrollment begins • October 2014: Coverage for those automatically enrolled begins

20. CCC Benefits for Individuals and their Families • One system of coordinated care • Person-centered care coordination • One ID card for all care • 24 hour/7 days a week, toll free number for assistance • Unified appeals process

21. Additional CCC Benefits • Supplemental 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 beneficiary’s medical psychosocial, cognitive and functional status

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

23. Commonwealth Coordinated Care: Key Partnerships • CCC Enrollment Facilitator is Maximus • VICAP • Office of Long-Term Care Ombudsman • Health Plans providing coverage under CCC: • Healthkeepers • Humana • Virginia Premier

24. Contact Information Office of Coordinated Care Virginia Department of Medical Assistance Services 600 E. Broad Street, Suite 1300 Richmond, VA 23219 CCC@dmas.virginia.gov