RHODY HEALTH OPTIONS (RHO) IMPLEMENTATION September 5, 2013

1. RHODY HEALTH OPTIONS (RHO) IMPLEMENTATION September 5, 2013

2. Agenda Neighborhood –Who we are Rhody Health Options Overview State update information Payment for Services Case Management Wrap up and Next Steps

3. Neighborhood- Who we are Founded by RI’s Community Health Centers to expand access to care and improve health for at-risk populations Incorporated as an HMO in December 1993; began serving members in Spring 1994 EOHHS partner for proactive Medicaid managed care Support Medicaid programs only 92,000 members currently Serve 67 percent of all RI Medicaid managed care participants Non-profit; offices in Providence

4. Our Network • Large network; nearly every doctor/provider in RI • More than 900 Primary Care Practitioners • 42% of Neighborhood’s members receive their primary care at one of the 21 Community Health Centers in the state • More than 2700 Specialists and robust ancillary and DME networks • More than 480 Behavioral Health Providers • All hospitals in the state • Nearly every pharmacy in the state

5. Accolades 97% of Neighborhood members would recommend us to family or friends (2012 CAHPS Survey) • Rated “Excellent” by NCQA since 2001 • Ranked as one of Top 10 Medicaid Health Plans in America by NCQA since rankings began in 2004 - (#5 in 2012) • 5th Fastest Growing Private Company in RI - Providence Business News (2011) • Sample of Community Service Awards • Healthy Moms, Healthy Babies Coalition • Latino Public Radio • Reach Out and Read Rhode Island • The African Alliance of Rhode Island • PARI Independent Living Center • Rhode Island Foster Parent Association

6. Our Membership Growth Adults eligible for Medicaid/Medicare - Medicaid benefits (Nov 2013) Adults in HealthSource RI – Both Individual (up to 250%) and Small Business (Jan 2014) Adults in Medicaid Expansion (Jan 2014)

7. Integrated Care Initiative • EOHHS is working with CMS on an Integrated Care Initiative • It is designed to transform the delivery of services to elderly and disabled Medicaid only members and Medicaid Medicare Eligible members (duals) to maintain a high quality of life and live independently in the community. • The goal of the program is to integrate the two government programs to eliminate the fragmentation and inefficiencies that exist today and improve the quality of care for members. • In June 2013 EOHHS selected Neighborhood to be its managed care organization to implement this program.

8. Rhody Health Options • Phase I • Implementation of Medicaid Long Term Care benefits to managed care beginning November 2013. • These members will be known as Rhody Health Options members. • Phase II • Adds the integration of the Medicare benefit • The full integration, is currently scheduled for implementation in early 2015.

9. Rhody Health Options Timeline • Awards announced August 2013 • Readiness Review July – Sept 2013 • Consumer letters Sept 1, 2013 - Feb 1, 2014 will be sent • EOHHS will be phasing in RHO membership in 4 waves • Approximately 6400 members per wave • Complete Enrollment Schedule available on EOHHS website • Members will be given the choice to opt out of the program • We are currently working with EOHHS to identify all members in Wave 1 to insure smooth transition. • Effective Enrollment Nov 1, 2013 - April 1, 2014 Dates • Presentations & Trainings - July 2013 and ongoing Trainings by EOHHS

10. State Update Schedule a Presentation on the Integrated Care Initiative The State will begin to set up community presentations on these two new programs: Rhody Health Options and Connect Care Choice Community Partners. If you would like to schedule a presentation for your agency or organization, please contact Alison Buckser at abuckser@ohhs.ri.gov Check the state website www.eohhs.ri.gov (under “Integrated Care”) Email your questions at: integratedcare@ohhs.ri.gov There will be an Enrollment Help Line starting on Sept 1, 2013.

11. Teams within Medical Management

12. Neighborhood Benefits Neighborhood Case Managers can assist with: LTSS Waiver application assistance Develop and monitor individualized Plan of Care Collaborate to assess for safe discharge plan to the community when appropriate Participate in discharge planning meetings with members and caregivers Facilitate community services to ensure safe transition plan

13. Facility Requirements Provide access for case managers to meet member and review medical record, including MDS Provide supportive clinical information for those receiving skilled services Collaboration in identification of those with potential discharge plan Collaboration in ensuring a safe transition to the community when applicable

14. Payment and Billing Process for Rhody Health Options • RhodyHealth Option members will be billed to Neighborhood Health Plan of RI • Connect Care Members will be billed to the state (as it is done today). • Claims typically process within 7-14 days

15. Payment and Billing Process for Rhody Health Options Neighborhood will require a claim submission for payment • Claim submission can be completed via electronic faxes regular mail or electronically via a clearinghouse

16. Contacts at Neighborhood Medical Management Michelle Lupoli, Director of Medical Management, 459-6035 Kathy Ullrich, Manager of Care Management, Duals 427-6526 Claims Production Meghan Ruane, Director of Operations, 459-6606 Provider Engagement and Contracting Pat Huschle, Director of Provider Engagement and Contracting,459-6012 Maureen Brousseau, Manager of Ancillary Network,459-6033

17. Questions?

18. NEXT STEPS AND FOLLOW UP