State of Vermont Demonstration to Integrate Care for Dual Eligible Individuals

1. State of VermontDemonstration to Integrate Care for Dual Eligible Individuals Service Delivery Workgroup Meeting #3: August 22, 2010

2. Agenda • Continued Discussion from Meeting #2: What do we mean by “Integrated Care”? • What was the model in MyCare? • What should it look like for people who are dually-eligible? • How should it work (e.g., service planning, service authorization, service coordination, notice and appeals)? Service Delivery Workgroup, Meeting 3 (August 22)

3. What is Integrated Care? • MyCare Guiding Principles: • Person-Centered Care: Consumers will be treated with dignity and respect and be active partners in their care. Services should be timely and delivered where and when they are needed. The consumer (and family) will work with an interdisciplinary team to develop a mutually acceptable plan of care. • Coordinated Care: All the people involved with a consumer’s care will communicate with each other, balancing the sharing of appropriate information with the consumer’s right to privacy. As a result, transitions across care settings will be smoother and better coordinated. • Quality of Care: Quality of care will be reinforced by utilizing best practice standards. Quality of services will be routinely monitored and assessed. • Caregiver Support: The essential role of informal/unpaid caregivers will be acknowledged and actively supported. • Integrated Funding: Funding streams for acute and long term care will be integrated to allow more flexibility to purchase services that enable consumers to live in the least restrictive setting for as long as possible and desired. Service Delivery Workgroup, Meeting #3 (August 22)

4. What is Integrated Care, cont.? • MyCare Core Concepts: • Provision of an Integrated and Coordinated Delivery System for all health services needed by an individual , ensuring access to and integration of preventive, primary, acute, post acute, rehabilitation, social and long-term care services • Coordinated care planning through a Person-Centered Interdisciplinary Care Team, comprised of the Participant, the Participant’s primary care provider, a non-medical service coordinator, and a registered nurse • Facilitate communication and coordination through the use of a common Centralized Comprehensive Record (ensuring patient privacy) • APrimary Contact Person for each person who will assist them in accessing services, information and decision-making Service Delivery Workgroup, Meeting #3 (August 22)

5. Interdisciplinary Team • From MyCare Model • Ensures a comprehensive interdisciplinary services delivery system that addresses both health care and long term care needs though an Interdisciplinary Care Team consisting of, at a minimum: • The participant, or family member/caregiver designee selected by the participant; • Primary Care Provider, (a primary care physician, nurse practitioner, or specialist physician) who agrees to serve as a primary care physician for the participant; • Case Manager/Masters Level Social Worker; and • Registered Nurse • When appropriate, other members shall be added to an individual participant’s ICT, based on the participant’s condition and/or needs. The composition of the ICT should be appropriate to a participant’s age and physical condition. Service Delivery Workgroup, Meeting #3 (August 22)

6. Service Authorization • MyCare Process: • Service Authorization shall mean authorization of a Participant’s request for the provision of a service (through the Individual Care Plan) • Signatures confirming the Individual Care Plan will be obtained from the applicant/representative and the primary care physician • Approval Process for services not in Individual Care Plan? Service Delivery Workgroup, Meeting #3 (August 22)

7. Appeal Process • MyCare Process: • If the ICT determines it cannot approve the participant’s or designated representative’s request for care/services, the participant/caregiver also will be advised of his or her right to appeal, and the procedures for filing an appeal Service Delivery Workgroup, Meeting #3 (August 22)