Michigan Association of COMMUNITY MENTAL HEALTH Boards

1. Michigan Association ofCOMMUNITY MENTAL HEALTHBoards MACMHB’s Presentation of Michigan’s Integrated Care for People who are Medicare-Medicaid Eligible MACMHB ~ www.macmhb.org ~ 517-374-6848

2. Purpose of this Forum MACMHB ~ www.macmhb.org ~ 517-374-6848 • Help persons understand what is in the plan. • Clarify questions about the plan that can be answered. • Help identify questions that need to be answered and parts of the plan that need to be clarified. • Explain MACMHB’s initial assessment of the plan. • Assist people in providing input regarding the plan.

3. Proposal MACMHB ~ www.macmhb.org ~ 517-374-6848 Change the financing model for ~ 200,000 person who are dually covered by Medicare and Medicaid • Move from the current fee for service model to an organized system of care with capitated funding Persons who are dual eligible include: • Persons with physical disabilities • Older persons who are frail • Persons with serious mental illnesses • Persons with developmental disabilities

4. Stated Goals of Integration MACMHB ~ www.macmhb.org ~ 517-374-6848 • Seamless delivery of services • Reduce fragmentation • Reduce barriers to home and community-based services • Improve quality of services • Simplify administration for beneficiaries & providers • Cost effectiveness aligning financial incentives

5. The Process MACMHB ~ www.macmhb.org ~ 517-374-6848 • Planning Contract received (April, 2011) • Multiple stakeholder input activities (July – December) • Interviews, forums, request for input, workgroups, written comments • Proposed Plan Issued (March 5, 2012) • Public Input on Plan (30 days) • MACMHB forums (8 sites through March) • MDCH forums (March 20th, March 29th) • Legislative Hearings – not yet scheduled • Submission to CMS – April 26, 2012

6. Stakeholder Themes MACMHB ~ www.macmhb.org ~ 517-374-6848 • Importance of self-determination and person centered planning • Assurance of access to existing array of services with expansion of service package • Guarantee services are of high quality and responsive to participant needs and desires • Assurance of well-coordinated care • Access to home and community-based supports and services versus facility-based care

7. Stakeholder Themes MACMHB ~ www.macmhb.org ~ 517-374-6848 • Maintenance of existing relationships between people receiving services and their providers, including specialists • Choice must be afforded in all areas of the plan • Importance of maximum enrollee protections throughout the process, especially in the enrollment process and in the due process rights afforded enrollees • Quality standards must be established and monitored

8. Flow of Funds (subject to CMS approval) MACMHB ~ www.macmhb.org ~ 517-374-6848 Federal Medicare, Federal Medicaid and State Medicaid Match flow to MDCH. MDCH will contract with two different types of entities: Integrated Care Organizations (ICOs) for managing all physical health care, pharmacy, long term care, nursing facility services. ICOs are defined as an insurance-based or provider based health organization that will manage and contract for physical health care services. These ICOs will be identified through a bidding process.

9. Flow of Funds (subject to CMS approval) MACMHB ~ www.macmhb.org ~ 517-374-6848 • Prepaid Inpatient Health Plans (PIHPs) for managing all specialty behavioral health and developmental disabilities services, behavioral health for mild/moderate conditions, acute psychiatric services, psychiatric consultation, substance use treatment • State will configure ICO and PIHP boundaries so they will be aligned. Regions are unlikely to conform to current Medicaid HMO and PIHP regions.

10. Flow of Funds (subject to CMS approval) MACMHB ~ www.macmhb.org ~ 517-374-6848 • ICOs will contract with: • Physical Health Providers • Long Term Care Providers • PIHPs will contract with: • CMHs • Behavioral Health Providers

11. ICO Financing and Coordinating Responsibilites MACMHB ~ www.macmhb.org ~ 517-374-6848 • Medicare Part A and B (primary and acute care) • Pharmacy Part D • Long term care services & supports, including community based and nursing facility, both skilled and custodial • Management of person-centered medical home • Care and supports coordination team at the “care bridge”

12. PIHP Financing and Coordinating Responsibilites MACMHB ~ www.macmhb.org ~ 517-374-6848 • Intellectual/developmental disabilities services • Serious mental illness • Substance use disorders • Behavioral health for mild/moderate disorders • Acute psychiatric hospitalizations (Medicare fee for service financed) • Care and supports coordination team at the “care bridge”

13. How Integration Happens MACMHB ~ www.macmhb.org ~ 517-374-6848 The Care Bridge: • A services or supports coordinator leads a multidisciplinary team to coordinate services & supports for the beneficiary according to a self determined, person centered plan of care • The services or supports coordinator has 24/7 contact responsibility for the beneficiary • Leading coordinating entity (ICO or PIHP) is defined by beneficiary and highest care need.

14. Enrollment process MACMHB ~ www.macmhb.org ~ 517-374-6848 Passive enrollment - beneficiary enrolled unless they indicate a choice to opt out Open enrollment for two months during phased implementation and subsequent enrollment: • Receive a letter with instructions and benefits under integrated system, opt out services and management • Toll free number for questions and opportunity for face to face • Likely to use an enrollment broker (also replicate the Medicare Medicaid Assistance Program process)

15. Enrollment Protections MACMHB ~ www.macmhb.org ~ 517-374-6848 • Education and Outreach • Choice of Providers • Appeals System Protection – uniform and user friendly requirements • Other Protections: • ICOs and PIHPs must have beneficiaries on their governance board • Quality review committees must have beneficiaries • Review feasibility of external ombudsman to assist beneficiaries

16. Phased Implementation – Geographic Basis MACMHB ~ www.macmhb.org ~ 517-374-6848 • Beginning July, 2013 – all beneficiaries in plan by June, 2014 • Quarterly Intervals using several regional areas • Regions developed based on potential for enrollment volume and other readiness factors • First group of counties will be selected to assure sufficient # of enrollees to demonstrate the plan, but will include less than ½ the population • Remaining counties grouped along logical geographic and health care market lines

17. Phased Implementation – Population Basis MACMHB ~ www.macmhb.org ~ 517-374-6848 • 1st Quarter – Persons with: • Physical disabilities • Serious mental illnesses • Substance use disorders • Older adults not in nursing facilities • 2nd Quarter – Persons in: • Nursing facilities • MI Choice Waiver • 3rd Quarter – Persons with intellectual/developmental disabilities

18. Public Input Opportunities MACMHB ~ www.macmhb.org ~ 517-374-6848 • MACMHB Forums • MDCH Forums • March 20th, 1:30 – 4:00 p.m.; Best Western Hotel (Causeway Bay), Lansing • March 29th, 1:30 – 4:00 p.m.; Greater Grace Temple, Detroit • Legislative Hearings – not yet scheduled

19. Public Input Opportunities MACMHB ~ www.macmhb.org ~ 517-374-6848 Copy of Plan at: www.michigan.gov/mdch, click on Integrated Care for Persons Dually Eligible for Medicare and Medicaid Comments by email at: IntegratedCare@michigan.gov Regular mail at: Integrated Care Medical Services Administration PO Box 30479 Lansing, MI 48909 – 7979 Comments due no later than close of business April 4, 2012

20. Questions ? MACMHB ~ www.macmhb.org ~ 517-374-6848 Michigan Association of Community Mental Health Boards 426 S. Walnut St, Lansing, MI 48933 (517) 374-6848 Michael Vizena Alan Bolter Executive Director Associate Director mvizena@macmhb.orgabolter@macmhb.org