Community Care Medical Home Enrollment For Adult Care Homes

1. Community Care Medical Home Enrollment For Adult Care Homes Hosted by: In conjunction with:

2. Medicaid is a health insurance program for low-income individuals and families As of September 2012, there are nearly 1.6 million beneficiaries of Medicaid Medicaid budget exceeds $11Billion Medicaid

3. Medical Home Enrollment Project • Goal: • To enroll each eligible Medicaid beneficiary with a Community Care of North Carolina medical home to improve their overall health and ensure their access to high quality, medically necessary health care in the most cost effective manner. • Project Focus • Increase the number of beneficiaries enrolled with a medical home • Increase enrollment among the Aged, Blind, and Disabled (ABD) beneficiaries to 75% of the total ABD population.

4. Medicaid Managed Care Programs Carolina ACCESS (CA) and Community Care of North Carolina (CCNC)

5. Community Care of NC Benefits to the beneficiary and ACH: • Primary Care Doctor who will lead their medical home team • 24-hour medical advice • A care manager to help manage the health care needs of the beneficiary • Follow-up appointments • Beneficiary education on self management • Special help monitoring and managing medications • Help when patients are transitioning from the hospital back to the facility

6. Community Care of NC Medical Home Referrals: • Required when seeking care for most specialty services. • Made at the discretion of the Community Care medical home. • Made by telephone or in writing • Should be obtained as needed prior to rendering services Additional Information regarding Community Care of North Carolina / Carolina ACCESS is available at http://www.ncdhhs.gov/dma/basicmed/Section4.pdf

7. Community Care of NC Primary Goals • Improve the care of Medicaid population while controlling costs • A “medical home” for beneficiaries, emphasizing primary care • Community networks capable of managing beneficiary care • Local systems that improve management of chronic illness in both rural and urban settings

8. Community Care of NC How it Works: • Coordination of local community providers (hospitals, health departments, LMEs and others) and primary care physicians • Provides clinical and performance improvement data through CCNC Informatics Center • Provides support for physician driven quality improvement initiatives regionally and statewide • Each network provides local care managers, and at least one pharmacist, psychiatrist, and medical director to improve local health care delivery

9. Legend AccessCare Network Sites Community Care Plan of Eastern Carolina AccessCare Network Counties Community Health Partners Community Care of Western North Carolina Northern Piedmont Community Care Community Care of the Lower Cape Fear Northwest Community Care Carolina Collaborative Community Care Partnership for Community Care Community Care of Wake and Johnston Counties Community Care of the Sandhills Community Care Partners of Greater Mecklenburg Community Care of Southern Piedmont Carolina Community Health Partnership Source: CCNC September 2012 Community Care of NC Camden Alleghany Currituck Northhampton r Gates Warren Ashe Surry Stokes a Person Rockingham Caswell Vance Pasquotank Hertford Halifax Watauga Perquimans Wilkes Chowan Yadkin Granville Avery Forsyth Bertie Franklin Orange Guilford Mitchell Alamance Durham Caldwell Alexander Nash Tyrrell Davie Yancey Edgecombe Madison Wake Washington Dare Iredell Davidson Martin Burke Wilson Randolph Chatham McDowell Catawba Buncombe Rowan Pitt Beaufort Haywood Hyde Swain Johnston Lincoln Rutherford Lee Greene Graham Henderson Cabarrus Harnett Jackson Wayne Gaston Stanly Polk Moore Cleveland Lenoir Transylvania Montgomery Craven Cherokee Mecklenburg Macon Pamlico Clay Sampson Cumberland Jones Richmond Hoke Union Anson Duplin Scotland Carteret Onslow Robeson Bladen Pender New Columbus Hanover Brunswick

10. Community Care of NC Networks: • Provide resources for care management, quality improvement, and cost containment • Seek to incorporate all providers, including safety net providers • Have Medical Management Committee oversight

11. Community Care of NC Disease Management ED Utilization Management Care Coordination for Children Behavioral Health Integration Chronic Care Program (ABD) Palliative Care Pharmacy Management Pregnancy Care Management Pain Management High Cost –High Risk Care Management Dental Screening and Fluoride Varnish Person Centered Medical Home Additional Information available at http://www.communitycarenc.org/

12. Medicaid Managed Care Programs Enrollment Process

13. Enrollment Prior to rendering services: Verify the beneficiary’s eligibility for Medicaid Use online verification tools like NCECS Webtool

14. Enrollment • Determine if the beneficiary is enrolled with a medical home • If yes, verify that the medical home is correct

15. Enrollment If the beneficiary is not linked to a medical home: • Determine the beneficiary’s Medicaid Coverage Category. • Are they eligible for CCNC enrollment?

16. Enrollment Yes No

17. Enrollment Once you confirm eligibility for Medicaid: • If the beneficiary is not enrolled with a medical home: • Explain the benefits of managed care • Ask for information about their primary care provider • Complete the enrollment form • Fax the enrollment form to DMA at 919-715-0844

18. Enrollment Once you confirm eligibility for Medicaid: • If the beneficiary does not have a medical home: • Explain the benefits of managed care • Use the provider directory to help them choose a primary care provider • Complete the enrollment form • Fax the enrollment form to DMA at 919-715-0844

19. Enrollment Start by locating the county where your ACH is located. Use the provider name and demographic information to identify a provider and complete the enrollment form.

20. Enrollment Once you confirm eligibility for Medicaid: • If the beneficiary’s medical home is incorrect : • Obtain information about the correct medical home • Complete the enrollment form • Fax the enrollment form to DMA at 919-715-0844

21. Enrollment

22. Enrollment • For residents with both Medicare and Medicaid. • Explains benefits and options of Community Care enrollment.

23. Enrollment When a resident chooses a new medical home, it is imperative that they establish a relationship with that new provider Immediately call the new medical home to make an appointment to establish a relationship, complete paperwork, and transfer records If a resident has not seen their chosen medical home within the past year, also call to make an appointment to maintain that relationship

24. Community Care of North Carolina http://www.communitycarenc.org/ Link to webinar presentation and enrollment form DMA CCNC/CA webpage http://www.ncdhhs.gov/dma/ca/ccncproviderinfo.htm CCNC/CA Recipient Handbook http://www.ncdhhs.gov/dma/ca/carechandbook.pdf email: adrienne.frederick@dhhs.nc.gov Benefits of Being a CCNC/CA Member http://info.dhhs.state.nc.us/olm/forms/dma/dma-9016.pdf Additional questions: Melanie.whitener@dhhs.nc.gov 828-304-2345 Enrollment Resources