MassHealth Demonstration to Integrate Care for Individuals with Dual Eligibility

1. MassHealth Demonstration to Integrate Care for Individuals with Dual Eligibility Open Public Meeting June 28, 2011 12 – 2 pm Transportation Building Conference Rooms 2 & 3

2. Meeting Goals • Provide brief update of MassHealth demonstration proposal and project status • Follow up on RFI response themes • Gather input on proposed demonstration model • Focus on areas with range of viewpoints • Review next steps 2 2

3. Development Opportunity • One of 15 states awarded a $1M planning contract from CMS Center for Medicare and Medicaid Innovation • Funding is to support the development of a design proposal for a State Demonstration to Integrate Care for Dual Eligible Individuals • Purpose is to identify, support and evaluate person-centered models that integrate the full range of acute, behavioral health, and long term supports and services • MassHealth’s design proposal submission target date is October 2011 • Design Contract award is the path to possible implementation funding

4. Proposed Demonstration Model • Target population • 115,000 dual eligibles ages 21-64 with full MassHealth and Medicare benefits • Delivery Model • Medicare would provide funding directly to MassHealth to cover a defined set of services for Dual Eligible members enrolled in the new model • MassHealth would combine the Medicare and Medicaid funding streams and pay the integrated care entities using a global payment method which provides incentives for quality care • Statewide integrated care model would be procured by MassHealth

5. Proposed Demonstration Model • Integrated care entity baseline requirements: • Foundation of primary care practices with person-centered medical home core competencies • Highly developed acute, primary care, behavioral health, and LTSS provider networks • Health Information Technology • Global payment for all MassHealth and Medicare services would cover acute and primary care, and a broader continuum of behavioral health and community support services • Contracted entities must demonstrate experience and competencies in serving individuals with disabilities, chronic behavioral health diagnoses, and chronic medical problems

6. Opportunities for Input & Engagement • Member Focus Groups • 4 focus groups with cross-disability dual eligible MassHealth members selected randomly from the caseload • Boston (June 2), Greenfield (June 9), Fall River (June 16), Lawrence (June 23): one rural, one in Spanish • Consumer Meetings • Open Public Meetings

7. RFI Responses • RFI responses and analysis • 55 respondents • All responses posted publicly; summary of themes will be made public • Broad range of type of respondents • Thoughtful input • Overall support for the proposed model • Areas of broad census • Areas of varied viewpoints

8. RFI Themes Topics for today’s discussion • Program Design and Care Delivery • Program Sustainability • Aligning Medicare and Medicaid

9. Discussion Guidelines: • State your name and your organization • Keep your comments brief • Focus your input on ways to address issues and move the project forward • Remember that we are all working toward the same goal: Building a model of care which best serves the needs of dually eligible members

10. Program Design and Care Delivery Suggested Areas for Discussion: • Benefits • Person-Centered Planning • Care Coordination and Care Teams • Member Protections

11. Program Sustainability Suggested Areas for Discussion: • Achieving Adequate Enrollment • Financing and Risk Adjustment • Quality Measurement and Incentives • Delivery Models and Requirements • Provider Networks • Technology

12. Aligning Medicare and Medicaid Suggested Areas for Discussion: • Interaction of State and Federal Rules • Flow of Medicare and Medicaid Funds • Outreach and Marketing • Administrative Practices

13. Next Steps Information andOpportunities foradditional input: • Website www.mass.gov/masshealth/duals • Upcoming meetings • Related materials • Duals@state.ma.us • Next meetings • Consumer Focused Meeting July 21, 10am – 12pm, 1 Ashburton Place, Boston Matta Conference Room, 11th floor • Open Public Meeting August 31, 10am – 12pm Worcester Public Library