Dual Eligibles: CMS Integration Efforts at the Federal Level. Ann Duarte Associate Regional Administrator CMS San Francisco

Transcription

1 Dual Eligibles: CMS Integration Efforts at the Federal Level Ann Duarte Associate Regional Administrator CMS San Francisco

2 Medicare-Medicaid Enrollees 10 million (approx) individuals with Medicare and Medicaid Dual Eligibles More likely to have mental illness, limitations in activities of daily living, and multiple chronic conditions. 2

3 Disproportionate Share of Spending 3

4 Medicare-Medicaid Coordination Purpose: Improve quality, reduce costs and improve the beneficiary experience. Ensure access to the services Improve state/federal coordination Identify and test innovative models Eliminate financial misalignments 4

5 Support for Care Coordination Program Alignment Initiative Removing barriers between programs Integrated Care Resource Center (ICRC) Support for state development of integrated care programs, promoting best practices Medicare Data to States - Improved access to Medicare data to support care coordination 5

6 Additional Opportunities and Tools to Support Care Coordination State Profiles State-specific demographic characteristics, utilization, and spending patterns of dual population Enhancements to the Chronic Condition Warehouse (CCW) New Mental Health and Tobacco Condition Flags: Bipolar disorders, schizophrenia and anxiety disorders Newly linked Medicare-Medicaid data: Eligibility, enrollment, service utilization and expenditures by both Medicare and Medicaid 6

7 Opportunity for Care Coordination: Financial Alignment Background: Creation of new models to integrate the service delivery and financing of both Medicare and Medicaid through a Federal-State demonstration to better serve the population Goal: Increase access to quality, seamlessly integrated programs for Medicare-Medicaid enrollees Demonstration Models: Capitated Model Comprehensive coordinated care Managed FFS Model Savings returned to state 7

8 Financial Alignment Initiative Vision: Improved beneficiary experience by: Focusing on person-centered models Developing navigable, simplified system of services Ensuring access to needed services and with beneficiary protections Establishing accountability Requiring robust network adequacy standards Evaluating data on access, outcomes, experience 8

9 Examples of Beneficiary Enhancements Person-centered care planning Choice of plans and providers Continuity of care provisions Care coordination and assistance with care transitions Enrollment assistance and options counseling 9

10 Examples of Beneficiary Enhancements (cont.) One identification card for all benefits and services Single statement of all rights and responsibilities Integrated grievances and appeals process Maximum travel and distance times Limitations on wait and appointment times 10

11 Support for Beneficiaries State Health Insurance Counseling and Assistance Programs (SHIPs) and Aging and Disability Resource Centers (ADRCs) Funding to support beneficiary outreach and one-on-one options counseling Ombudsman Services Funding for states, advocates and other key partners to ensure Ombudsman services are available 11

12 Financial Alignment Initiative Update: Where Are We Now 11 total approved Financial Alignment Demonstration Sites Capitated Demonstrations: Massachusetts, Ohio, Illinois, California, Virginia, New York, South Carolina, Washington, Michigan, and Texas Managed Fee for Service Demonstrations: Washington and Colorado Minnesota approved for alternative model 12

13 Cal MediConnect 11 Medicare-Medicaid Plans 8 county service area Demonstration ends December 31, 2017 County Marketing Enrollment San Mateo, Riverside, San Bernardino, San Diego Enrollment as of October 1, 2014: 49,000 February 2014 April 2014 Los Angeles March 2014 April 2014 Santa Clara October 2014 January 2015 Alameda, Orange TBD 2015 TBD

14 Implementation To to Date Collaboration and feedback with beneficiaries, advocates, providers, plans, and our state partners Feedback loop helps allow for continued learning Implementation Lessons Enrollment transactions Locating and engaging beneficiaries Health risk assessments 8

15 The Year Ahead Implementation activities for new states (SC, NY, WA, MI, RI, and TX) Post-implementation monitoring and oversight activity in live states (MA, IL, CA, VA and OH) Evaluation plan posted: Medicaid-Coordination/Medicare-and-Medicaid- Coordination/Medicare-Medicaid-Coordination- Office/FinancialAlignmentInitiative/Evaluations.html 15