Medicaid Managed Care is Coming to Illinois WHAT YOU NEED TO KNOW. March Case Manager Webinar Series

Transcription

1 Medicaid Managed Care is Coming to Illinois WHAT YOU NEED TO KNOW March Case Manager Webinar Series

2 Welcome! Welcome to our webinar series on Medicaid managed care for people with HIV in Illinois. Last month Overview of managed care with a focus on the Integrated Care Program (ICP) Today Managed care for dual eligibles people on Medicare & Medicaid

3 Use the question feature to ask questions. Or you can questions Everyone can ask questions at any time using the questions feature You can also questions to

4 Today s Presenters Jessie Beebe, AIDS Foundation of Chicago Erin Weir, Manager of Health Care Access, AgeOptions

5 Four main ways people with HIV can get on Medicaid in IL Seniors & People with a Disability Low-income adults who are totally disabled with no work history Dual Eligibles Low-income adults who are totally disabled who have a work history New eligibles, ACA eligibles Low-income adults age who are not disabled and do not have children in the home (CountyCare) Parents/Caretakers Low-income parents or caretakers who have children in their home

6 Illinois Medicare Medicaid Alignment Initiative (MMAI) March

7 What We Will Cover Today Background Illinois Managed Care Initiatives Medicare/Medicaid Financial Alignment Initiative (MMAI) 7 7

8 Background - Illinois Managed Care Initiatives 8

9 Background - Illinois Managed Care Transitions State Initiatives Public Act , January 2011: Illinois must move 50% of all Medicaid recipients into risk-based care coordination by 2015 Save Medicaid Access and Resources Together Act (SMART Act), May 2012: Save $16.1 million by integrating care for most complex Medicaid beneficiaries (acute, primary, behavioral, and long-term services and supports)

10 Care Coordination vs. Managed Care Managed care: a system of financing and delivering health care, involves the use of a managed care organization (MCO) that is responsible for implementing techniques generally designed to reduce cost of care and improve quality. Techniques may include care coordination and/or integrated delivery systems (provider networks), utilization review, emphasis on preventive care, or financial incentives to encourage members to use care efficiently ( 10

11 Care Coordination vs. Managed Care Care coordination: Using a primary point of contact to establish communication and collaboration among a patient s health care providers to ensure that: Individuals receive appropriate care and information about his/her care services are not duplicated or conflicting patient receives appropriate follow-up to ensure improvement of condition(s) ( 11

12 Illinois Managed Care Initiatives Affecting Older Adults & People with Disabilities (AABD/SPD Medicaid) Integrated Care Program Medicare/Medicaid Alignment Initiative (MMAI) Innovations Project

13 Illinois Managed Care Initiatives Affecting Other Populations Children, families, and the new Medicaid category known as ACA adults will also be rolled into managed care initiatives over time Managed care organizations (MCO s) Innovations Project (CCE s and MCCN s) Accountable Care Entities (ACE s)

14 Questions?

15 Medicare Medicaid Financial Alignment Initiative (MMAI) 15 15

16 Background - MMAI Centers for Medicare and Medicaid Services (CMS) issued demonstration project to increase care coordination for dual eligibles (people with Medicare and Medicaid) Illinois application approved February 22, 2013 Memorandum of Understanding between CMS and state of Illinois available here: p?counter=4547

17 Who Will MMAI Affect? Full benefit dual eligible beneficiaries (people with Medicare and full Medicaid benefits not spenddown ) who are: Over the age of 21 and in the Seniors and Persons with Disabilities (SPD) Medicaid category (also known as AABD) Living in Chicago area or Central Illinois: Chicago: Cook, Lake, Kane, DuPage, Will, and Kankakee counties Central IL: Knox, Peoria, Tazewell, McLean, Logan, DeWitt, Sangamon, Macon, Christian, Piatt, Champaign, Vermilion, Ford, Menard, and Stark counties About 135,000 people

18 How Will MMAI Work? HFS will contract with managed care companies to coordinate all medical, pharmaceutical, behavioral health, and long term services and supports One plan will cover all services (Medicare Parts A, B, D, and Medicaid) - members will no longer need to find providers who accept Medicare and Medicaid (will need to use plan s network instead)

19 How Will MMAI Work? Plans may not charge higher cost-sharing than traditional fee-for-service Medicaid Consumers must use plan network providers 180 day transition period Must cover out of network emergency care Plans will have some flexibility to provide services that are not currently covered by Medicare and Medicaid (if they choose)

20 How Will MMAI Work? Managed care companies will use a medical home model Team-based approach; focus on integrating primary, behavioral health, and acute care services across providers Plans will use several components to coordinate care, including health information technology (HIT), risk assessments, care management, and multidisciplinary care teams Members will choose a medical home and Primary Care Provider (PCP)

21 How Will MMAI Work? Care Management Services will be offered to all enrollees to help coordinate medical services and long term services and supports (LTSS) All enrollees will be assigned a Care Coordinator and have access to an Interdisciplinary Care Team (ICT) within their MMAI plan. Care Coordinator standards/training, caseloads, and contact requirements are based on the individual s risk level (health risk screening conducted in first 60 days of enrollment) and specific Home and Community Based Service (HCBS) Waiver requirements High risk enrollees must be contacted by the ICT at least every 90 days

22 MMAI Enrollment Enrollment will be conducted through the Client Enrollment Broker (just like ICP) Must use Client Enrollment Broker to enroll, opt out of the program or disenroll Call Client Enrollment Broker to compare plan options, including plan s provider networks, at Can also Compare plan benefits at Will be able to view minimal information about the MMAI plans on the Medicare Plan Finder, but cannot enroll on the Plan Finder

23 Visit enrollhfs.illinois.gov/choose/compare-plans to compare benefits. Client Enrollment Broker will also assist with comparing plans and provider networks.

24 Go to plan website to view more detailed benefit information and find in network providers. Must call Client Enrollment Broker or fill out paper application to enroll. Scroll down to compare overview of plan benefits

25 Questions?

26 MMAI Enrollment: For individuals who are not receiving Long Term Care Supports and Services (LTSS)

27 MMAI & LTSS Long Term Care Services and Supports (LTSS) Helps individuals perform activities of daily living (eating, cooking, bathing, getting dress, cleaning, etc) May be provided in a long term care facility or through home and community based services Many older adults in Illinois receive home and community based services through the Community Care Program

28 Voluntary Enrollment- Individuals not receiving LTSS Begins March 2014 Letters will be sent to individuals about 30 days before voluntary enrollment begins explaining the program and their options Clients can respond to letter by: 1) Choosing to voluntarily enroll in an MCO of their choice, OR 2) Wanting to opt out of the program entirely

29 Passive Enrollment- Individuals not receiving LTSS Begins June 2014 Individuals will begin to be automatically enrolled into an MCO after June 2014 if they did not make a choice during Voluntary Enrollment Passive enrollment is expected to be conducted in phases -With a maximum enrollment of 5,000 beneficiaries/month in the Chicago area, and a maximum of 3,000 beneficiaries/month in Central Illinois

30 Passive Enrollment- Individuals not receiving LTSS Clients will begin receiving a notice about 60 days before they are passively enrolled into a plan. Clients have the option to 1) Not respond to the letter and be automatically enrolled in the MCO listed on the notice 2) Respond to the letters by choosing an MCO of their choice 3) Opt out of the program entirely to continue to receive regular Medicare and fee-for-service Medicaid

31 Once Enrolled- Individuals not receiving LTSS Once a client is enrolled into an MCO, they can change plans on a monthly basis throughout year will not be locked into a plan Can disenroll from the program at any time of the year to receive regular Medicare and feefor-service Medicaid (unless receiving LTSS) Can change PCP at any time (changes will occur within 30 days)

32 Questions?

33 MMAI Enrollment: Individuals receiving LTSS

34 Voluntary Enrollment- Individuals receiving LTSS Expected to begin July 2014 Individuals will receive letters around June explaining the program and their options Clients will have about 90 days to respond to letter by: 1) Choosing to voluntarily enroll in an MCO of their choice OR 2) Wanting to opt out of the program for their Medical services, but not for their LTSS (Individuals must receive their LTSS under an MCO) -If a client chooses to opt out of their MCO, they will receive Medicare and Medicaid (fee-for-service) for all of their hospital and medical care claims, but their LTSS services will be paid by the MCO.

35 Passive Enrollment: Individuals receiving LTSS Expected to begin in September 2014 Individuals will be automatically enrolled into an MCO if they did not make a choice during Voluntary Enrollment Clients can opt out for medical services, but not for their LTSS services

36 Once Enrolled- Individuals Receiving LTSS Will be locked in to whatever plan they choose for one year after the initial 90 day election period and will not be able to switch their MCO throughout the year They can disenroll from their MCO for their medical services at any time of the year, but not for their LTSS services Can change PCP at any time (changes will occur within 30 days)

37 MMAI Plans Illinois Department of Healthcare and Family Services has chosen 8 plans to provide MMAI services: Chicago area (Chicago and surrounding suburbs): Aetna Better Health IlliniCare (Centene) Meridian Health Plan of Illinois HealthSpring Humana Blue Cross/Blue Shield of Illinois Central Illinois: Molina Healthcare Health Alliance

38 MMAI Resources Client Enrollment Broker: (877) MMW MMAI fact sheet and timeline: HFS website Care Coordination: ages/default.aspx 38

39 For More Information 39 39

40 Resources on Illinois Managed Care and Care Coordination Illinois Department of Healthcare and Family Services (HFS) Care Coordination Roll-Out Plan: HFS website on Care Coordination: (MMAI proposal and information, information about Innovations Initiative) Make Medicare Work Coalition Managed Care Toolkit MedicaidandManagedCare.html (Includes ICP & MMAI fact sheets, recorded webinars, enrollment timelines, and other resources)

41 MMW Website Please visit our website at to... Access our materials on Medicare, Medicaid, and the Affordable Care Act Sign up for our list to receive registration information for our webinars, trainings, and meetings and to receive our alerts, bulletins, and other healthcare related materials View our Calendar of Events

42 Thank you! If you have questions, contact: AgeOptions (800) TTY: (708) This presentation was supported in part by grants from the Chicago Community Trust, the Retirement Research Foundation, the Michael Reese Health Trust, and an anonymous donor. 42

43 Jessie Beebe