Managed Care for Duals
|
|
- Chloe Hood
- 8 years ago
- Views:
Transcription
1 Managed Care for Duals Jim Schultz, MD, MBA Chief Medical Officer, CCC Gary Rotto Director of Health Policy March 6, 2013
2 Patients with both Medicare and Medicaid 10 million in US, 1.2 million in California Poor, mentally ill, disabled 60% > 65, poor 40% < 65, disabled Very sick 20% of Medicare population but 31% of expense 15% of MediCal population but 40% of expense 2
3 38% with permanent disability 40% with severe cognitive impairment (Alzheimer s, severe mental illness, etc) Many in long term care facilities Poor: 50% with annual income < $10,000 $350 BILLION market nationally
4 4
5 Medicare: Part A: hospital, acute care Part B: MD visits, tests- ANY MD/facility Part D: meds Deductible, share of cost, donut hole for meds fee-for-service reimbursement MediCal: Medicare copay/deductible/soc Long term care/custodial care Dental Transport fee-for-service reimbursement
6 Created by SB 1008 and SB 1036 Two Major Parts of the Initiative Duals Demonstration Managed Medi-Cal Long-Term Supports and Services (LTSS): 6
7 Have other private or public health insurance. Individuals with developmental disabilities receiving services through a Department of Developmental Services (DDS) 1915(c) waiver; regional center; state developmental center; or intermediate care facilities for the developmentally disabled (ICF/DD). Enrolled in Nursing facility/acute hospital waiver service HIV/AIDS waiver services Assisted living waiver services In-Home Operations waiver services. 7
8 76,860 in San Diego 2nd largest county 18,000 IHSS recipients are dual eligibles (72% of total IHSS population) 71% over 65 Less than 20% in managed care 8
9 What are the key components? Implement Fixed payment for total care Mandatory assignment of patients to a managed care plan, +/-choice of plan Managed Care plans allowed To limit provider network Drug formularies Contract with limited vendors and facilities
10 Health plans to contract with the County for services including: In-Home Supportive Services (IHSS): Client continues to hire, fire & supervise care provider County social worker performs assessments Public Authority provides registry, training, provider enrollment, payroll Multipurpose Senior Services Program: Case Management services provided by County. January 2015, MSSP becomes managed care benefit Plans can request additional IHSS and will pay for it 10
11 Government perspective: Fixed predictable costs Control over future cost growth Elimination of cost risk -all risk passed on to managed care plan Potential for improved coordination of care improved quality reduced cost 11
12 Before: Pt any MD office or hospital; service rendered MD or hospital claim to CMS CMS $ to MD/hosp (fixed payment, usually about 25% of charges) MD/Hosp balance bills MediCal for residual (?)
13 After: CMS/state $$$ to HMO HMO 20-30% retention Capitation to provider group for: Primary care only All MD cost MD plus partial hospital cost Total care Net effect: 20-30% retention (profit target) for HMO, risk passed on to provider groups to manage (very simplified)
14 Coordinate and responsible for all Medical Services All Medicare and Medi-Cal services currently covered Long-term care services and supports (LTSS) Institutional Long-Term Care (SNF) Personal care services/ihss Community Based Adult Services (CBAS)(formerly ADHC) Multi-purpose Senior Services Program (MSSP) 14
15 MD/Hospitals: Provide a lot of services Provide new technology Provide expensive services No reward for quality No reward for efficiency Prescribe the best med Order the latest test/newest tech
16 MD/Hospitals: Reduce service volume Reduce service intensity Reduce referrals to specialists Order least expensive med Don t order tests Avoid latest tech
17 If a Medicare Plan Retain as much of the premium as possible Pass on as much of the risk as possible Marketing push Gather data demanded by CMS/state Find healthier subsets of patients to market to Profit imperative ($$ currently going to pt care diverted) If a MediCal Plan Will they really make $$?
18 Based on current experience with SnPS population, already converted to managed care Disruption of primary care relationships Forced change of patient s medical home Disruption of longstanding specialty relationships, including those with unique super-specialists Loss of medication due to new formulary requirements
19 Change of facilities Hospital not contracted Long term care facilities not contracted Delayed access Limitation of specialty network Limitation of specialty network Limitation of primary care network Need for prior authorization for services Need for formulary trials of meds/denial etc.
20 Different insurers for Medicare and MediCal potential for different PCPs, auth processes, provider networks, formularies, etc. Better care coordination Overall cost savings?? More appropriate provision of care based on evidence Data- quality and outcomes scores now possible
21 Revised to start in September Pushed back from January 21
22 Poor outreach and insufficient communication to beneficiaries and providers Problems with default assignments Systemic problems processing Medical Exemption Beneficiaries mental health needs not adequately addressed 22
23 Not the patients-most unaware until they seek services Insurers- feeding frenzy Approaching Community Health Centers for 1 st time Willing to take MediCal-only patients in order to gain access to Duals Medical Providers: mixed Coordination of care a plus Jumping through hoops factor-exponential and very worrisome
24 Traditional Medicare-only providers unprepared for: Severity of illness/complex co-morbidities Mental illness factor Impact of lower education level Impact of lower socioeconomic scale/ language and culture issues Dealing with long term care patients in volume
25 Good for taxpayers and government budgets Good for some health plans if allowed to pass on risk and take off the top Could be good for patients if care coordinated through a medical home and quality metrics implemented Could be good for sophisticated integrated health care systems used to managed care Many patients will dislike limited choice Many patients likely to suffer due to lack of ability to navigate a complex system without some safeguards
26 26
State of California HEALTH AND HUMAN SERVICES AGENCY
EDMUND G. BROWN JR. GOVERNOR State of California HEALTH AND HUMAN SERVICES AGENCY Governor's Coordinated Care Initiative Long-Term Services and Supports Aging DIANA S. DOOLEY SECRETARY Alcohol and Drug
More informationUPDATED: NOVEMBER 2009 344.1 RESOURCES THIRD PARTY RESOURCES
UPDATED: NOVEMBER 2009 344.1 NOTE: Enrollment in Medicare is a condition of eligibility for Medicaid. Beginning in 2006, persons entitled to Part A and/or enrolled in Part B are eligible for the prescription
More informationCalifornia s Proposed 2012-13 Budget: Impact on California s Seniors and People with Disabilities
California s Proposed 2012-13 Budget: Impact on California s Seniors and People with Disabilities On January 5, 2012, California Governor Edmund G. Brown, Jr., released his proposed budget, outlining his
More informationCal MediConnect Plan Guidebook
Cal MediConnect Plan Guidebook Medicare and Medi-Cal RG_0004006_ENG_0214 Cal MediConnect Plans RIVERSIDE & SAN BERNARDINO COUNTIES IEHP Dual Choice 1-877-273-IEHP (4347) (TTY: 1-800-718-4347) www.iehp.org
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile North Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More informationSpecial Needs Plans. A Platform and Strategy for Quality and Control Provider Sponsored
A Platform and Strategy for Quality and Control Provider Sponsored Special Needs Plans Alicia Heazlitt, VP, Signature HealthCARE Will Saunders, CEO, AllyAlign Health Agenda Agenda Items Introductions The
More informationImportant Information About Your Medicare and Medi-Cal Benefits
State of California Cal MediConnect Health and Human Services Department of Health Care Services P.O. Box 989009, West Sacramento, CA 95798-9850 XX/XX/XXXX Important Information About Your Medicare and
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Montana Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6
More informationPresented to: Long Term Care Workgroup May 26, 2011
Presented to: Long Term Care Workgroup May 26, 2011 Partners in the Grant SC Department of Health and Human Services Sam Waldrep Roy Smith Project Coordinator Office of Research and Statistics Institute
More informationMaryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012
Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint
More informationIntroducing OneExchange.
RETIREE BENEFITS Introducing OneExchange. OneExchange provides you with plan advice and enrollment assistance to choose Medicare supplemental healthcare and prescription drug coverage that s right for
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile The National Summary Centers for Medicare & Medicaid Services Introduction... 1 Data Source and General Notes... 2 Types and Ages of Medicare-Medicaid Enrollees...
More informationThe Role of Technology in California s Dual Eligibles Coordinated Care Demonstration
The Role of Technology in California s Dual Eligibles Coordinated Care Demonstration Following the passage of SB 208 (Steinberg, 2010) and the receipt of federal planning funds to develop new models of
More informationCalifornia s Medi- Cal Home & Community Based Services Waivers, Benefits & Eligibility Policies, 2005-2008
University of California San Francisco California Medicaid Research Institute (CaMRI) School of Medicine California s Medi- Cal Home & Community Based Services Waivers, Benefits & Eligibility Policies,
More informationMaryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid
More informationNew Hampshire Department of Health and Human Services. Medicaid Care Management Program Step 2 Design Concept
New Hampshire Department of Health and Human Services Medicaid Care Management Program Step 2 Design Concept Redesign of New Hampshire s Long Term Services and Supports Delivery System: A Concept Paper
More informationWhat is the Low Income Subsidy? Ginger Rogers Medicare Part D Disability Drug Benefit Helpline Disability Rights Wisconsin
What is the Low Income Subsidy? Ginger Rogers Medicare Part D Disability Drug Benefit Helpline Disability Rights Wisconsin 1 What is the Low Income Subsidy? Also known as LIS or Extra Help Medicare beneficiaries
More informationTransitioning Beneficiaries with Complex Care Needs to Medicaid Managed Care: Lessons from California
Transitioning Beneficiaries with Complex Care Needs to Medicaid Managed Care: Lessons from California Carrie L. Graham, PhD Health Research for Action UC Berkeley School of Public Health for Medicaid Managed
More informationRULES OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION BUREAU OF TENNCARE
RULES OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION BUREAU OF TENNCARE CHAPTER 1200-13-17 TENNCARE CROSSOVER PAYMENTS FOR MEDICARE TABLE OF CONTENTS 1200-13-17-.01 Definitions 1200-13-17-.04 Medicare
More informationMedi-Growth Medicaid, Medicare Poised to Expand
C H A P T E R 7 Medi-Growth Medicaid, Medicare Poised to Expand More than 100 million Americans rely upon Medicaid and Medicare for insurance coverage. Medicaid, the government s insurance program for
More informationNew York DISCOs: Managed care plans for people with developmental disabilities - Critical factors for financial viability
New York DISCOs: Managed care plans for people with developmental disabilities - Critical factors for financial viability Melissa Fredericks, FSA, MAAA Rob Parke, FIA, ASA, MAAA Jane Suh The model for
More informationImproving Service Delivery for Medicaid Clients Through Data Integration and Predictive Modeling
Improving Service Delivery for Medicaid Clients Through Data Integration and Predictive Modeling Getty Images, istock David Mancuso, PhD July 7, 2015 1 The Medicaid Environment Program costs are often
More informationSummary of the Major Provisions in the Patient Protection and Affordable Health Care Act
Summary of the Major Provisions in the Patient Protection and Affordable Care Act Updated 10/22/10 On March 23, 2010, President Barack Obama signed into law comprehensive health care reform legislation,
More informationMultipurpose Senior Services Program (MSSP) An Overview of CalOptima MSSP
Multipurpose Senior Services Program (MSSP) An Overview of CalOptima MSSP Snack & Learn May 29, 2012 1 Supported by the California Department of Health and Human Services Agency and U.S. Department of
More informationManaged Care in Minnesota
Managed Care in Minnesota This profile reflects state managed care program information as of August 2014, and only includes information on active federal operating authorities, and as such, the program
More informationWelcome! Medicare Advantage. Elderplan Advantage Institutional Special Needs Plan
Elderplan Advantage Institutional Special Needs Plan 1 Welcome! Goals for today: To give you an overview of Medicare Advantage Works To give you a sense of the role of ISNP in an SNF To provide a description
More informationDepartment of Developmental Disabilities
MBR General DDDCD21 Funds Used for the ICF/MR Franchise Permit Fees R.C. 5112.37, 5112.31, 5112.371, R.C. 5112.37, 5112.31, 5112.371, R.C. 5112.37, 5112.31, 5112.371, R.C. 5112.37, 5112.31, 5112.371, 5112.39
More informationMedicare Advantage special needs plans
C h a p t e r14 Medicare Advantage special needs plans R E C O M M E N D A T I O N S 14-1 The Congress should permanently reauthorize institutional special needs plans. COMMISSIONER VOTES: YES 16 NO 0
More informationMedi-Cal Policy Institute
Medi-Cal Policy Institute REVISED EDITION, SEPTEMBER 2001 Understanding Medi-Cal: Long-Term Care The Medi-Cal Policy Institute, established in 1997 by the California HealthCare Foundation, is an independent
More informationMontefiore s Population Health Management Services. October 23, 2015
Montefiore s Population Health Management Services October 23, 2015 Integrated Delivery System Our Locations 3,092 Acute Beds Across 10 Hospitals Including 132 beds at the Children s Hospital at Montefiore
More informationHow To Improve Health Care In The United States
Duals Demonstration Panel ICE 2013 Annual Conference Kerry Branick, Medicare Medicaid Coordination Office, Washington DC Susan Castleberry, Consortium for Medicare Health Plan Operations, Region IX, San
More informationDEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW
DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW North Carolina General Assembly Fiscal Research Division February 2005 Overview Purpose of Medicaid Impact of Medicaid - On the State Economy
More informationPROVIDER BULLETIN No. 05-05
PROVIDER BULLETIN No. 05-05 February 15, 2005 TO: FROM: BY: RE: Speech Therapy Providers Mary Steiner, Interim Administrator, Medicaid Division Marsha Rekart, Program Specialist Medicaid coverage of speech
More informationCoordinated Care Initiative Fix List
Coordinated Care Initiative Fix List The following table describes problems brought to the attention of the National Senior Citizens Law Center (NSCLC) during the implementation of the Coordinated Care
More informationHealth Care Reform WHAT DOES IT MEAN FOR PEOPLE WITH HIV?
Health Care Reform WHAT DOES IT MEAN FOR PEOPLE WITH HIV? Overcoming Health Disparities in the California Bay Area Using HIV/AIDS as a Model San Francisco May, 2012 ANNE DONNELLY PROJECT INFORM ADONNELLY@PROJECTINFORM.ORG
More informationAnnual Notice of Changes for 2016
Healthy Advantage Plus HMO offered by Molina Healthcare of Utah Annual Notice of Changes for 2016 You are currently enrolled as a member of Healthy Advantage Plus HMO. Next year, there will be some changes
More informationCONTENTS. o o o o o o o o o o o o
CONTENTS o o o o o o o o o o o o What Are Medicare Advantage (MA) Plans? Who Can Join and When? MA Trial Right Special Election Period How MA Plans Work MA Costs Types of Medicare Advantage Plans Rights
More informationDepartment of Social and Health Services Aging and Disability Services Administration
WASHINGTON STATE S Department of Social and Health Services Aging and Disability Services Administration Governor Gregoire s Budget Reduction Alternatives October 31, 2011 1 The 2012 Budget Historical
More informationTestimony on: Medicare Part D and Dual Eligibles. presented to: Senate Committee on Ways and Means
ROBERT M. DAY, DIRECTOR DIVISION OF HEALTH POLICY AND FINANCE KATHLEEN SEBELIUS, GOVERNOR Testimony on: presented to: Senate Committee on Ways and Means by: Scott Brunner Division of Health Policy and
More informationFACT SHEET Medicare Advantage (Part C): An Overview (C-001) p. 1 of 5
FACT SHEET Medicare Advantage (Part C): An Overview (C-001) p. 1 of 5 Medicare Advantage (Part C): An Overview Medicare Advantage is also known as Medicare Part C. A Medicare Advantage (MA) plan is an
More informationWhat s a Medicare Advantage Plan?
Revised April 2015 What s a Medicare Advantage Plan? You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the
More informationOptimum HealthCare Sales Video Script - H5594_14SalesVideo_CMS Approved
Optimum HealthCare Sales Video Script - H5594_14SalesVideo_CMS Approved Thank you for joining us for this special presentation on Optimum HealthCare s Medicare Advantage Plans. Today we will explain the
More informationKaiser Permanente Southern California Depression Care Program
Kaiser Permanente Southern California Depression Care Program Abstract In 2001, Kaiser Permanente of Southern California (KPSC) adopted the IMPACT model of collaborative care for depression, developed
More informationFlorida Medicaid and Implementation of SB 2654
Florida Medicaid and Implementation of SB 2654 Shachi Mankodi Counsel to the Chief of Staff Florida Agency for Health Care Administration Autism Compact Presentation September 18, 2008 Overview What is
More informationA Conversation About Medicare Part A, B, C and D
Please take this moment to convert the display to Full Screen A Conversation About Medicare Part A, B, C and D www..com A Conversation About Medicare Part A, B, C and D www.healthcaremedicalpharmaceuticaldirectory.com
More informationCare needs for dual-eligible beneficiaries
C h a p t e r6 Care needs for dual-eligible beneficiaries C H A P T E R 6 Care needs for dual-eligible beneficiaries Chapter summary In this chapter Dual-eligible beneficiaries are eligible for both Medicare
More informationMedicare Resource Guide
Medicare Resource Guide Patient Name Dear Patient, Please take the time to read the following sections of this brochure as noted by your healthcare provider. These different components of Medicare deal
More information1 ALPHA-1 FOUNDATION. Private Insurance: Virtual Support Group Telecall and Webinar
1 ALPHA-1 FOUNDATION Open Enrollment for Medicare and Private Insurance: How to choose the plan that will work for you Virtual Support Group Telecall and Webinar Prepare Yourself Know your healthcare needs
More informationHome Care Association of WA April 15, 2015. Health Homes and Accountable Communities of Health State Innovation Model (SIM)
Home Care Association of WA April 15, 2015 Health Homes and Accountable Communities of Health State Innovation Model (SIM) 1 WASHINGTON STATE HEALTH HOME PROGRAM 2 The Affordable Care Act The Affordable
More informationUnderstanding Health Insurance
Understanding Health Insurance Health insurance can play an important role when it comes to medical bills and prescription medications it can help protect you from high expenses. There are many types of
More information230 S. Bemiston; Suite 900 Clayton, MO 63105 (314)727-5522 FAX (314)727-5568 www.mrctbenefitsplus.com www.mrctquote.com
Life & Health Insurance Advisor MRCT Benefits Plus is a comprehensive employee benefits, wellness and Human Resources consulting firm offering a variety of financial services to businesses and individuals
More informationSpecial Needs Plan Model of Care 101
Special Needs Plan Model of Care 101 What is a Special Needs Plan? First of all it s a Medicare MA-PD, typically an HMO Consists of Medicare enrollees who meet special eligibility requirements In our case
More informationManaged Care in California
Managed Care in California This profile reflects state managed care program information as of August 2014, and only includes information on active federal operating authorities, and as such, the program
More informationCHAPTER 9 THIRD PARTY LIABILITY AND COORDINATION OF BENEFITS
CHAPTER 9 THIRD PARTY LIABILITY AND COORDINATION OF BENEFITS 9.0 -THIRD PARTY LIABILITY AND COORDINATION OF BENEFITS DETERMINING OTHER HEALTH INSURANCE COVERAGE Behavioral health/integrated care providers
More informationMedicare Advantage Funding Cuts and the Impact on Beneficiary Value
Medicare Advantage Funding Cuts and the Impact on Beneficiary Value Commissioned by Better Medicare Alliance Prepared by: Milliman, Inc. Brett L. Swanson, FSA, MAAA Consulting Actuary Eric P. Goetsch,
More informationH7833_150304MO01. Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas
H7833_150304MO01 Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas Agenda Connecting Medicare and Medicaid Eligible Members Service Coordination
More informationMedicaid Support for Community Prevention
Medicaid Support for Community Prevention ASTHO Million Hearts Peer Call April 4, 2014 Anne De Biasi Director of Policy Development About TFAH: Who We Are Trust for America s Health (TFAH) is a non-profit,
More informationMental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado As of July 2003, 377,123 people were covered under Colorado s Medicaid and SCHIP programs. There were 330,499 enrolled in the
More informationNew York State Department of Health s Demonstration to Integrate Care for Dual Eligible Individuals Final Proposal Submitted to CMS on May 25, 2012
New York State Department of Health s Demonstration to Integrate Care for Dual Eligible Individuals Final Proposal Submitted to CMS on May 25, 2012 This publication was developed under Contract Number
More informationSolutions for Today Flexibility for Tomorrow.
Solutions for Today Flexibility for Tomorrow. Medicare Products and Services For More Information call our Senior Care Specialist, Raun Lynch at 856.380.5079 Or visit us on the web at www.cbdi-inc.com
More informationOverview of CARES Training
Chapter Three CARES Page III.1. Overview of CARES Training Training Goal: The overall goal for this training is to increase a participant s knowledge of the CARES Program so: 1) they will be able to determine
More informationWhat this means for Idaho?
What this means for Idaho? Why now? The 2011 Idaho Legislature approved the Medicaid Cost Containment and Health Care Improvement Act : The current fee-for-service health care delivery system of payment
More informationRisk Adjustment: Implications for Community Health Centers
Risk Adjustment: Implications for Community Health Centers Todd Gilmer, PhD Division of Health Policy Department of Family and Preventive Medicine University of California, San Diego Overview Program and
More informationTransitioning Beneficiaries with Complex Care Needs to Medicaid Managed Care:
issue brief Transitioning Beneficiaries with Complex Care Needs to Medicaid Managed Care: Updated July 2013 Insights from California EXECUTIVE SUMMARY Between June 2011 and May 2012, the California Medicaid
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Kentucky Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
More informationAHLA. BB. Accountable Care Organizations and the Medicare Shared Savings Program. Troy Barsky Crowell & Moring LLP Washington, DC
AHLA BB. Accountable Care Organizations and the Medicare Shared Savings Program Troy Barsky Crowell & Moring LLP Washington, DC Daniel F. Murphy Bradley Arant Boult Cummings LLP Birmingham, AL Terri L.
More informationWashington Individual Provider (IP) Program
Washington Individual Provider (IP) Program Unionization in Participant Direction Programs: Impact on State and Financial Management Services Operations Financial Management Services Conference November
More informationPROTOCOLS FOR OCCUPATIONAL THERAPY PROVIDERS
PROTOCOLS FOR OCCUPATIONAL THERAPY PROVIDERS Type of Services Provided Services provided by Occupational Therapy providers are covered for Santa Barbara Health Initiative (SBHI), San Luis Obispo Health
More informationAccountable Care and Value Based Payments 101: Government Programs Update
1 Accountable Care and Value Based Payments 101: Government Programs Update June 24 th, 2014 Dave Neiman, FSA, MAAA Senior Consulting Actuary DaveN@Wakely.com (720) 226-9806 2 Caveats Opinions expressed
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
Page1 G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify G.6 When to Notify G.11 Case Management Services G.14 Special Needs Services G.16 Health Management Programs
More informationElizabeth Dudek Secretary, Agency for Health Care Administration. House Health Care Appropriations Subcommittee January 15, 2013
Florida Medicaid: An Overview Elizabeth Dudek Secretary, Agency for Health Care Administration House Health Care Appropriations Subcommittee January 15, 2013 AHCA Overview The Agency for Health Care Administration
More informationSMART Humana Group Medicare
SMART Humana Group Medicare Group Medicare GHHHNYFEN 0813 Overview of Humana Medicare Medicare is the largest government-sponsored health insurance program in the United States, serving more than 49 million
More informationAccreditation of Medi-Cal, Healthy Kids and Healthy Families Program.
Accreditation of Medi-Cal, Healthy Kids and Healthy Families Program. 1 Overview of Medi-Cal Expansion Transition of HWLA Members to Medi-Cal Key Changes for Transitioning Members Continuity of Care Protections
More informationFunctional Assessment Processes for Medicaid Personal Care Services
Functional Assessment Processes for Medicaid Personal Care Services By Susan M. Tucker and Marshall E. Kelley Spring 2011 No. 7 The Community Living Assistance Services and Supports (CLASS) Plan a groundbreaking
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More informationMedicare & UC Medical Benefits
Medicare & UC Medical Benefits UCSB Health Care Facilitator Program Laura Morgan 893-4201 UC Retirement Administration Service Center (RASC) 1-800-888-8267 This presentation is intended for communication
More informationUnderstanding your. Medicare options. Medicare Made Clear TM. Get Answers Series. Y0066_120629_084915 CMS Accepted
Understanding your Medicare options. Medicare Made Clear TM Get Answers Series Y0066_120629_084915 CMS Accepted learning about Medicare Choices. Eligibility Coverage options When to enroll Next steps and
More informationMedicaid in New Jersey
Medicaid in New Jersey New Jersey Medicaid, administered by the Division of Medical Assistance and Health Services, covers certain medical and health care services for individuals who meet eligibility
More informationChoosing a Medicare Advantage plan you ll be confident in.
Choosing a Medicare Advantage plan you ll be confident in. Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Continued enrollment depends on the contract between
More informationCalifornia Association of Public Authorities
California Association of Public Authorities OVERVIEW OF THE GOVERNOR S FY 15-16 STATE BUDGET PROPOSALS FOR IHSS IHSS Budget Overview... 1 Restoration of Across the Board Reduction... 2 IHSS Caseload Information...
More informationPrescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
More informationMarilyn Tavenner Administrator Centers for Medicare and Medicaid Services Attention: CMS-1612-FC 7500 Security Blvd Baltimore, MD 21244
February 6, 2015 Marilyn Tavenner Administrator Centers for Medicare and Medicaid Services Attention: CMS-1612-FC 7500 Security Blvd Baltimore, MD 21244 RE: Medicare Program; Medicare Shared Savings Program:
More informationNJ Department of Human Services
NJ Department of Human Services FREQUENTLY ASKED QUESTIONS (FAQs) NJ FamilyCare MANAGED LONG TERM SERVICES AND SUPPORTS (MLTSS) (Revised May 5, 2014) NJ FamilyCare MANAGED LONG TERM SERVICES AND SUPPORTS
More informationPWC Self-Insurance Health Fund
PWC Self-Insurance Health Fund Finance Department Human Resources November 23, 2010 0 0 Background 1992 1992-2002 2002 2006 Today Managed Care decade begins Ten years of moderate rate increases for County
More information2015 Optimum Healthcare Sales Presentation Video Transcript-
2015 Optimum Healthcare Sales Presentation Video Transcript- H5594_15SalesPresVidv2_CMS_Approved Welcome to this presentation on Optimum HealthCare s Medicare Advantage Plans. Today you will learn about
More informationWisconsin Long-Term Care Insurance Partnership Program WI Medicaid Training PART I
Wisconsin Long-Term Care Insurance Partnership Program WI Medicaid Training PART I Introduction to the WI Long- Term Care Insurance Partnership Program and The Wisconsin Medicaid Program: An Overview The
More informationCopayment: The amount you must pay for each medical visit to a participating doctor or other healthcare provider, usually at this time service.
Basic Terms How to calculate Out of Pocket Costs on a Hospital Stay: If you have a $2000 deductible and 30% coinsurance health insurance plan. If you have a $10,000 emergency room or hospital stay your
More informationBAKERSFIELD CITY SCHOOL DISTRICT
BAKERSFIELD CITY SCHOOL DISTRICT INSURANCE PLANS for RETIREES 2015-2016 GENERAL INFORMATION About DISTRICT Plans for Retirees And INDIVIDUAL Retiree Plans, SISC Sponsored Retirees of the Bakersfield City
More informationCMS NEWS. October, 25, 2012 (202) 690-6145
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 CMS NEWS FOR IMMEDIATE RELEASE Contact: CMS Media Relations October,
More informationU.S. Department of Health and Human Services. Centers for Medicare & Medicaid Services Region VIII FINAL REPORT
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services Region VIII FINAL REPORT Montana EPSDT Review Report Dental Services April 1 3, 2008 Executive Summary The Early and
More informationManaged Care in New York
Managed Care in New York This profile reflects state managed care program information as of August 2014, and only includes information on active federal operating authorities, and as such, the program
More informationResponse to Serving the Medi Cal SPD Population in Alameda County
Expanding Health Coverage and Increasing Access to High Quality Care Response to Serving the Medi Cal SPD Population in Alameda County As the State has acknowledged in the 1115 waiver concept paper, the
More informationNational Benefit Fund
1199SEIU National Benefit Fund June 2015 SUMMARY PLAN DESCRIPTION Section VI Retiree Health Benefits A. Retiree Health Benefits B. Using Your Benefits Wisely C. If You Retire at or after Age 65 and Live
More informationCMS REGULATORY ACTION
CMS REGULATORY ACTIONS CMS REGULATORY ACTION Government Provider Cost Limit Regulation Imposes new restrictions on payments to providers operated by units of government and clarifies that those entities
More informationImplementing Florida Medicaid Managed Care Redesign. Justin Senior Deputy Secretary for Medicaid Florida Agency for Health Care Administration
Implementing Florida Medicaid Managed Care Redesign Justin Senior Deputy Secretary for Medicaid Florida Agency for Health Care Administration Implementing Medicaid Program Redesign: Overview 1. Steps Once
More informationYour complimentary Medicare Guidebook
Learn Protect Assess Enroll Your complimentary Medicare Guidebook About this Guidebook If you or someone you care for is new to Medicare or will be soon, this Guidebook will help make Medicare easier to
More informationGAO MEDICARE ADVANTAGE. Relationship between Benefit Package Designs and Plans Average Beneficiary Health Status. Report to Congressional Requesters
GAO United States Government Accountability Office Report to Congressional Requesters April 2010 MEDICARE ADVANTAGE Relationship between Benefit Package Designs and Plans Average Beneficiary Health Status
More informationAnnual Notice of Changes for 2015
Coventry Advantage (no drug) (HMO) offered by Coventry Health Care of Missouri, Inc. Annual Notice of Changes for 2015 You are currently enrolled as a member of Coventry Advantage (no drug) (HMO). Next
More informationBuilding an Accountable Care Organization. Jean Malouin, MD MPH University of Michigan Health System September 21, 2012
Building an Accountable Care Organization Jean Malouin, MD MPH University of Michigan Health System September 21, 2012 Agenda UMHS overview PGP demo ACO precursor Current efforts underway Role of primary
More informationLong Term Care Issues. HFMA Healthcare Financial Management Association Thursday March 17 th 2011 Los Angeles, CA
Long Term Care Issues HFMA Healthcare Financial Management Association Thursday March 17 th 2011 Los Angeles, CA Presenter Michael Lesnick Ron Wall 714-323-5968 909-472-8900 MikeL@axiomhc.com RonW@axiomhc.com
More information