Virginia

1
Virginias Blueprint for the Integration of
Acute and Long-Term Care ServicesThe Second
National Medicaid Congress
Cindi B. Jones, Chief Deputy Director Department
of Medical Assistance Services
June 14, 2007
2
The Elderly And Disabled Represent 30 Percent of
Program Recipients
Demographics Of Recipients In Virginias Medicaid
Program
Adults
Aged
13
10
30
Blind
20
Disabled
57
Children
Note Unduplicated count of recipients in FY 2005
3
Yet They Account For Three-Quarters Of Program
Spending
Expenditures
Recipients
Aged
10
26
30
Aged
Blind Disabled
20
71
Adults
13
Blind Disabled
45
57
Children
9
Adults
21
Children
Notes FY 2005 recipient and expenditure data
4
This Obviously Means The Cost Of Serving The
Elderly and Disabled Is Substantially Greater
Than The Cost Of Care For Children
12,000
11,595
10,831
10,000
8,000
4,720
6,000
4,000
3,109
1,725
2,000
0
Blind Disabled
Aged
All Recipients
Children
Adults
Notes FY 2005 recipient and expenditure data
5
Virginias Waiver Programs For The Elderly And
Disabled Are Expensive But Still Less Costly Than
Comparable Institutional Care
Per Person Institution
Per Person Waiver
29,705
23,904
Waiver Programs
DD
Tech Assisted
EDCD
AIDS
MR
6
DMAS Key LTC Performance Measure Focuses on
Community Based Care
7
Governor Kaine and General Assembly Directs DMAS
to Develop A Blueprint for the Integration of
Acute and Long Term Care 2006 Virginia Acts of
the General Assembly (Item 302, ZZ)

• This plan shall
• explain how the various stakeholders will be
  involved in the development and implementation of
  the new program model(s)
• describe the various steps for development and
  implementation of the program model(s), include a
  review of other States models, funding,
  populations served, services provided, education
  of clients and providers, and location of
  programs and
• describe the evaluation methods that will be used
  to ensure that the program provides access,
  quality, and consumer satisfaction.

8
DMAS Held a Series of Three Meetings on Acute and
Long Term Care Integration Models and Issues
(during Summer/Fall 2006)

• First Meeting Provided an overview of Medicaid
  funded acute and long term care services in
  Virginia and across the United States.
• Second Meeting Facilitated a meeting with
  stakeholders so they could provide input on the
  options for developing an integrated acute and
  long term care program in Virginia.
• Third Meeting Heard public comment on the
  integration of acute and long term care.

9
What is Integration?

• Current Systemfee for service and fragmented
• Primary and Acute Care Services
• Physician
• Hospital
• Pharmacy
• Labs
• Disease Management
• Long Term Care Services
• Nursing Homes
• Home and Community Based Care Waiver programs (7)
• Case Management

• New SystemManaged care and coordinated
• Combines all acute and long term care services
  (except for certain waiver programs) under one
  capitated rate
• Combines Medicare and Medicaid funding
• ONE CALLALL CARE NEEDS
• Right Services at Right Time

10
Two Models for Integration

• Community Model Program of All Inclusive Care
  for the Elderly or PACE. Combines Medicaid and
  Medicare funding to provide all medical, social,
  and long term care services through an adult day
  health care center.
• Six communities actively pursuing PACE6 were
  awarded start up grants (250,000 each).
• Hampton Roads (2)
• Richmond (1)
• Lynchburg (1)
• Far Southwest (2)

11
Two Models for Integration(continued)

• Regional Model Could range from a capitated
  payment system for Medicaid (potentially
  integrating Medicare funding) for acute care
  costs with care coordination for long term care
  services, to a fully capitated system for all
  acute and long term care services

12
Development of a PlanPopulations Covered All
234,945 Low-Income Seniors and Persons with
Disabilities (ABD)

• Medicaid Only (non-duals) 86,732 clients
• Dont use long term care services (79,045
  clients)
• Use long term care services (7,687 clients)

• Medicaid and Medicare (dual eligibles) 148,213
  clients
• Dont use long term care services (115,152
  clients)
• Use long term care services (33,061 clients)

13
Development of a PlanServices Included

• All Medicaid and Medicare primary, acute and long
  term care services (including nursing facility
  care and home and community based waiver
  services)
• Home health and personal care services will
  continue to be the cornerstone to keeping clients
  in their homes
• Services carved out
• Behavioral Health Services (state plan option
  only)
• Certain waiver programs (MR, DS, DD, Technology
  Assisted)

14
Development of a PlanEnrollment Options

• Community Model/PACE Enrollment will be
  voluntary
• Regional Model Enrollment will be mandatory for
  managed care programs for acute care needs only
  enrollment will be voluntary for managed care
  program for both acute and long term care needs
  (clients will be enrolled and have the
  opportunity to opt out).

15
Development of a PlanProviders

• Community Model Federal and state approved PACE
  sites
• Regional Models Current managed care
  organizations and/or Medicare Advantage Plans,
  Special Needs Plans

16
Integration Models WillBe Phased In

• Community Model/PACE
• Current System One Pre-PACE site more than 10
  years (Sentara Senior Community Center)
• Phase I (2007-2008) Six full PACE sites
• Two in Hampton Roads, One in Richmond, Two in the
  far Southwest, One in Lynchburg
• Phase II (2007-2009)
• DMAS determines underserved areas of the state
  and issues a Request for Application for
  additional PACE sites. Next site location is
  Northern Virginia

17
Integration Models WillBe Phased In (continued)

• Regional Models
• Current System Managed care for acute care
  needs only49,000 ABDs with no Medicare and with
  no long term care services.
• Phase I (2007-2008) Expands managed care for
  primary and acute care needs only to the ABDs
  with no Medicare but who have long term care
  needs. LTC services remain fee for service.
• Will not include nursing facility residents
• Will not include Technology Assisted Waiver
  clients
• Will not move current LTC waiver clients into
  managed care.

18
Integration Models WillBe Phased In (continued)

• Regional Models
• Phase II (2008-2010) Fully integrates acute and
  long term care services and combines Medicaid and
  Medicare funding. Excludes certain home and
  community-based care waiver program services (MR,
  DS, DD, Tech) but does include the clients for
  coordination of acute and primary care services.
• Next Steps
• Will include stakeholder input throughout the
  development and implementation of this phase
• Will develop a Request for Proposals in 2007
• Will start as a pilot/regional program in 2008
• Movement of populations, services, and funding
  sources likely to be phased in over time