The Integration of Acute and Long Term Care Services: Status of Phase I and Decisions for Phase II P

1
The Integration of Acute and Long Term Care
Services Status of Phase I and Decisions for
Phase IIPresentation to Managed Care
Organizations
Department of Medical Assistance
Services September 10, 2007
2
The Blueprint for the Integration of Acute and
Long Term Care 2006 Virginia Acts of the General
Assembly (Item 302, ZZ)

• Completed December 2006, this plan
• explains how the various stakeholders are
  involved in the development and implementation of
  the new program models
• describes the various steps for development and
  implementation of the program models
• includes a review of other States models,
  funding, populations served, services provided,
  education of clients and providers, and location
  of programs and
• describes the evaluation methods that will be
  used to ensure that the program provides access,
  quality, and consumer satisfaction.

3
The Blueprint for the Integration of Acute and
Long Term Care(continued)

• 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.

4
Implementation Regional ModelPhase I

• Current System Mandatory managed care for acute
  care needs only49,000 low income seniors and
  individuals with disabilities (Aged, Blind, and
  Disabled) with no Medicare and with no long term
  care services.
• Phase I (September 1, 2007) Managed care
  organization (MCO) enrollees who become eligible
  for home and community-based service waiver
  programs will remain in their MCOs for acute and
  primary medical services. These individuals will
  continue to receive HCBC waiver services through
  the fee for service program.

5
Implementation Regional Model Phase I

• Implementation date is September 1, 2007 CMS has
  approved the 1915(b) waiver modification.
• In the first year, will impact about 500 Medicaid
  only clients who are receiving managed care first
  and now need long term care services.
• Phase I is statewide wherever there are MCOs.
• Populations excluded during Phase I (most of
  these populations are included in Phase II)
• Will not include dual eligibles (Medicaid and
  Medicare)
• Will not include nursing facility residents
• Will not include Technology Assisted Waiver
  clients
• Will not move current LTC waiver clients into
  managed care.

6
Implementation Regional Model Phase I
(continued)

• DMAS conducted several activities to ensure a
  smooth transition to Phase I
• Made changes to information system and to
  recipient and provider communications, amended
  MCO contracts, modified 1915(b) waiver, and
  promulgated regulations
• Met with various stakeholder groups over past
  nine months
• Met with and trained MCOs
• Designated two transition coordinators to assist
  providers, recipients, and MCOs.

7
Implementation Regional Model Phase II

• The roll out of Phase II will be on a scheduled
  and layered approach over time based on
• Geographic location (pilot first in two areas)
• Populations Included
• Funding sources (Medicaid and Medicare)
• Services Included
• The focus will be what is feasible and will
  ensure a smooth transition for our recipients and
  providers.
• Federal Authority
• 1915 (b) and (c) combination waiver will allow
  for mandatory enrollment

8
Implementation Regional Model Phase
II-Geographic Location

• On a geographic basis, the roll out will be one
  area at a time (every six months) until statewide
  
• Tidewater August 8, 2008initial wave
• 13 cities and counties
• Richmond January 2009initial wave
• 12 cities and counties
• Northern August 2009
• Surrounding counties Winter 2010
• Rural Summer 2010/Winter 2011
• Tidewater and Richmond were selected first
  because of their strong health systems,
  competitive atmosphere, urban environment, and
  size of their Medicaid population.

9
Implementation Regional Model Phase
II-Geographic LocationInitial Wave
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Localities - Tidewater
OPERATIONAL TIMELINE Tidewater August 2008
Frederick
Winchester
Manassas Park
Clarke
Loudoun
Falls Church
Warren
Arlington
Fauquier
Shenandoah
Alexandria
Fairfax City
Rappahannock
Fairfax
PrinceWilliam
Manassas
Page
Rockingham
Harrisonburg
Culpeper
Stafford
Madison
Highland
KingGeorge
Fredericksburg
Greene
Augusta
Orange
Staunton
Westmoreland
Spotsylvania
Albemarle
Bath
Essex
Waynesboro
Northumberland
Caroline
Louisa
Charlottesville
Lexington
Clifton Forge
Richmond
Fluvanna
King Queen
Buena Vista
Accomack
Covington
Nelson
Hanover
Goochland
Lancaster
Rockbridge
Alleghany
King William
Middlesex
Henrico
Amherst
Buckingham
Powhatan
NewKent
Botetourt
Richmond
Matthews
Gloucester
Cumberland
Lynchburg
Craig
Northampton
Chesterfield
JamesCity
Appomattox
CharlesCity
Roanoke
Amelia
Bedford
Col.Heights
Giles
Salem
Prince Edward
York
Poquoson
Roanoke City
Buchanan
Prince George
Petersburg
Campbell
Williamsburg
Bedford
Montgomery
Surry
Nottoway
Hopewell
Hampton
Dickenson
Isle ofWight
Bland
Dinwiddie
Tazewell
Newport News
Charlotte
Radford
Wise
Norfolk
Lunenburg
Franklin
Pulaski
Sussex
Portsmouth
Russell
Floyd
Norton
Wythe
Virginia Beach
Brunswick
Smyth
Pittsylvania
Franklin
Henry
Suffolk
Lee
Carroll
Washington
Emporia
Chesapeake
Scott
Southampton
Danville
Mecklenburg
Galax
Patrick
Halifax
Grayson
Greensville
Martinsville
Bristol
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Localities - Richmond
OPERATIONAL TIMELINE Richmond February 2009
Frederick
Winchester
Manassas Park
Clarke
Loudoun
Falls Church
Warren
Arlington
Fauquier
Shenandoah
Alexandria
Fairfax City
Rappahannock
Fairfax
PrinceWilliam
Manassas
Page
Rockingham
Harrisonburg
Culpeper
Stafford
Madison
Highland
KingGeorge
Fredericksburg
Greene
Augusta
Orange
Staunton
Westmoreland
Spotsylvania
Albemarle
Bath
Essex
Waynesboro
Northumberland
Caroline
Louisa
Charlottesville
Lexington
Clifton Forge
Richmond
Fluvanna
King Queen
Buena Vista
Accomack
Covington
Nelson
Hanover
Goochland
Lancaster
Rockbridge
Alleghany
King William
Middlesex
Henrico
Amherst
Buckingham
Powhatan
NewKent
Botetourt
Richmond
Matthews
Cumberland
Lynchburg
Craig
Northampton
Chesterfield
Gloucester
JamesCity
Appomattox
CharlesCity
Roanoke
Amelia
Bedford
Col.Heights
Giles
Salem
Prince Edward
Poquoson
Roanoke City
York
Buchanan
Prince George
Petersburg
Campbell
Williamsburg
Bedford
Montgomery
Surry
Nottoway
Hampton
Hopewell
Dickenson
Bland
Dinwiddie
Tazewell
Newport News
Isle ofWight
Charlotte
Radford
Wise
Norfolk
Lunenburg
Franklin
Pulaski
Sussex
Portsmouth
Russell
Floyd
Norton
Wythe
Virginia Beach
Brunswick
Smyth
Pittsylvania
Franklin
Henry
Suffolk
Lee
Carroll
Washington
Emporia
Chesapeake
Scott
Southampton
Danville
Mecklenburg
Galax
Patrick
Halifax
Grayson
Greensville
Martinsville
Bristol
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Implementation Regional Model Phase
II-Populations

• At the end of Phase II, the goal is to have more
  than 200,000 low income seniors and persons with
  disabilities (known as the Aged, blind, and
  disabled) in some form of Medicaid managed care
  for their acute care needs only and/or long term
  care needs.
• The roll-out for populations in the geographic
  areas will include
• Medicaid only and Medicaid and Medicare (dual
  eligibles)-initial wave
• Nursing Facility Clients (new admissions
  only)-initial wave
• Home and Community Based Care Waiver Clients
• Existing and new Elderly and Disabled with
  Consumer Direction and AIDS waiver
  clients-initial wave
• Later, existing and new Mental Retardation, Day
  Support, Developmental Disabilities, Alzheimer's,
  Tech waiver clients for acute care needs only
  (could be put in Phase I option at any time)

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Questions

• ??
• Questions and comments may be forwarded to us via
• ALTCMCO_at_dmas.virginia.gov