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

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The Integration of Acute and Long Term Care
Services Status of Phase I and Decisions for
Phase IIPresentation to Mental Health/Mental
Retardation/Substance Abuse Services Providers
Department of Medical Assistance
Services September 18, 2007
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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.

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Blueprint for the Integration of Acute and
Long-Term Care Services
Virginia Department of Medical Assistance
Services December 15, 2006 Found at
http//www.dmas.virginia.gov/altc-home.htm
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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.

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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.

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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.

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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

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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.

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Implementation Regional Model Phase
II-Geographic LocationInitial Wave
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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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Implementation Regional Model Phase II-Funding

• To have truly integrated acute and long term care
  services, both the Medicaid and Medicare funding
  (through a Medicare Advantage Plan or a Special
  Needs Plan) need to be combined within the
  administration of one Managed Care Organization.
• However, due to the timing of federal
  requirements for Special Needs Plans (or SNPs),
  DMAS will need to start the initial wave with a
  Medicaid only integrated model for acute and long
  term care services.
• The Request for Proposals for the Integrated
  Managed Care Program will require that all
  participating health plans be classified as a
  Medicare Advantage and/or SNP or are
  working/applied for the classification.

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Implementation Regional Model Phase II-Services

• Medicaid managed acute and long term care
  services
• All current Medicaid state plan primary and acute
  care services, including mental health and
  transportation services
• Excluded are the state plan option mental health
  services that are currently carved out
• All Elderly and Disabled with Consumer Direction
  waiver services, including adult day health care,
  personal care aide (both agency and
  consumer-directed), personal emergency response
  systems and medication monitoring, and up to 720
  hours per year of respite care (both agency and
  consumer-directed). Environmental modifications,
  assistive technology, transition services, and
  transition coordination will be added with Money
  Follows the Person in May 2008.
• All HIV/AIDs waiver services, including personal
  care aide (both agency and consumer directed),
  private duty nursing, nutritional supplements,
  respite care (up to 720 hours per year), and case
  management. Transition services, personal
  emergency response systems and medication
  monitoring, assistive technology, and
  environmental modifications will be added with
  Money Follows the Person in May 2008.

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Implementation Regional Model Phase II-Services

• Medicaid managed acute and long term care
  services (continued)
• Nursing Facility Care (for a short period of
  time)
• This allows the MCO an opportunity to move the
  client back home with community based care
  services, if appropriate.
• Additional services
• Care Coordination intensive care management for
  long term care service clients
• 24-hour/7 days a week access line
• Disease management (if applicable)

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Implementation Regional Model Phase II-Services

• Home and Community Based Care Waiver Services
  Excluded
• Mental Retardation, Day Support, Developmental
  Disabled
• These waivers have waiting lists
• Technology Dependent
• This waiver is the most expensive
• Alzheimer's Assisted Living Waiver
• Numbers too small at this time
• Medicare Managed Care Services Once the
  Medicare Advantage Plans or SNPS are in place,
  the Medicare/Medicaid clients will have
  coordinated Medicare services also. These plans
  may add enhanced services, such as dental care,
  vision, and hearing.

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Implementation Regional Model Phase II- Other
Decisions

• Enrollment
• Medicaid Managed Acute and Long Term Care
  Enrollment will be mandatory with opt-out
  provisions (first 90 days, annual enrollment
  period, or if meet established good cause)
• Medicare Managed Acute and Long Term Care
  (Special Needs Plans or Medicare Advantage
  Plans). Voluntary and based on Medicare rules.
• In order to reduce disruption of care, DMAS will
  be developing ways to ensure that the Medicaid
  and the Medicare plans are the same provider.
• Federal Authority
• 1915 (b) and (c) combination waiver will allow
  for mandatory enrollment

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Implementation Regional Model Phase II- Other
Decisions

• Managed Care Organizations
• Choose through Request for Proposal (RFP) process
  with a minimum of two plans for each region
• Health plans must have Medicare Advantage or SNP
  or working toward it
• Must have health plan accreditationURAC/NCQA
• Out of state plans can bid if licensed in
  Virginia and can fully demonstrate that they can
  meet the RFP requirements

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Questions

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