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Sarah Broughton, MSW Outreach and Education Coordinator

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Department of Medical Assistance Services Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst Virginia Department of Medical ... – PowerPoint PPT presentation

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Title: Sarah Broughton, MSW Outreach and Education Coordinator


1
Department of Medical Assistance Services
  • Sarah Broughton, MSW Outreach and Education
    Coordinator
  • Patti Davidson, MSW Program Analyst
  • Virginia Department of Medical Assistance
    Services
  • LTC Medicaid Subcommittee
  • February 27, 2014

http//dmasva.dmas.virginia.gov
1
2
Overview
Important Contact Information
Eligibility and Enrollment
Commonwealth Coordinated Care Program Highlights
3
CCC Highlights
4
CCC Highlights
Healthkeepers Humana Virginia Premier
5
Who is eligible for CCC?
  • Full benefit Medicare-Medicaid Enrollees
    (entitled to benefits under Medicare Part A and
    enrolled under Medicare Parts B and D, and
    receiving full Medicaid benefits)
  • Participants in the Elderly or Disabled with
    Consumer Direction Waiver
  • Residents of nursing facilities
  • Age 21 and Over
  • Live in designated regions (Northern VA,
    Tidewater, Richmond/Central, Western/Charlottesvil
    le, and Roanoke)

6
Who is not eligible for CCC?
  • Individuals not eligible include those in
  • ID, DD, Day Support, Alzheimer's, Technology
    Assisted HCBS Waivers
  • MH/ID facilities
  • ICF/IDs
  • PACE (although they can opt in)
  • Long Stay Hospitals
  • Money Follows the Person (MFP) program
  • Hospice
  • Other Comprehensive Coverage (TPL)

7
Enrollment
  • Enrollment in CCC will be in five regions of the
    Commonwealth
  • Central Virginia/Richmond
  • Tidewater
  • Northern Virginia
  • Roanoke area
  • Western/Charlottesville area

8
Virginias Service Regions
9
Enrollment
  • Enrollment will be in two phases
  • The first phase is called voluntary enrollment
    where an individual proactively enrolls in the
    program
  • The second phase is called automatic enrollment
    where the individual is automatically enrolled
    into the CCC program.
  • Intelligent Assignment will consider previous
    enrollment with the health plans or the health
    plan network that includes the current adult day
    health provider or nursing facility (if
    applicable).

10
Intelligent Assignment
  • Individuals will be automatically enrolled after
    considering
  • The Health Plan network that includes their
    current adult day health provider
  • The network that includes the enrollees nursing
    facility (if applicable)
  • An enrollees previous enrollment with the
    health plans

11
Beneficiary Choice
  • Most importantly, if an individual is unhappy
    with a chosen health plan, he/she may, at any
    time, request reassignment to another health plan
    or opt out of the program and return to
    traditional Medicare and Medicaid (changes will
    be made the first of the month)

12
Enrollee Benefits
One system to coordinate care
Designated Care Manager
Person-centered care coordination
One ID card for all care
24/7 local call center with access to beneficiary
records
Unified appeals process
13
Supplemental Benefits and Supports
  • Varies by health plan
  • May include
  • Dental
  • Vision, to include eyeglasses
  • Podiatry
  • Hearing exams, to include hearing aides

14
CCC Ready for Launch
15
2014 Implementation Timeline
March
April
May
June
July
Aug
Oct
16
CCC is Different From Medallion II
  • CCC is for those who are eligible for BOTH
    Medicare and Medicaid
  • Enrollees with Medicare are NOT eligible for
    Medallion II
  • Includes Nursing Facility residents and
    individuals in the EDCD waiver

17
Overview of Enrollment Process
  • VaMMIS identifies a list of CCC eligible Medicaid
    recipients and this file is sent to CMS
  • CMS runs VaMMIS list through Infocrossing and
    identifies individuals who are not CCC eligible
    from the Medicare side
  • ESRD
  • Hospice
  • Medicare A/B/D issues and sends back. 
  • Those who remain eligible are loaded into
    VaMMIS (by DMAS) with an E. 
  • Individuals eligible for CCC may
  • Opt-in
  • Or will eventually be automatically enrolled if
    no choice is made

18
Overview of Enrollment Process contd
  • Eligible Virginians will receive numerous letters
    informing them of their eligibility and providing
    information on the CCC program
  • MAXIMUS is the third party enrollment broker

Refer all calls questions to
MAXIMUS 1-855-889-5243
19
Important CCC Contact Information
Refer all calls questions to MAXIMUS
  • Phone 1-855-889-5243
  • Monday-Friday 830-600
  • starting March 3, 2014
  • or
  • Website www.virginiaccc.com

20
Important CCC Contact Information
  • Questions about CLAIMS should be referred back to
    the Medicare-Medicaid Plan (MMP)

21
Important CCC Contact Information
  • Providers and advocacy groups should send CCC
    questions and presentation requests to
  • Office of Coordinated Care
  • Virginia Department of Medical Assistance
    Services
  • 600 E. Broad Street, Suite 1300
  • Richmond, VA 23219
  • CCC_at_dmas.virginia.gov
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