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 Assistance
  Services
• LTC Medicaid Subcommittee
• February 27, 2014

http//dmasva.dmas.virginia.gov
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Overview
Important Contact Information
Eligibility and Enrollment
Commonwealth Coordinated Care Program Highlights
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CCC Highlights
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CCC Highlights
Healthkeepers Humana Virginia Premier
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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)

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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)

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Enrollment

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

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Virginias Service Regions
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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).

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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

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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)

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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
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Supplemental Benefits and Supports

• Varies by health plan
• May include
• Dental
• Vision, to include eyeglasses
• Podiatry
• Hearing exams, to include hearing aides

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CCC Ready for Launch
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2014 Implementation Timeline
March
April
May
June
July
Aug
Oct
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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

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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

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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
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Important CCC Contact Information
Refer all calls questions to MAXIMUS

• Phone [phone]
• Monday-Friday 830-600
• starting March 3, 2014
• or
• Website www.virginiaccc.com

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Important CCC Contact Information

• Questions about CLAIMS should be referred back to
  the Medicare-Medicaid Plan (MMP)

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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