March 2016 VAPCP 1 Department of Medical Assistance Services An Introduction to Managed Long Term Services and Supports (MLTSS)

Slides:



Advertisements
Similar presentations
DDRS Health Homes Initiative: Meeting the Triple Aim through Care Coordination. Shane Spotts Director, Indiana Division of Rehabilitation Services May.
Advertisements

Medicaid Division of Medicaid and Long-Term Care Department of Health and Human Services Long-Term Care Managed Care.
Medicaid Division of Medicaid and Long-Term Care Department of Health and Human Services Managed Long-Term Services and Supports.
Medicaid Division of Medicaid and Long-Term Care Department of Health and Human Services Managed Long-Term Services and Supports 1.
Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst Virginia Department of Medical Assistance Services LTC Medicaid.
Commonwealth Coordinated Care and Future Medicaid Reforms
Karen E. Kimsey Deputy Director of Complex Care and Services Virginia Department of Medical Assistance Services VAPCP Spring Conference May 21, 2013
Karen E. Kimsey Deputy Director of Complex Care and Services Virginia Department of Medical Assistance Services Arc Of Virginia Convention August 9, 2013.
Department of Medical Assistance Services
Illinois Human Service Commission Rebalancing Workgroup August 2, 2012.
MEDICAID – CONTEXT FOR CHANGE Mike Cheek Vice President, Medicaid and Long Term Care Policy.
The Department of Medical Assistance Services Barbara R. Seymour, BSW, HCCS 1.
Money Follows the Person (MFP) Demonstration and Home and Community-Based Services Waivers Options Counselor Training June 2014.
1 Medicaid Long-Term Services and Supports Eric Saber, Health Policy Analyst Long Term Care and Community Support Services Maryland Department of Health.
1115 WAIVER Utah Department of Health Division of Medicaid and Health Financing 1Chacon.
California’s Coordinated Care Initiative Department of Health Care Services 5/2/
Programs of All-Inclusive Care for the Elderly (PACE) Oklahoma Health Care Authority (OKHCA)
Department of Medical Assistance Services
Virginia Association of Area Agencies on Aging
Department of Medical Assistance Services Virginia Elder Rights Coalition Kristin Burhop and Elizabeth Smith December 5,
Kristin Burhop Director, Office of Coordinated Care Virginia Department of Medical Assistance Services Adult Services Committee September 18 th, 2013
Cal MediConnect Martha Smith
Managed Long Term Care Plans Mandatory Enrollment Linda Gowdy Home Care Association May 31,
Virginia’s Blueprint for the Integration of Acute and Long-Term Care Services The Second National Medicaid Congress Cindi B. Jones, Chief Deputy Director.
Sarah Broughton, MSW: Outreach and Education Coordinator Patti Davidson, MSW: Program Analyst Elizabeth Smith, RN: Program Analyst Virginia Department.
VISIONING SESSION May 29, NWD Planning Grant  One year planning grant, started October 1, 2014; draft plan by September 30, 2015; final plan by.
Medicaid and Behavioral Health – New Directions John O’Brien Senior Policy Advisor Disabled and Elderly Health Programs Group Center for Medicaid and CHIP.
Balancing Incentive Program and Community First Choice Eric Saber Health Policy Analyst Maryland Department of Health and Mental Hygiene.
The Challenges of the Medicaid Modernization Mandate – Part 1 Joel L. Olah, Ph.D., LNHA Executive Director Aging Resources of Central Iowa Iowa Assisted.
1 NAMD: Moving Past the Hype: Real World Payment Reforms in Virginia November 8, 2011 (2:15-3:45 p.m. session) Cindi B. Jones, Director Virginia Department.
The Affordable Care Act: Individuals with Disabilities, Individuals with Chronic Conditions and Individuals Who Are Aging Damon Terzaghi Nancy Kirchner.
New York State Department of Health Office of Long Term Care Long Term Care Restructuring Annual Long Term Care Ombudsman Training Institute October 18,
MARY SOWERS 1 Medicaid Basics: Long Term Services and Supports Center for Medicaid and State Operations Disabled and Elderly Health Programs Group.
DBHDS Virginia Department of Behavioral Health and Developmental Services Improving Discharge Processes Updates on Waiver Changes Heidi Dix Assistant Commissioner.
HEALTH HOMES ARKANSAS DEPARTMENT OF HUMAN SERVICES LONG-TERM CARE POLICY SUMMIT SEPTEMBER 5, 2012.
“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.
MassHealth Managed Care for Older Members and Members with Disabilities Lori Cavanaugh Director of Purchasing Strategy NASHP Annual Conference October.
“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.
Healthy Alaska Plan Alaska Medicaid Redesign Initiative North Star Council on Aging Senior Center presented by Denise.
0 Florida’s Medicaid Reform National Medicaid Congress June 5, 2006 Thomas W. Arnold Deputy Secretary for Medicaid.
HCBS Community Rule & Delaware’s Transition Plan JULY 22, 2015.
“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.
Managed Medicaid in Virginia. Revenue Cycle Trends and Updates LTC/Post Acute Care  Case Management of Reimbursement Government sponsored program days.
1 1 Michele Goody, Director Cross Agency Integration July 2014 Community First MassHealth Initiatives and Programs.
The State Perspective: Rebalancing Long-Term Services and Supports Cynthia H. Woodcock Alliance for Health Reform Briefing October 3, 2011.
Community Based Adult Services (CBAS) Program Stakeholder Update Toby Douglas, Director California Department of Health Care Services (DHCS) December 12,
Idaho Medicaid Overview Disability Rights Idaho. Idaho Medicaid Overview ▪Medicaid is a federal/state partnership program designed to provide the benefits.
UPCOMING STATE INITIATIVES WHAT IS ON THE HORIZON? MERCED COUNTY HEALTH CARE CONSORTIUM Thursday, October 23, 2014 Pacific Health Consulting Group.
Alaska Medicaid January 27, 2014 Department of Health & Social Services Director Margaret Brodie.
A Strong Foundation for System Transformation Barbara Coulter Edwards Director Disabled and Elderly Health Programs Group Center for Medicaid, CHIP and.
April Department of Medical Assistance Services An Introduction to Managed Long Term Services and Supports (MLTSS)
Www2.illinois.gov/hfs 11 Illinois Department of Healthcare and Family Services Medicaid Managed Long Term Services and Supports (MLTSS) Implementation.
MLTSS FAQs Frequently Asked Questions for Stakeholders on Managed Long- Term Services and Supports (MLTSS) What is Managed Long Term Services and Supports.
1 Department of Medical Assistance Services An Introduction to Managed Long Term Services and Supports (MLTSS) Department of Medical.
MassHealth Restructuring Update Jeff Keilson June 7, 2016.
Suzanne S. Gore Director, Policy and Research Virginia Department of Medical Assistance Services SNP Alliance Meeting October 10, 2013 Commonwealth Coordinated.
1 Department of Medical Assistance Services An Introduction to Commonwealth Coordinated Care Plus (A Managed Long Term Services.
CCC PLUS Commonwealth Coordinated Care Plus
Overview of CCC Plus for CSB/BHA Case Managers
Alaska Medicaid January 27, 2014
MLTSS Delivery System SubMAAC
Katherine Neuhausen, MD, MPH Chief Medical Officer
Commonwealth Coordinated Care Plus
An Introduction to Commonwealth Coordinated Care Plus
O V E R V I E W.
MLTSS Kristin Murphy.
67th Annual HSFO Conference Louisville, KY
Trends & Transitions: Future for Long Term Care
West Virginia Medicaid Summit
Optum’s Role in Mycare Ohio
Presentation transcript:

March 2016 VAPCP 1 Department of Medical Assistance Services An Introduction to Managed Long Term Services and Supports (MLTSS)

MLTSS: Legislative Mandate 2 General Assembly Directives beginning 2011 through 2015 Continue to transition fee- for-service populations into managed care Phases 3 of Medicaid Reform Move forward with managed long term services and supports (MLTSS) initiatives Value of Managed Care Timely access to appropriate, high- quality care; comprehensive care coordination; and budget predictability Consistent with Virginia General Assembly and Medicaid reform initiatives, DMAS is moving forward transitioning individuals from fee-for-service delivery models into managed care

MLTSS and National Trends  Many states are moving LTSS into managed care programs and towards payment/outcome driven delivery models – LTSS spending trends are unsustainable – Managed care offers flexibility not otherwise available through fee-for-service – Affordable Care Act emphasis on care coordination/integration of care 3 Virginia’s MLTSS efforts are consistent with National trends

Benefit of MLTSS 4 Current LTSS spending trends are unsustainable The current fee-for-service system lacks comprehensive care coordination, the flexibility to provide innovative benefit plans & value based payment strategies, and budget predictability Medicaid Enrollment v. Expenditures

What Will Not Change 5  DMAS remains committed to the CCC program for the duration of our contract with CMS (through December 2017)  MLTSS will include many of the core program values from CCC (e.g., person centered, integrated care, care coordination, etc.)  MLTSS allows us to proceed with the directives from the General Assembly to move our remaining vulnerable populations into a coordinated care delivery model  MLTSS is being thoughtfully developed in a manner that allows sufficient time for program development, stakeholder input, and a strategic implementation  Stakeholder input into advancing MLTSS began in May 2015 and continues

What Will Not Change Coordinated system of care that focuses on improving quality, access and efficiency  Improves quality of care and quality of life  Enhances community-based infrastructure and community capacity  Promotes innovation and value based payment strategies  Improves care coordination and reduces service gaps  Better manages and reduces expenditures and provides for budget predictability (full-risk, capitated model) 6 Vision and goals remain the same

MLTSS Included Populations Approximately 45,000 individuals Full Medicaid and any Medicare benefits Nursing facility and Waiver participants* Duals excluded from CCC Demo Approximately 19,000 individuals Nursing facility and Waiver participants* Waiver individuals in Medallion 3.0 (health and acute care program (HAP) Non-Duals with LTSS Approximately 68,000 individuals CCC eligible & not enrolled (approximately 39,000) will transition during MLTSS regional launch CCC enrolled (approximately 29,000) will transition to MLTSS at end of CCC demo; January 1, 2018 CCC Demo Population 7 *MLTSS will exclude Alzheimer’s Assisted Living Waiver and Money Follows the Person Participants

MLTSS Excluded Populations and Services  Limited Coverage Groups (Family Planning, GAP, QMB only, HIPP, etc.)  Medallion 3.0 and FAMIS  ICF-ID Facilities  Veterans Nursing Facilities  Psychiatric Residential Treatment Level C  Money Follows the Person  PACE  Certain Out of State Placements  Hospice and ESRD (MLTSS enrolled individuals who elect hospice or have ESRD will remain MLTSS enrolled) 8  Dental  School Health Services  Community Intellectual Disability Case Management  ID, DD, and DS Waiver Services, including waiver related transportation services, until after the completion of the ID/DD redesign  Developmental Disability Support Coordination  Preadmission Screening Excluded PopulationsCarved-Out Services Excluded Populations are not MLTSS eligible; coverage will continue through fee-for-service Carved-out services are paid through fee- for-service for MLTSS enrolled individuals

9 MLTSS Regional Map  MLTSS will operate statewide and will offer individuals a choice between at least 2 health plans per region  MLTSS Health Plans will be competitively procured (RFP)

MLTSS Person Centered Delivery Model 10 Fully Integrated & Person Centered Model Integrates Physical, Behavioral, SUD, & LTSS Intensive Care Coordination Timely Access & Enhanced Community Capacity Improved Quality Management Rewards High Quality Care with Value Based Payments Improved Efficiency and Fiscal Stability Person centered, coordinated system of care that improves community access, quality, efficiency and value

Coordination with Medicare MLTSS plans must operate (or obtain approval to operate ) as Medicare Dual Special Needs Plans (DSNP) DSNPs operate under contract with Medicare and Medicaid Once DSNPs are operational, MLTSS individuals will have the option to choose the same plan for Medicare and Medicaid coverage DMAS Contracts (DSNP and MLTSS) will facilitate care coordination across the full continuum of care 11 MEDICARE COVERS  Hospital care  Physician & ancillary services  Skilled nursing facility (SNF) care  Home health care  Hospice care  Prescription drugs  Durable medical equipment MEDICAID COVERS  Medicare Cost Sharing  Hospital and SNF (when Medicare benefits are exhausted)  Nursing home (custodial)  HCBS waiver services  Community behavioral health and substance use disorder services,  Medicare non-covered services, like OTC drugs, some DME and supplies, etc.

MLTSS Proposed Program Launch DateRegionTotals * July 1, 2017Tidewater16,613 September, 2017Central22,743 October 1, 2017Charlottesville/Western16,045 November 1, 2017Roanoke/Alleghany/Southwest23,111 December 1, 2017Northern/Winchester24,064 January 2018 CCC Enrolled (Transition plan is to be determined with CMS) 29,219 TotalAll Regions131,795 *Source – VAMMIS Data; approximate totals based upon MLTSS targeted population as of January 31, 2016 DRAFT

MLTSS Next Steps...  RFP (publish, evaluate, negotiate, readiness, award)  Work with CMS 1115 Waiver (DSRIP/MLTSS) Regulations Readiness review MCO Contracts  Systems enhancements  Ongoing stakeholder and member engagement, outreach and education  Program launch in regional phases  Ongoing program monitoring and evaluation 13

Questions If you have additional questions or would like to join our stakeholder list and receive ongoing updates on MLTSS, us at 14