CCC PLUS Commonwealth Coordinated Care Plus Presented by The Virginia Dept. of Medical Assistance Services

Overview of Presentation. Agenda: -Introduction to The Arc of Virginia -CCC Plus -Questions & Answers

About The Arc of Virginia. State chapter of The Arc of the United States Nation’s oldest and largest organization Serving people with or at risk of developmental disabilities. Non-profit organization We work to promote and protect the human rights of people with or at risk of developmental disabilities and actively support their full inclusion and participation in the community throughout their lifetime.

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Commonwealth Community Care Plus. WHAT IS CCC Plus?

Agenda CCC Plus Program Overview CCC Plus Rationale Background and Key Facts Vision and Goals Populations Services Proposed Regional Launch CCC Plus Enrollment

Overview of Commonwealth Coordinated Care Plus (CCC Plus) Primary goal is to improve health outcomes New statewide Medicaid managed care program beginning Aug 2017 for over 216,000 individuals Participation is required for qualifying populations Integrated delivery model that includes medical services, behavioral health services and long term services and supports (LTSS) Care coordination and person centered care with an interdisciplinary team approach

Virginians covered by Medicaid/CHIP 1 Million + 1 in 8 Virginians rely on Medicaid 1 in 3 Births covered in Virginia 2 in 3 Nursing facility residents are supported by Medicaid 62% of Long Term Services & Supports spending is in the community 50% of Medicaid beneficiaries are children Medicaid is primary payer for Behavioral Health services

Medicaid Population Coverage in Virginia SFY 2016 Elderly 79,815 Elderly 363,643 Individuals with Disabilities 227,501 Children in Low Income Families 642,391 Parents, Caregivers, and Pregnant Women

Medicaid Expenditures Enrollment vs. Expenditures 100% 11% Parents, Caregivers & Pregnant Women Children in Low Income Families 28% 80% 20% 60% 49% 48% 40% Individuals with Disabilities 20% 17% 6% 18% Elderly 0% Enrollment = 1,313,350 Expenditures = $8.67 Billion Older adults and individuals with disabilities 23% of the Medicaid population = 66% of expenditures

Virginia Legislative Mandates General Assembly directed DMAS to transition individuals from the Fee-For-Service delivery model into the Managed Care Model to achieve high quality care and budget predictability. 2017 2011

National Trends Many states are moving LTSS into managed care programs and towards payment/outcome driven delivery models Better care coordination/integration of care can address rising health care costs and growing population eligible for Medicaid

MCOs contract with providers Managed Care Basics DMAS Contracts with MCO Pays MCO per- member-per-month MCO MCOs contract with providers Providers Care for Enrollees Pay claims submitted by providers Bill MCOs for enrollee care

6 Health Plans Contracted Statewide Aetna Better Health of Virginia Anthem HealthKeepers Plus Magellan Complete Care of Virginia Optima Health United Healthcare Virginia Premier Health Plan 10

CCC Plus Populations 65 and older Adults and children living with disabilities Individuals living in Nursing Facilities (NFs) Individuals in Tech Assisted Waiver Individuals in EDCD Waiver Individuals in the 3 waivers serving the DD populations for their acute and primary services *CCC and Medallion 3 ABD populations transition to CCC Plus

Excluded Populations Other Programs Members of Medallion and FAMIS Limited Coverage Groups Governor’s Access Plan (GAP) Family Planning Qualified Medicare Beneficiaries only Special Low-Income Medicare Beneficiaries Health Insurance Premium Payment (HIPP) Qualified Disabled Working Individuals Qualifying Individuals Other Programs Members of Medallion and FAMIS managed care PACE (Program of All –Inclusive Care for the Elderly) Money Follows the Person (MFP) Alzheimer’s Assisted Living Waiver (AAL) Special Conditions Hospice and End Stage Renal Disease (CCC Plus enrolled individuals who elect hospice or have ESRD will remain CCC Plus enrolled) Specialized Settings Intermediate Care Facilities for Individuals with Intellectual Disability Veterans Nursing Facilities Psychiatric Residential Treatment Level C State facilities: Piedmont, Catawba and Hancock The Virginia Home until Summer 2018

CCC Plus Person Centered Delivery Model Timely Access & Enhanced Community Capacity Improved Quality Management Rewards High Quality Care with Value Based Payments Intensive Care Coordination/ Integration with Medicare Integrates Physical, Behavioral, ARTS, & LTSS Improved Efficiency and Fiscal Stability Fully Integrated & Person Centered Model

Model of Care Elements Specific approaches for vulnerable subpopulations Staff and provider training Provider networks having specialized expertise and use of clinical practice guidelines and protocols Assessments Interdisciplinary care teams (ICT) Individualized care plans (ICP) Care coordination Transition programs The CCC Plus Care Coordinator will work with the Member and the Members Care Team to develop a person centered care plan that includes all service needs

Coordination with Targeted Case Managers Targeted Case Management (TCM) Services assist individuals in gaining access to specific services TCM services include: early intervention, developmental disabilities, mental health, treatment foster care, addiction and recovery treatment services (ARTS), and high risk prenatal and infant case management services CCC Plus Care Coordinators will incorporate but not duplicate services provided by the TCM CCC Plus Care Coordinator Targeted Case Manager

Coordination with Medicare and Medicaid Medicare covers: Hospital care Medicaid covers: Medicare Cost Sharing CCC Plus covers: Medicaid services Physician & ancillary services Hospital and SNF (when Medicare benefits are exhausted) Medicare coinsurance and deductibles Skilled nursing facility (SNF) care Coordination with the members Medicare health plan Nursing facility(custodial) Home health care HCBS waiver services Dual Special Needs Plan (DSNP) contracts facilitate care coordination across the full delivery system Hospice care Community behavioral health and substance use disorder services Prescription drugs Durable medical equipment Medicare non-covered services, like OTC drugs, some DME and supplies, etc. Option to choose the same health plan for Medicare and Medicaid

Dual Special Needs Plan CCC Plus is a Medicaid Plan D-SNP is a Medicare Advantage Plan In 2018 for Medicare Plans, duals can have: Traditional Medicare (Fee For Service) D-SNP from the same health plan as CCC Plus D-SNP from another health plan Another Medicare Advantage plan Individuals can, but are not required to, enroll in the same health plan for your Medicare and Medicaid benefits. This will enhance and simplify the coordination of their benefits and reduce their burden.

Carved Out Services Services for CCC Plus enrolled individuals that are paid for through fee-for-service. *Carved-out services are are paid by DMAS or a DMAS Contractor for managed care enrolled individuals Dental Services (Smiles for Children) School Health Services Preadmission Screening Developmental Disabilities (DD) Waivers – Carve out includes waiver services, related transportation, case management and support coordination. Also includes waiver services covered through EPSDT for DD Waiver enrolled individuals. (DD Waiver services covered through EPSDT includes: Private duty nursing, Skilled nursing, Personal care, Assistive Technology, Center-based Crisis, Community- based Crisis.) Non-waiver services are covered under CCC Plus program.

Carved Out Services Community Mental Health Rehabilitation Services will be carved out until Jan 1, 2018. These services will be covered by Magellan, the behavioral health services contractor for DMAS. Services include: Mental Health Case Management Therapeutic Day Treatment (TDT) for Children Day Treatment/ Partial Hospitalization for Adults Crisis Intervention and Stabilization Intensive Community Treatment Mental Health Skill-building Services (MHSS) Intensive In-Home Psychosocial Rehab Level A and B Group Home Treatment Foster Care Case Management Behavioral Therapy Mental Health Peer Supports

Differentiating CCC Plus & Medallion 3 Populations Served Will Serve ~216,000 Medallion 3.0 – Serves ~ 771,000 Serves older individuals ages 65+, Adults and children with disabilities Serves maternity, infants, children, teens, and their caregivers; also serves aged blind or disabled (ABD) individuals1 Includes individuals with Medicare (Duals) and individuals with other insurance coverage Excludes individuals with Medicare/other insurance coverage Includes individuals in nursing facilities Excludes individuals in nursing facilities Includes individuals receiving LTSS in the community for primary, acute, and long term services and supports Includes some individuals receiving LTSS in the community for their non-waiver services (known as HAP participants2) 1Medallion 3 individuals with an ABD aid category will transition to CCC Plus on January 1, 2018. 2Medallion 3 includes a number individuals enrolled in the EDCD & DD waivers (known as the Health and Acute Care Program or HAP). HAP populations receive their non-waiver services, such as physician, outpatient and hospital services through the health plan. HAP individuals will transition to CCC Plus during the CCC Plus regional implementation, beginning in Tidewater on August 1, 2017.

Differentiating CCC Plus & Medallion 3 What’s Different? Statewide Operations ✓ Accomack & Northampton are in Tidewater for CCC Plus and in Central for Medallion 3.0 Enrollment is mandatory for qualifying populations Qualifying populations are different Open Enrollment (OE) CCC Plus OE is between Oct – Dec each year with a Jan 1 effective date. Medallion 3 varies by region Choice of up to 6 health plans Four of the health plans are in CCC Plus and Medallion 3.0 Care Coordination All CCC Plus individuals will have an assigned care coordinator

Differentiating CCC Plus & Medallion 3 Comparison of Carved-Out Services* Carved out of CCC Plus? Carved out of Medallion 3.0? What’s Different? Community Mental Health Rehabilitation Services (CMHRS) ✓ Until 1/1/2018 Until Medallion 4.0 Same until 1/1/2018 Dental Services through the DMAS Smiles for Children program Same; plans may cover adult dental as an enhanced benefit School Health Services Same DD Waiver Services Early Intervention Services Not Carved-Out Early Intervention services are covered by the Member’s CCC Plus health plan *Carved-out services for managed care populations are covered through fee-for-service or the fee-for-service contractor

Differentiating CCC Plus & CCC Operates statewide in six regions Operates in five of the six regions Mandatory Enrollment Optional Enrollment Choice of up to 6 health plans Choice of up to 3 health plans Populations include duals/non-duals, children/adults, NF and five HCBS Waivers Populations include full dual adults; including NF and EDCD HCBS Waiver Coordination of Medicare benefits through companion D-SNP or MA Plan same Medicare/Medicaid Plan Continuity of care period is 90 days Continuity of care period is 180 days Individuals enrolled in CCC will transition to CCC Plus when the CCC demonstration ends on January 1, 2018.

Current Waivers Elderly or Disabled with Consumer Direction (EDCD) Aging or have a physical disability Technology Assisted (Tech) Waiver dependent on technological support and require substantial, ongoing skilled nursing care

Commonwealth Coordinated Care Plus Waiver Combines EDCD and Tech Waiver populations Includes comprehensive service array Effective 7/1/2017

CCC Plus Waiver Services Adult Day Health Care Personal Assistance Services Private Duty Nursing Respite care Services Facilitation Assistive Technology Environmental Modifications Personal Emergency Response System Transition Services

CCC Plus will operate statewide, across 6 regions CCC Plus Regions CCC Plus will operate statewide, across 6 regions A list of CCC Plus regions by locality is available at: http://www.dmas.virginia.gov/Content_pgs/mltss-proinfo.aspx

CCC Plus Enrollment by Region & Launch Date Regions Regional Launch Aug 1, 2017 Tidewater 20,404 September 1, 2017 Central 23,102 October 1, 2017 Charlottesville/Western 17,133 November 1, 2017 Roanoke/Alleghany 10,974 Southwest 12,772 December 1, 2017 Northern/Winchester 26,262 January 2018 CCC Demonstration (Transition plan determined with 28,785 CMS) Persons who are Aged, Blind, Disabled (ABD) 76,607 (Transitioning from Medallion 3.0) Total All Regions 216,039 Source: VAMMIS Data; totals are based on CCC Plus target population data as of March 2017

CCC Plus Enrollee Benefits Person centered, individualized support plan Same standard Medicaid services provided Choice of health plans Care coordinator for each individual Team of health care professionals working together Assistance connecting to housing, food and community resources Possible additional benefits offered by health plans

Enrollee Protections During the continuity of care period of 90 days, MCOs have to pay existing providers MCO must go out of network to provide a service that they don’t have in network Individuals in Nursing Facility (NF) at the time of enrollment will not be moved even if the NF does not choose to participate. NF will be paid as an out of network provider. 30

Access to Care Standards Staffing Number and mix of providers Hours of operation MCO Network Adequacy Dimensions Accommodations for physical disabilities Translation services Geographic Proximity Provider to member Member to Provider

Options for MCO Problem Resolution Enrollee Resources Options for MCO Problem Resolution MCO DMAS Ombudsman Contact Care Coordinator After MCO appeal process … can appeal through the State Fair Hearing Process Contact the Office of the State Long -Term Care Ombudsman for assistance Submit a complaint Appeal any adverse action or medical decision

MCO Assignment Process CCC Plus Eligible Individuals Previous MCO Assigned Previous Medicare MCO Y N Y Previous Medicaid MCO Previous MCO Assigned N MCO affiliation with: Nursing Facility EDCD / Adult Day Health Provider Tech Private Duty Nursing Provider Y Matching MCO Assigned Medallion 3.0 ABD population transition in Jan 2018 will use a different process N MCO Randomly Assigned

Initial Enrollment Package Letter Brochure Comparison Chart Town Hall Invitation

Enrollment Letters – Enrollee Choice of Health Plan “Initial Assignment Letter” Enrollees will receive an initial assignment into a health plan along with a comparison chart of all of the health plans available in their region. Enrollees can change their health plan by contacting the CCC Plus Helpline by the “call by date” identified in their Initial Assignment Letter or by using the website. Enrollees will be informed of the potential option of PACE. “Confirmation Letter” A Confirmation Letter will be mailed to the enrollee confirming their Health Plan assignment. Enrollees have 90 days from their effective date to change their final health plan assignment by contacting the CCC Plus Helpline. In 2018, an annual open enrollment period will occur October through December, effective for January 1.

CCC Plus Enrollment CCC Plus Helpline: Maximus Enrollees change plans by calling the CCC Plus Helpline or via the website. Neutral third party Assist in determining which providers are contracted with specific health plans. Answer questions about additional benefits offered by participating health plans. Can field complaints about health plans, access to care or services and reports to DMAS

Enrollment Website

Call by Date – 18th Effective Sept 1 Effective October 1

Changing Health Plans 90 days from effective date in CCC Plus Open enrollment in 2018 -Oct/Nov/Dec “Good Cause” at any time (e.g. for continuity of care or due to poor quality care) Exemptions PACE

Member Town Hall – 2 per region Agenda Introductions DMAS program overview Each Health Plan will present on benefits, care coordination, contact information. Question and Answer

CCC Plus Provider Benefits MCOs must pay at least the Medicaid rates for NF, waivers, early intervention, community behavioral health, addiction, recovery and treatment services Value based payment opportunities Enrollee periodic health risk assessments enhance care planning Care coordinator fosters communication among an interdisciplinary care team Care coordinator assists with problem solving and connects enrollees to local resources

Provider Enrollment MCO Providers NCQA accreditation Credentialing standards Providers Meet MCO credentialing standards (can take 90+ days) Follow NCQA, state and federal requirements

Coverage Requirements and Service Authorizations MCOs must cover services at least to the extent covered under the Medicaid fee-for-service program MCOs may establish different service authorization requirements Cannot impose more restrictive benefit maximums than those that exist under the DMAS fee-for-service program Can require authorization for any services Most MCOs use a portal for service authorizations DMAS is working with the MCOs to streamline claims and service authorization processes

Next Steps… Regional Implementation & Ongoing Monitoring & Program Evaluation Ongoing Stakeholder & Member Engagement, Outreach & Education CCC Plus Plans and Provider Workgroups (Nursing Facility, Personal Care, CSBs Early Intervention, Hospice.) CCC Plus Health Plan Readiness Deliverables and Training

Thank You! Additional CCC Plus information is available at: For More Information . . . Additional CCC Plus information is available at: http://www.dmas.virginia.gov/Content_pgs/mltss - home.aspx Send CCC Plus questions, comments, and suggestions to: CCCPlus@dmas.virginia.gov

Thank You This presentation will be posted on The Arc of Virginia’s website http://www.thearcofva.org/resources- services/recorded-webinars/ The Arc of Virginia will continue to provide information and education about CCC Plus as it becomes available. Stay tuned! Click to Add notes Lucy