New Jersey’s Health System Advancing Integration for Dual Eligibles

Slides:

Advertisements

Similar presentations

October 2009 Presentation by EDS Provider Relations Field Consultants UB-04 Billing Medicare Replacement Plans.

Advertisements

Introduction to Dual Eligible Integration National Senior Citizens Law Center and Families USA Webinar July 13, 2011.

Medicaid Managed Care Initiatives December STAR Capitated, Health Maintenance Organization (HMO) model for non-disabled pregnant women and children.

Medicaid Division of Medicaid and Long-Term Care Department of Health and Human Services Managed Long-Term Services and Supports.

Consumer Advocacy and Financial Alignment Demonstrations Health Action 2014 Krystal Knight New York State Policy Director.

Medicaid Division of Medicaid and Long-Term Care Department of Health and Human Services Managed Long-Term Services and Supports 1.

Medicaid Managed Care Key Concerns J Input of Stakeholders J Enrollment and Marketing J Services and Benefits J Access to Experienced Providers J Reimbursement.

Medicaid Member Card July Medicaid Member Card Medicaid and PCN members received a new wallet-sized plastic Medicaid card starting July 2014 Each.

Medicaid Managed Care for Elderly and Persons with Disabilities Pam Coleman Texas Health and Human Services Commission October 11, 2006.

Sarah Broughton, MSW Outreach and Education Coordinator Patti Davidson, MSW Program Analyst Virginia Department of Medical Assistance Services LTC Medicaid.

HMO Special Needs Plan (SNP) BlueCare Plus Tennessee, an Independent Licensee of the BlueCross BlueShield Association BlueCare Plus Tennessee is an HMO.

Challenges of Serving Low-income Medicare Beneficiaries: Impact of Cost Sharing Cindy Parks Thomas Brandeis University Schneider Institute for Health Policy.

Illinois care coordination: MMAI Enrollment Strategies

DentaQuest Provider Training Amerigroup Plans Effective 9/1/2013.

Demonstration Proposal to Integrate Care for Dual Eligible Individuals: FIDA Update Mark Kissinger, Director Division of Long Term Care March 13, 2013.

Medicare Part D: 2007 Presented by MMA Project Team Oregon Dept. of Human Services.

Additional Safeguards Session Law Recoupment/Repayment Plan Personal Care Services State Plan Amendment July 2, 2014.

RHODY HEALTH OPTIONS (RHO) IMPLEMENTATION

WellCare SNP Model of Care Program

Medicaid Transition Healthy PA to HealthChoices 1.

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

SCHOOL BOARD OF CLAY COUNTY Annual Enrollment Plan Year.

Connecting SNPs with State Medicaid Programs October 18, 2007 Charles J. Milligan, Jr. Executive Director.

Managed Long Term Care Plans Mandatory Enrollment Linda Gowdy Home Care Association May 31,

HP Provider Relations October 2011 CMS-1500 Billing Medicare Replacement Plans.

Improving Care for Medicare-Medicaid Enrollees Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 19, 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.

MassHealth Managed Care for Older Members and Members with Disabilities Lori Cavanaugh Director of Purchasing Strategy NASHP Annual Conference October.

Medicaid Expansion in 2014 ACA creates new option to expand Medicaid eligibility Ensures Medicaid coverage for all adults with incomes up to 138%

Section 1115 Waiver Implementation Plan Stakeholder Advisory Committee May 13, 2010.

“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.

Consumer-focused Meeting September 27, 2011 Integrating Medicare and Medicaid for Individuals with Dual Eligibility.

Improving Care for Medicare-Medicaid Enrollees Marc Steinberg Medicare-Medicaid Coordination Office Centers for Medicare & Medicaid Services August 5,

HP Provider Relations October 2010 CMS-1500 Billing Medicare Replacement Plans.

Federal Updates Presented by Becky A. Kurtz Director, Office of LTC Ombudsman Programs NALLTCO Member Meeting – November 16, 2014.

Special Needs Plans Sandra Bastinelli, MS, RN Acting Director, Division of Special Programs Medicare Advantage Group Center for Beneficiary Choices.

Community Based Adult Services (CBAS) Program Stakeholder Update Toby Douglas, Director California Department of Health Care Services (DHCS) December 12,

Maximize Administrative Savings with an Enterprise Payment Integrity Strategy.

MLTSS FAQs Frequently Asked Questions for Stakeholders on Managed Long- Term Services and Supports (MLTSS) What is Managed Long Term Services and Supports.

Suzanne S. Gore Director, Policy and Research Virginia Department of Medical Assistance Services SNP Alliance Meeting October 10, 2013 Commonwealth Coordinated.

Model of Care- Provider Program

University of Texas System 2017 UT SELECT Part D Overview

NJAAHAM Semi Annual Billing Seminar April 12, 2017

Teachers’ Retirement Insurance Program (TRIP)

Commonwealth Coordinated Care

AHCCCS, Division of Health Care Management

October 26, 2010 Gaylord Palms Orlando, FL

Update on CMS Financial Alignment Initiative and State Integration Efforts Inside and Outside Demonstration Authority Lindsay Barnette Medicare-Medicaid.

Coordination of Care and Integrated Care New York State Perspective

MLTSS Delivery System SubMAAC

Consumer protections in Medicare – Medicaid coordinated care models SNP Executive roundtable March 30, 2015 Lynda Flowers Senior Strategic Policy Advisor.

CBHDA Small Counties Strategic Planning Meeting Operationalizing the Medicaid Managed Care Final Rule May 18, 2017.

State Perspectives on Alternative Approaches to Integration ARIZONA

New Jersey’s Health System Advancing Integration for Dual Eligibles

Department of Medical Assistance Services

April Updates Medicare Advantage.

Policy Options to Enhance Medicare-Medicaid Integration for D-SNP Enrollees Nancy Archibald Senior Program Officer, Center for Health Care Strategies SNP.

Medicare Enrollment Period Changes and Medicare Advantage Updates

O V E R V I E W.

Idaho Duals’ Programs Medicare Medicaid Coordinated Plan (MMCP)

Centennial Care 2.0 MCO Readiness

DRAFT - FOR REVIEW PURPOSES ONLY

Trends & Transitions: Future for Long Term Care

Presented to the System Leadership Team July 9, 2010 Robin Kay, Ph.D.

Operations Update February 22, 2019

UnitedHealthcare Dual Complete® ONE

The Office of Health Insurance Programs (OHIP) and The Division of Family Health (DFH)

Texas Council Managed Care Summit

Presentation transcript:

New Jersey’s Health System Advancing Integration for Dual Eligibles Karen L. Brodsky Chief of Managed Care Contracting Division of Medical Assistance & Health Services New Jersey Department of Human Services October 1, 2013

NJ FamilyCare Enrollment Total Medicaid/SCHIP – 1.3 m Dual enrollment – 173,920 (13%) Medicaid managed care enrollment – 1.2 m (90%) D-SNP enrollment – 26,213 (12% of duals in managed care) Dual enrollment – 140,464 (81% of all duals in NJ) September 2013

Medicaid Managed Care Plans Serving Duals Amerigroup 16,807 Healthfirst NJ 9,026 Horizon NJ Health 52,385 UnitedHealthcare 36,033 TOTAL 114,251 September 2013

NJ D-SNP Plans Serving Duals Amerigroup 2,435 Healthfirst NJ 4,693 Horizon NJ Health 9,473 UnitedHealthcare 9,612 TOTAL 26,213 September 2013

NJ Developments for Duals Voluntary managed care enrollment 2000 - Sept 2011 Mandatory managed care enrollment October 2011 Dual SNPs January 2012 Managed long term services and supports July 2014

Regulatory Steps 1915b waiver for mandatory enrollment of duals into managed care Medicaid managed care contract amendment MIPPA contract to provide Medicaid wrap services in the D-SNP, approval Comprehensive Medicaid Waiver (1115) approval

TPL issues that surfaced with mandatory managed care Provider selection Who is the member’s PCP? Referrals for Medicaid-only benefits

TPL Issues, continued Balance billing Crossover claims process Medicaid obligation When is balance billing a dual okay? Minimizing a beneficiary’s out-of-pocket costs Medicare provider options

Clear Communications with mandatory managed care for duals TPL Guide Client notification letters Client and Provider FAQs Focused flyers Medicaid HMO mailings Public forums with stakeholders Website

Member ID Card Issues Which Member ID card should a dual use? What PCP name should be printed on the Member ID card?

Strategic Dual Integration Opportunities (Slide 1) Readiness reviews for D-SNPs, MLTSS, behavioral health Passive enrollment from MMC to D-SNP Eliminate cost shifting for costliest services Medicare Advantage SNP-specific Star Ratings

Strategic Dual Integration Opportunities (Slide 2) Include Medicare deeming in Model of Care to avoid hidden EQRO costs to state Overlap of MMC/D-SNP contract time periods and State/Federal budget years Remove EOC conflict between Rx copay and LIS rider SNP Star Ratings

Operational Dual Integration Opportunities (Slide 1) Eligibility & Enrollment/Disenrollment Procedures Marketing review Care management Streamlining the appeals process and integrated denial notice

Operational Dual Integration Opportunities (Slide 2) Quality standards & monitoring Provider network analysis Ensuring members get one EOB and member handbook Integrate provider manual Close-out procedures

Contact Information Karen L. Brodsky Chief of Managed Care Contracting Division of Medical Assistance and Health Services New Jersey Department of Human Services karen.brodsky@dhs.state.nj.us Elizabeth Wood Director of Dual Integration Division of Medical Assistance and Health Services elizabeth.wood@dhs.state.nj.us