1. 2147 Staples Mill Road Richmond, VA 23230
Commonwealth Coordinated Care Plus CCC Plus Waiver & CCC Plus Managed Care
The Arc of Virginia
2147 Staples Mill Road Richmond, VA 23230 T
Lucy Cantrell
7.1.17
Welcome to the Commonwealth Coordinated Care Plus webinar. The Arc of Virginia is pleased to provide this information to you. CCC Plus is VA’s new Medicaid program that has the CCC Plus Waiver and the CCC Plus Managed Care Program. Effective July 1, 2017, the Elderly or Disabled with Consumer Direction and the Technology Assisted waivers were combined into one singular waiver, the CCC Plus Waiver. For the CCC Plus Managed Care Program, there will be a staggered system of enrollment across the state. Lots of changes that offer some new and expanded services and other supports.

2. AGENDA Agenda: Introduction to The Arc of Virginia Virginia Medicaid
Commonwealth Coordinated Care Plus Waiver
- Eligibility Determination Process
- Services and Supports
Commonwealth Coordinated Care Plus Managed Care
Advocacy!
For our agenda, we will briefly introduce you to The Arc of Virginia, we will go over the basics of Virginia’s Medicaid program, we learn about VA’s new Commonwealth Coordinated Care Plus Waiver Program and Commonwealth Coordinated Care Managed Care Program and Advocacy!

3. About The Arc of Virginia
The Arc of Virginia is a state chapter of The Arc of the United States, the nation’s oldest and largest organization of and for people with intellectual and developmental disabilities (I/DD) and their families. The Arc’s mission is 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.

4. There are 24 local chapters of The Arc across Virginia
There are 24 local chapters of The Arc across Virginia. If you are not already a member of The Arc, we hope that you will join your local Arc or one near you or join The Arc of Virginia.

5. About The Arc of Virginia
What We Do:
Public Policy Advocacy
Individual and Family Support
New Path for families in Early Intervention
Grow the Movement
Annual State Convention August 7-9, 2017
Chapter Support
The Arc of Virginia is a leader in public policy advocacy for people with developmental disabilities (DD) and their families. We work to ensure that advocates are at the table when policy is discussed and we work with legislators and policy makers year round representing the needs and issues of people with DD. Additionally we assist individuals and families with Information and Referral. New Path is our program for families in early intervention. We grow the movement for A Life Like Yours and we hold an Annual State Convention for individuals, families, educators, service providers, and professionals.

6. Virginia Medicaid Introduction
Medicaid Program Oversight
State Federal
Department of Medical Centers for Medicare &
Assistance Services Medicaid
(DMAS) (CMS)
Virginia’s Medicaid Waiver program is operated by the VA Dept. of Medical Assistance Services or DMAS. The federal agency with oversight of every states’ Medicaid Program is the Centers for Medicare and Medicaid or CMS.

7. Virginia Medicaid $ 8 Billion in Fiscal Year 2016
General Assembly determines State funding
$ 8 Billion in Fiscal Year 2016
(includes Federal and State funding)
50% from state funds % from federal funds
Where does Virginia’s Medicaid money come from? Medicaid is currently a partnership between the federal and state governments. The VA General Assembly determines how much state money will go to Medicaid and the federal government matches that amount. 50% of the Medicaid funds come from state funds and 50% from federal funds

8. Medicaid Mandated Services All States
EPSDT
Family Planning
Health Clinics
Home Health Service
Hospital Services
Lab and X-Ray Services
Medicare Premiums
Nurse-Midwife Services
Nurse Practitioner
Nursing Facilities
Physician Services
Transportation
The federal government requires that states receiving money for Medicaid provide mandated services. These services include physician services, transportation, home health services and all of the services you see on the slide. EPSDT is Early Periodic Screening Diagnosis and Treatment. We will discuss that more later.

9. Medicaid Optional Services Selected by Virginia
Case Management
Home and Community Based Waivers
Home Health
Hospice
ICF-DD
Mental Health Services
Optometry
PT, OT, Speech Therapy
Podiatry
Prescribed Drugs
Prosthetics
Psychology
States may also add optional services to their Medicaid program. VA’s optional services include prescribed drugs, mental health services, therapies and all listed on the slide. Home and Community Based Waivers are an optional service that VA provides. Waivers are not required by the federal government.

10. Home and Community Based Waivers
States apply for Medicaid Waivers to the federal Medicaid agency known as the Centers for Medicare and Medicaid Services (CMS). This enables states to waive the requirements that individuals must reside in an institution in order to receive Medicaid funding for services. With a waiver, people who meet qualifications may have their services in their home rather than an institution.
To provide Home and Community Based Waivers, states apply for Medicaid Waivers to the federal Centers for Medicare and Medicaid (CMS).

11. Once enrolled in a Medicaid Waiver …
Medicaid Benefits
Once enrolled in a Medicaid Waiver …
Medicaid card
All Waiver and State Plan (Mandatory and Optional Services) services you are eligible for
May be enrolled in a Medicaid managed care plan

12. Early & Periodic Screening Diagnosis & Treatment
EPSDT
Medicaid benefits for children under the age of 21
 Must be eligible for Medicaid
 Monitor to prevent health and disability conditions from occurring or worsening
Treatment to “correct or ameliorate conditions,” including maintenance services
EPSDT Fact Sheet:
Early and Periodic Screening Diagnosis and Treatment is a mandated service for states receiving Medicaid funds to provide. EPSDT offers a variety of services including medical, behavioral and nursing services and assistive technology for children up until the age of 21.

13. HIPP Health Insurance Premium Payment (HIPP)
Health Insurance Premium Payment (HIPP) for Kids
May pay a portion or total health insurance premium
Application separate from Medicaid eligibility and filed with Dept. of Medical Assistance Services
Call
HIPP or the Health Insurance Premium Payment program is a Medicaid Program. For Medicaid Members who also have employer based health insurance, the employee may be eligible for the Health Insurance Premium Payment Program. HIPP may pay a portion or the total health insurance premium for qualifying plans by reimbursing the employee. An application separate from the Medicaid application is submitted to Dept. of Medical Assistance Services. For more information go the link provided.

14. Medicaid Works People with disabilities who work
Available to people enrolled in Waivers
Enroll before income goes above $804/month
Complete an agreement, then work –
Income (gross earnings) up to $75,000 a year
Resources up to $35,684
Medicaid Works is a work incentive program for people with disabilities who are working to earn more money, have more savings and not lose their public benefits including Medicaid. To use Medicaid Works, individuals must enroll before their income (earned and unearned) goes above $804 per month. In Medicaid Works, an individual may have income up to $75,000 a year and have resources up to $35,684. The money amounts for Medicaid Works may change year to year.

15. Patient Pay
People may have to pay for some Waiver services if they have income over $1,212 per month
No patient-pay for Alzheimer’s and Tech Waivers
Some exceptions for persons who are working
People may have to pay for some Waiver services if they have income over $1,212 per month. There are some exceptions for people who are working.

16. Medicaid Appeal Rights
Individuals have the right to challenge decisions and actions regarding Medicaid. For example denial of the waiver may be appealed to the VA Dept. of Medical Assistance Services (Medicaid).
Fair Hearing
Appeal must be requested within 30 days of the decision or action that you disagree with
Decision should be issued by the Hearing Officer within 90 days
For more information about Medicaid appeal rights go to:

17. Home & Community Based Care Waivers
Waivers give States the flexibility to develop and implement alternatives to institutionalization.
Home and Community Based Care Waivers allow states to develop alternatives to institutionalization. Families want their children to live with them, adults want to live in their chosen community and have access to all of the benefits of life in the community rather than living in an institution such as a nursing home or other institutional setting.

18. Home & Community Based Medicaid Waivers
Living in the community independently or with family or friends is the way that people want to live. Medicaid Waivers pay for supports and services that people need to live their life in the community rather than an institution such as a nursing home, hospital or training center. People of all ages have Medicaid Waivers.

19. CCC Plus Waiver
Commonwealth Coordinated Care(CCC) Plus Medicaid Waiver Effective July 1, 2017
Commonwealth Coordinated Care (CCC) Plus Waiver became effective July 1, 2017.

20. Combination of Existing 1915 c Waivers
Combines Elderly or Disabled with Consumer Direction and Technology Assisted Waiver
Expands current services to both populations
Waiver becomes Commonwealth Coordinated Care Waiver
Effective 7/1/2017
Virginia combined its EDCD and Tech Assisted waivers into a single waiver called the Commonwealth Coordinated Care Plus Waiver. It expands services. The CCC Plus Waiver became effective July 1, 2017
CCC
Plus Waiver
Tech Waiver
EDCD
Waiver

21. Services will automatically continue through CCC Plus Waiver
Current service authorizations will continue
No Changes to FFS waiver processes
People who have been on the EDCD or Tech Waiver will have their services continue automatically through the CCC Plus Waiver.
There are no changes to the Fee for Services (FFS) waiver processes. Current service authorizations continue. There are no changes to the screening processes. No changes to the enrollment and service authorization process. No action is required by providers.
Pre-admission screening processes unchanged
Enrollment and service authorization process unchanged
No action is required by providers

22. Criteria for CCC Plus Waiver
Functional Needs Category
Combination of:
Activities of daily living
Behavior and orientation
Mobility
Joint motion
Medication administration
Nursing or Medical Needs Category
Risk of Placement in a Nursing Facility within 30 days
The criteria for the CCC Plus Waiver is the same as the criteria for the former EDCD and Tech Waivers. The individual must have functional dependencies in the areas such as activities of daily living (bathing, dressing, eating etc.), behavior and orientation, mobility, joint motion and medication administration. The individual does not have to have functional dependencies in all of those areas but in a combination of some of areas. You must have a medical or nursing need. You must also be at risk of placement in an nursing home or facility within 30 days. For many people, they don’t consider themselves or their family member to be at risk of nursing home placement. It is important to think about how the person would function if there was no other support available, no caregiver to assist with medical needs. Also are there health conditions of the parents or caregivers which impact their ability to provide care?(mental health conditions, physical problems, caregiving responsibilities for others). As an example, if the person does not sleep well and the parents or caregivers are helping the child or adult during the night, and they lose sleep, that puts the child at risk of placement. It is very important that parents, the caregivers or the individual him or herself, give as much information as possible about their support needs. This is a time to talk about the most difficult times – this is a deficit based assessment.

23. Long-Term Care Medicaid Eligibility Process for Waivers
Screening First
Financial Eligibility Second
Screening for all Waivers must be provided without any charge to the individual
Medicaid Waivers are for people who have long-term care needs and need supports and services to live in their home. VA operates several waiver programs. To apply for a Medicaid Waiver there are two steps. First an individual is screened to determine if they meet the criteria for long-term care. Then financial eligibility is determined.

24. Screening for CCC Plus Waiver
Preadmission Screening Teams of the Dept. of Health and/or Dept. of Social Services OR
Hospitals
Screening tool-UAI (Uniform Assessment Instrument)
No waiting list if found eligible
Can receive services through the CCC Plus Waiver while on waiting list for DD Waiver.
To be screened for the CCC Plus Waiver, contact your local Dept. of Social Services or Health Dept. and asked to be screened for the CCC Plus Waiver or long-term care. If you are asked “Do you mean for a nursing home?”, your answer is “yes”. Be prepared to report any medical conditions, disability and types of supports or services you/your family member needs for medical or nursing needs and for everyday activities of daily living. We will look at the types of services available in a few minutes that you may need. If you are denied a screening, request a letter of denial. You cannot be denied a screening.

25. Long-Term Care Medicaid Waivers
Must Need Long-Term Care
Assessment / screening
Financial Thresholds
Monthly income limit $2,205
Resource limit $2,000 adults
Parent income & resources do NOT count regardless of child’s age
Disability determination at age 18
The screening or assessment is to determine if the person meets the criteria for long-term care. To meet the long-term care criteria a person must need the level of care that would be provided in a nursing facility. The financial criteria for adults (age 18 and over) is that their monthly income may not be over $2,205 and they may not have more than $2000 in resources. For children (under 18), parent income and resources do not count. It does not matter what the parental income is for children. Once an individual turns 18 years, they must have a “disability determination” to maintain eligibility. Families need to be very aware if their child under 18, is on a Medicaid Waiver that they must initiate the disability determination process at age 18 by applying for Supplemental Security Income (SSI) through Social Security. This process can take months so it is best to seek the disability determination as soon as the child turns 18. Otherwise the child will be at risk of losing their eligibility for their Medicaid eligibility and their waiver services.

26. Special Needs Trusts & ABLE Accounts
Maintain assets for future needs
Protects from disqualifying for public benefits - -
-For attorneys skilled in benefits planning:
Virginia has strict income and resource limits for those who are using Medicaid. However there are ways to maintain and protect assets. Special needs trusts and ABLE accounts are ways to protect assets. On the slide you see the links to some of the organizations that have trusts, ABLE accounts and attorneys who are knowledgeable in this area.

27. CCC Plus Waiver Services
Adult Day Health Care
Personal Assistance Services
Private Duty Nursing
Respite care
Services Facilitation
Assistive Technology (AT)
Environmental Modifications (EM)
Personal Emergency Response System
Transition Services
The CCC Plus Waiver offers 9 services that you see listed on the slide.
Services Facilitation assists the individual/family/caregiver in arranging for services that are consumer directed.
Transition Services assist an individual who is moving from a nursing facility or institution to the community. In the next few slides we will look at each of the other services in some detail.

28. CCC Plus Waiver Services
AT and EM
Limited to $5000 per year for each service
Private Duty Nursing
Must meet current Tech waiver criteria
Respite
Limited to 480 hours/ fiscal year
Increase from 360 hours for Tech waiver
Assistive Technology (AT) and Environmental Modifications expanded to include EDCD population with annual limits of $5000 for each service in the new CCC Plus Waiver.
Private Duty Nursing is only available to those who meet the Tech waiver criteria – these are individuals who are dependent on ventilator for a portion of the day or require complex tracheostomy care.
Respite will be 480 hours for all individuals based on July 1- June 30 year.

29. CCC Plus Waiver Services
Adult Day Health Care
Group setting
Social and recreational activities
Typically used by people who are elderly and cannot be left alone

30. CCC Plus Waiver Services
Assistive Technology
Process:
Prescription for AT evaluation
Evaluation by a qualified Medicaid professional
Quote by a Medicaid AT provider
Delivery after authorization
Limited to $5,000 per calendar year
-Assistive technology is specialized medical equipment, supplies, devices, controls, and appliances, not available under the State Plan for Medical Assistance, which enable individuals to increase their abilities to perform activities of daily living (ADLs), or to perceive, control, or communicate with the environment in which they live, or which are necessary for life support, including the ancillary supplies and equipment necessary to the proper functioning of such technology. (communication devices, computers, etc.) The process to apply for Assistive Technology is described in the slide.

31. CCC Plus Waiver Services
Environmental Modifications
Modifications to primary home
Ramps and other access features
Fences and other security measures
Modifications to primary vehicle
Lifts, ramps, hand controls
Limited to $5,000 per calendar year
Environmental modifications are physical modifications to the home or a vehicle to address health or safety concerns and/or increase the individual’s independence. There are examples (not inclusive) of modifications.

32. CCC Plus Waiver Services
Nursing
Private Duty Nursing
Continuous care up to 16 hours/day
Only if not covered by private health insurance
Must meet specific criteria (previous Tech Waiver criteria)
Home Health Nursing provided for periodic support and maintenance
Private Duty Nursing is only available to individuals who are dependent on ventilator for a portion of the day or require complex tracheostomy care.

33. CCC Plus Waiver Services
Personal and Attendant Care
Assistance with activities or daily living (ADLs) and Instrumental ADLs
Can be provided in any environment
Supervision for up to 8 hours/day when the primary caregiver(s) are working or going to school for all ages
Consumer Directed or Agency service
Personal/attendant Care services provide assistance with activities of daily living, access to the community, self-administration of medication, supervision, and the monitoring of health status and physical condition.
Activities of daily living (ADLs) – bathing, dressing, toileting, eating,
Instrumental ADLs – laundry, meal prep, vacuuming, cleaning etc.
Consumer directed services allow the individual/family to recruit, hire, train, supervise and fire people of their choice to provide the service.
Agency directed services are provided by an agency that provides the service.

34. CCC Plus Waiver Services
Personal Emergency Response System
Can include a medication management system
Individual must:
Not be able to use a phone in an emergency
Be 14 years or older
Left alone for a portion of the day
Have the cognitive ability to use the device
PERS is an electronic device and monitoring service that enable individuals, who are at least 14 years of age, to secure help in an emergency and it can include a medication management system.

35. CCC Plus Waiver Services
Respite
Must have a primary caregiver
Caregiver does not have to live with the individual receiving services
Can be provided in any environment
480 hours per year – July 1-June 30
Consumer Directed or Agency service
Respite is a service that gives the primary unpaid caregiver a break from providing care to an individual on a short term basis.

36. AN INTRODUCTION TO COMMONWEALTH COORDINATED CARE
PLUS
A Managed Care Long Term Services and
Supports Program
Commonwealth Coordinated Care Plus is the Managed Care Program in CCC Plus.

37. 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
The care coordination will be under the “umbrella” model with help from the care coordinator and an interdisciplinary team approach. Care coordination is one of the new elements of the CCC Plus.

38. 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
CCC Plus was mandated by the VA General Assembly. The Dept. of Medical Assistance Services (DMAS) is transitioning individuals from fee for service (FFS) delivery model to a managed care model to achieve high quality care and budget predictability.
2011

39. MCOs contract with providers
Managed Care Basics
DMAS
Contracts with MCO
Pays MCO per-member-per-month
MCO
MCOs contract with providers
Pay claims submitted by providers
Providers
Care for Enrollees
Bill MCOs for enrollee care
DMAS contracts with managed care organizations (MCO)
DMAS pays a per-member per-month (PMPM)
The managed care organizations contract with providers and pay claims
The providers of care for individuals bill the managed care organizations for services provided.
Managed Care is different from Fee for Service. In Fee for Service, DMAS pays the provider of the service directly.

40. 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
The CCC Plus Populations are listed on the slide.
ABD = Aged, Blind and Disabled
DD = Developmental Disability
EDCD = Elderly or Disabled with Consumer Directed Waiver
The 3 DD Waivers are: Community Living (CL), the Family and Individual Support (FIS), and the Building Independence (BI) Waivers. 

41. Excluded Populations Limited Coverage Groups
Governor’s Access Plan (GAP)
Family Planning
Qualified Medicare Beneficiaries only
Special Low-Income Medicare Beneficiaries
Qualified Disabled Working Individuals
Other Programs
Members of Medicaid 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)
Health Insurance Premium Payment (HIPP)
There are populations that are excluded from the CCC Plus. They include limited coverage groups, and those in other Medicaid programs including HIPP, the Health Insurance Premium Payment Program. They are listed on this slide and the following slide.

42. Excluded Populations Specialized Settings Special Conditions
Intermediate Care Facilities for Individuals with Intellectual Disability
Veterans Nursing Facilities
VA Home
Psychiatric Residential Treatment (Level C)
State facilities: Piedmont, Catawba and Hancock
CCC Plus Excluded Local Government- Owned Nursing Facilities
Bedford County Nursing Home
Birmingham Green
Dogwood Village of Orange County Health and Rehabilitation
Lake Taylor Transitional Care Hospital
Lucy Corr Nursing Home
Special Conditions
Hospice and End Stage Renal Disease
(CCC Plus enrolled individuals who elect hospice or have ESRD will remain CCC Plus enrolled)
There are populations who are excluded from CCC Plus. These include individuals who are in specialized settings, those in Hospice and End Stage Renal Disease.

43. Developmental Disabilities Waiver Users
Commonwealth Coordinated Care Plus
If you receive supports through one of the DD Waivers – Building Independence Waiver, Community Living Waiver or the Family & Individual Supports Waiver – your Waiver services will not be impacted by any of the CCC Plus changes.
However, your Medicaid medical services may be administered by one of the CCC Plus managed care organizations/health care plans.

44. 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
To learn details about the Health Plans:
DMAS has contracted with 6 health plans.

45.
TTY 711 or
Added benefits:
Adult dental
2 exams and cleanings and 1 set of x-rays each year, plus fillings, extractions, root canal and dentures (up to $525 each year)
Adult hearing
Exam and 1 hearing aid each year (up to $500 each year)
Adult vision
Eye exam and $100 for frames, glasses or contacts each year
Phone services
Free cell phone with 350 minutes each month, data and free unlimited texting
Wellness programs
Wellness rewards card
Regional wellness center
Other benefits
No Place Like Home grants for home modifications and rental assistance
Memory alarms and devices
Community health worker to help with housing, food, employment, community resources and more
Diabetic shoes or inserts
Meals delivered to your home after discharge, 2 meals each day for 7 days
2 exams and cleanings and 1 set of x-rays each year (up to $1,500 each year)
$150 for glasses or contact lenses every two years
Free smartphones for texts and appointment reminders
Rewards for healthy behaviors
Help to quit smoking
Fresh meals delivered to your home after discharge
Environmental and home modifications
Supportive employment services
Online, interactive cognitive behavioral therapy support
Community Connections online directory of community services and organizations
Enhanced short-term services for all members, when needed
Personal care attendant
Respite care
Caregiver training and support
2 exams and cleanings and 1 set of x-rays each year
1 exam and up to $1,000 for hearing aids and unlimited visits for fitting
60 hearing aid batteries
$100 for glasses (lenses and frames) each year
Smartphone with free minutes, data, texts and calls
Mobile app to use on the go
Online search tool to find food, jobs and more
Online peer support services
More than 25,000 providers statewide to choose from
12 rides to community events, grocery stores, hair salons and more
Healthy Rewards Gift Card program
$50 for assistive devices and
$50 for walker and wheelchair accessories
HEPA-grade air purifier
1 exam, cleaning and set of x-rays each year
Annual hearing exam
1 hearing aid for each ear every 36 months
Annual exam and refraction
Discounts on eye glasses
Free cell phones with 350 minutes and unlimited texting
Weight management
Wellness rewards
Individualized, fully- integrated program with a state-wide network of providers
Assistive devices
Extended respite for caregivers
Diabetic foot care
Pest control
Meals delivered to your home after discharge from inpatient hospital or nursing facility,
2 meals each day for 7 days
Eye exam each year and frames and lenses every 2 years if needed
Free smartphone with 350 minutes each month, unlimited texting, and pre- programmed contacts for benefit and NurseLine support
Alere Quit For Life program and resources to quit smoking or tobacco use
Weight Watchers: 10 meeting vouchers each year, resources for healthy eating and weight loss
Baby Blocks prenatal care rewards for attending prenatal and baby’s appointments
Health4Me® free mobile app for health tips, reminders and care team secure messaging
Meals delivered to your home after discharge from inpatient hospital or nursing facility,
Exams, cleanings and x-rays each year
Eye exams plus up to $100 for lenses or frames
Wellpass program with free smartphone, unlimited texting, and minute and data packages
Exercise at YMCA, YWCA and Curves
Smoking cessation services and resources
Healthy Heartbeats prenatal and postpartum wellness program
Chronic disease management including self-management education classes
Gift card rewards for wellness and preventive activities
Online tools for accessing health plan services
Meals delivered to your home after discharge from hospital or nursing facility for up to 14 days
There are six health plans. They each have added benefits that are listed on the slide. Adult dental services are now available in each plan as well as a wide variety of other benefits. More information about the plans can be viewed here:
CCC PLUS 0617
X For a list of doctors and hospitals that work with each plan, go to the plan’s website or call their toll-free number listed above.
X For a list of basic benefits that all plans offer, see the brochure in this packet.

46. CCC Plus Regions CCC Plus will operate statewide, across 6 regions
CCC+ will operate statewide, across 6 regions.
A list of CCC Plus regions by locality is available at:

47. 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 CMS)
28,785
Persons who are Aged, Blind, Disabled (ABD)
(Transitioning from Medallion 3.0)
76,607
Total
All Regions
216,039
Source: VAMMIS Data; totals are based on CCC Plus target population data as of March 2017
Enrollment will be staggered geographically across the state.
CCC Demonstration enrollees will have a seamless transition from CCC to CCC+ effective January 1, 2018
Those individuals who are aged, blind or disabled (ABD) will transition from Medallion effective January 1, 2018

48. 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 benefits of CCC Plus:
Everyone will have a care coordinator from their health plan/managed care organization. This is new.
A care coordinator to works with you and your doctor to create a health care plan just for you. Your care coordinator can answer your questions about health benefits and help you get the care you need. Your care coordinator will:
Be your main contact for your questions about healthcare services
Ask you questions about your health
Work with you to make a written plan to help you meet your health goals
Help you make doctor appointments if needed
Help you find transportation for doctor visits
Make sure you have all pre-approvals and referrals when needed
Help you access community and social services
Talk with you and your health care team to make sure your needs are met.

49. Coordination with Targeted Case Managers
CCC Plus Care Coordinator
Targeted Case Manager
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
Everyone in CCC Plus will have a care coordinator. This is one of the changes. There are many people who are receiving case management or services coordination from a different organization. If the individual has a targeted case manager, then the health plan care coordinator works with the targeted case manager and does not duplicate services.

50. 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.
When you are enrolled into CCC Plus you have a 90 day continuity of care period where the MCO must pay your existing providers so that you/the individual maintains their services and does not lose care. If the MCO does not have a service in their network, then they must go out of network.
For last bullet, an example would be if Mary Smith lives in ABC Nursing Facility and chooses to remain there and the NF chooses to not be enrolled with Mary Smith’s MCO, then the MCO must pay the NF as an out of network provider.

51. Options for MCO Problem Resolution
Enrollee Resources
Options for MCO Problem Resolution
MCO
DMAS
Ombudsman
Contact Care Coordinator
Submit a complaint
Appeal any adverse action or medical decision
After MCO appeal process …
can appeal through
the State Fair Hearing Process
Contact the Office of the State Long -Term Care Ombudsman for assistance
If there are problems, individuals may contact their health plan care coordinator at the managed care organization to seek resolution.
MCOs must respond to grievances, appeals and claims from members
Members receive written notice from MCO of any adverse action and information on MCO appeal process
Once the MCO internal appeal process is exhausted, and if it is still not resolved, members have a right to appeal adverse decisions through the Dept. of Medical Assistance Services’ State Fair Hearing Process
Long Term Care Ombudsman can serve as an advocate and may be contacted at anytime when you need MCO problem resolution.

52. Initial Enrollment Package
Letter
Brochure
Comparison Chart
Town Hall Invitation
Individuals will receive an initial enrollment package from the VA Dept. of Medical Assistance Services (Medicaid) that will contain a letter, a brochure and other information explaining CCC Plus. It will tell you which health plan/managed care organization you are initially assigned to. It will have an invitation to “members” about Town Hall meetings that will be held across the state for members to attend to learn more about CCC Plus. Members will receive this information about 30 days before their region’s enrollment dated. For example, the Tidewater area received their enrollment information about July 1, for the August 1 enrollment. The Winchester Northern VA area will receive their enrollment package by Nov. 1 for the December 1 enrollment.

53. Changing Health Plans 90 days from effective date in CCC Plus
Open enrollment in Oct/Nov/Dec
“Good Cause” at any time (e.g. for continuity of care or due to poor quality care)
Exemptions
PACE
You/members will initially be assigned to a health plan/MCO, however you may change plans. Members have 90 days from the effective date in CCC Plus to change health plans. In 2018 there will be open enrollment from Oct. – Dec
You may change health plans at any time if there is “Good Cause”.

54. Enrollment Letters – Enrollee Choice of Health Plan
“Initial Assignment Letter”
1. 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.
2. 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.
3. Enrollees will be informed of the potential option of PACE.
“Confirmation Letter”
1. A Confirmation Letter will be mailed to the enrollee confirming their Health Plan assignment.
2. Enrollees have 90 days from their effective date to change their final health plan assignment by contacting the CCC Plus Helpline.
3. In 2018, an annual open enrollment period will occur October through December, effective for January 1.

55. MCO Assignment Process
CCC Plus Eligible Individuals Y
Previous MCO Assigned
Previous Medicare MCO 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
The initial assignment of CCC Plus members to a Health Plan is based on the process on the slide. Basically members are assigned to their existing or previous MCO. For those who do not have an existing or previous MCO, they are randomly assigned to an MCO.
The Medallion 3.0 Aged, Blind Disabled (ABD population will transition in 2018 with a different assignment process. N
Medallion 3.0 ABD population transition in Jan 2018 will use a different process
MCO Randomly Assigned

56. 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
Toll-free number:   TTY:   Hours of operation:  Monday – Friday, 8:30 a.m. – 6:00 p.m.
There is a CCC Plus Helpline. Members may call Maximus to change plans by calling the CCC Plus Helpline. The Helpline can assist with determining if your providers and doctors are in specific health plans, answer questions about additional benefits in the health plans, answer questions and field complains.

57. Carved Out Services
Services for CCC Plus enrolled individuals that are paid for through fee-for-service.
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 are paid by DMAS or a DMAS Contractor for managed care enrolled individuals
Some services are carved out out, meaning they are paid by DMAS or a DMAS contractor for managed care enrolled individuals rather than through a managed care organization.
Specific services are paid through fee-for-service for CCC+ enrolled individuals, thus being “carved-out” from the other services offered by a MCO.
The carved out services are listed on this slide and the following slide.
Covered Services included in CCC Plus: primary, acute, outpatient, home health, pharmacy, DME, and non-waiver transportation care and services.

58. Carved Out Services
Community Mental Health Rehabilitation Services will be carved out until Jan 1, 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
Magellan will continue to serve as the Behavioral Health Services Contractor and pay the claims for these services until Jan. 1, 2018

59. Commonwealth Coordinated Care Plus
CCC Plus Website:
You will lots of information on the website. You may enroll on the CCC Plus website.

60. 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
Members are invited to attend Member Town Halls to learn about CCC Plus and ask questions. Click on the link to find a town hall near you or go to:

61. CCC Plus Member Conference Calls
Ask Your Questions, Make Your Comments
Dates: Every Tuesday starting on July 11, 2017 through December 2017
Time: 12:00 p.m. – 12:30 p.m.
Participants: Calls are open to the first 100 callers
1.Call
2.Press * #
3.Follow the voice prompts.
You may join CCC Plus Member Conference Calls to ask questions or make comments.

62. More Information Additional CCC Plus information is available at:
For More Information . . .
Additional CCC Plus information is available at:
home.aspx
Send CCC Plus questions, comments, and suggestions to:

63. Got It?
Let’s Recap, shall we??!!?

64. Commonwealth Coordinated Care Plus Waiver
CCC Plus Waiver Recap 1
Commonwealth Coordinated Care Plus Waiver
Replaced the Technology Assisted Waiver and the Elderly or Disabled with Consumer-Directed Waiver on July 1, 2017.
If already on EDCD or Tech Waivers, no need to do anything.
New CCC Plus Waiver services may be available to you!

65. CCC Plus Managed Care Program Recap 2
Commonwealth Coordinated Care (CCC) Plus Managed Care Program
Includes many people with disabilities, but not all.
Starts in different parts of the state at different times
across the state.
If you are enrolled in the CCC Plus managed care program, your CCC Plus Waiver services will also be administered by your managed care company. The timeline for this will be based on where you live in Virginia.

66. CCC Plus Managed Care and Developmental Disability Waivers Recap 3
If you receive supports through one of the Developmental Disability (DD) Waivers (BI, FIS, CL), your Waiver services will not be impacted by the CCC Plus changes. A managed care organization will NOT administer your waiver services. However, your Medicaid medical services may be administered by one of the CCC Plus managed care organizations/health plan care plans.

67. Stay Current State Regulations being revised
Provider Manuals being revised
Green Waiver Guide being revised
Join The Arc of VA, Follow us on Facebook

68. CCC Plus Waiver CCC Plus Medicaid Manual being developed
Follow current Medicaid Manuals for EDCD and Tech until the new manual is posted
The Medicaid Manuals are located on the DMAS website.

69. Be Informed!
Sign up for The Arc of VA Updates:
Visit our website:
“Like” us on Facebook:
Follow us on Twitter:

70. Communicate to your State and Federal Legislators!
Every Voice and Face Matters!
Share your story
Include a picture
Find your legislators

71. Advocate for Community Services!
Stay informed about issues, policy, legislation that affects people with disabilities
Join your local Arc and The Arc of VA to learn about issues and advocate with others.
Know your elected representatives in the VA General Assembly and US Congress.
Tell your story
Prepare your 3 minute elevator speech
Write, Call, Visit your representatives.
Attend Virginia’s Public Budget Hearings in January
You make a big impact! Individuals, Advocates and Families have an important role and responsibility to ensure that people with disabilities are receiving valued services that support a full, inclusive life with dignity. Our legislators need to hear how VA’s services system is working and what is important. Every voice matters! Be a part of ensuring that VA offers the essential services and supports necessary for all to have a healthy and productive life. Join with others!

72. Contact The Arc of Virginia
Questions?
Contact The Arc of Virginia
Tel: (804)
More info about Waivers on our website