1. An Introduction to Commonwealth Coordinated Care Plus
Department of Medical Assistance Services
An Introduction to
Commonwealth Coordinated Care Plus
(A Managed Long Term Services and Supports Program)
Presented by: Sandra Brown
Department of Medical Assistance Services
October 2016 1

2. Agenda Virginia Public Procurement Key Facts about Virginia Medicaid
Legislative Mandates
National Trends
Commonwealth Coordinated Care Plus
A comparison of CCC Plus and CCC
Next Steps
Ongoing Opportunity for Stakeholder Input
CCC Plus References 2

3. Virginia Public Procurement Act
Presently, we are operating under a competitive procurement and we may not be able to respond to all of your questions.
DMAS must operate under strict Code of Ethics Rules until successful completion of the competitive procurement process (also known as the RFP process), in accordance with the Virginia Public Procurement Act, §2.2‐4300 of the Code of Virginia.
DMAS published the RFP on April 29, 2016, and it is available at: 3

4. Virginia’s Medicaid Program Facts
1 Million +
Virginians covered by Medicaid/CHIP
2in3
Residents in nursing facilities supported by Medicaid - Primary payer for LTSS
1in8
Virginians rely on Medicaid
50%
Medicaid beneficiaries are children
58%
Long-Term Services & Supports spending is in the community
1in3
Births in Virginia covered by
Medicaid
Behavioral Health Medicaid is primary payer for services 4

5. Virginia Medicaid Population and Expenditures
Medicaid expenditures are disproportionate to covered populations. Older adults and individuals with disabilities make up over 25% of the total population, yet almost 70% of expenditures are attributed to this group. 5

6. Legislative Mandates: Managed Care
Consistent with Virginia General Assembly and Medicaid reform initiatives, DMAS is moving forward transitioning individuals from fee-for-service delivery models into managed care.
General Assembly Directives beginning 2011 through 2015
Continue to transition fee-for-service populations into managed care
Phase 3 of Medicaid Reform Initiatives
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 6

7. Benefits of Managed Care
Managed Care Basics
DMAS contracts with managed care organizations (MCO)
DMAS pays a per-member per-month (PMPM) payment
MCOs contract with providers and pay claims
75% of Virginia Medicaid enrollees are currently enrolled in Medallion 3, a managed care program.
Benefits of Managed Care
Improves quality of care
Broader provider network
More flexible – can include services that cannot be provided in fee-for-service
Actuarial soundness to ensure rates are not too low
Care coordination assists member with navigation through system
Private sector shares risk with government 7

8. Introducing Commonwealth Coordinated Care Plus
(CCC Plus)
New statewide Medicaid managed care program beginning July 2017
Will serve approximately 213,000 individuals with complex care needs
Integrated delivery model that includes medical services, behavioral health services and long-term services and supports 8

9. CCC Plus Person Centered Delivery Model
Fully Integrated & Person Centered Model
Integrates Physical, Behavioral, SUD, & LTSS
Intensive Care Coordination/ Integration with Medicare
Timely Access & Enhanced Community Capacity
Improved Quality Management
Rewards High Quality Care with Value Based Payments
Improved Efficiency and Fiscal Stability 9

10. Medicare and Medicaid MEDICAID COVERS Hospital care
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. 10

11. How will Medicare and Medicaid coordinate?
CCC Plus requires each participating health plan to become a D-SNP as part of their plan offerings. D-SNP’s are Dual Eligible Special Needs Plans.
D-SNP’s are Medicare Advantage Plans that include Part A, Part B, Part D and supplemental benefits.
D-SNP’s operate under contracts with Medicare and Medicaid.
Once D-SNP’s are operational, CCC Plus individuals will have the option to choose the same plan for Medicare and Medicaid coverage.
6 health plans start 1/1/17 11

12. CCC Plus Populations 213,653 Individuals
Duals (Full Medicaid) with and without LTSS
Not CCC Enrolled 87,414
CCC Enrolled 27,281
will transition 1/2018
Non Duals with LTSS
FFS
9,818
Medallion 3.0 HAP*
9,713
Non Dual /Non LTSS aged, blind or disabled Individuals
79,427
Aged, Blind, Disabled (ABD)
3,039
Medallion 3.0
76,388
114,695
19,531
Approximations based upon July 31, 2016 MMIS Data
*HAP - 12

13. Commonwealth Coordinated Care Plus Regions
CCC Plus will operate statewide, across 6 regions, and will offer individuals choice between at least 2 health plans per region
CCC Plus Health Plans will be competitively procured (RFP)
RFP Released April 29, 2016
Southwest
Roanoke / Alleghany
Western / Charlottesville
Northern / Winchester
Central
Tidewater
A list of CCC Plus regions by locality is available at: 13

14. CCC Plus Populations by Region
CCC Plus Enrollment By Region and Launch Date
Date
Regions
Regional launch
All Populations
July 1, 2017
Tidewater
19,863
45,952
September 1, 2017
Central
23,342
52,067
October 1, 2017
Charlottesville/Western
16,851
29,736
November 1, 2017
Roanoke/Alleghany
11,639
25,712
Southwest
12,669
21,717
December 1, 2017
Northern/Winchester
25,620
38,469
January 2018
CCC Demonstration
(Transition plan determined with CMS)
27,281
Aged, Blind and Disabled (ABD)
(Transitioning from Medallion 3.0)
76,388
Total
All Regions
213,653
Source – VAMMIS Data; totals are based on CCC Plus target population data as of July 31, 2016
All populations is CCC + ABD + MLTSS by region – make new chart 14

15. CCC Plus Excluded Populations and Services
Carved-Out Services
Limited Coverage Groups (Family Planning, GAP, QMB only, HIPP, etc.)
ICF-ID Facilities
Veterans Nursing Facilities
Psychiatric Residential Treatment Level C
Money Follows the Person
Hospice and ESRD (CCC Plus enrolled individuals who elect hospice or have ESRD will remain CCC Plus enrolled)
Medallion 3.0 and FAMIS MCO
PACE
Dental
School Health Services
Intellectual Disability Case Management
ID, DD, and DS Waiver Services, including waiver related transportation services (acute care will be under CCC Plus)
Individuals and Families Developmental Disability Services Support Coordination
Preadmission Screening
Excluded Populations are not CCC Plus eligible; coverage will continue through fee-for-service (or through the Medallion 3.0/FAMIS MCO or PACE provider for MCO/PACE enrolled individuals)
CCC Plus carved-out services are paid through fee-for-service for CCC Plus enrolled individuals 15

16. Health Plans Selected for Negotiations
in all 6 Regions
Aetna Better Health of Virginia
Anthem HealthKeepers Plus
Humana
Magellan Complete Care of Virginia
Optima Health
United Healthcare
Virginia Premier Health Plan

17. CCC Plus Builds on CCC Lessons Learned
CCC allows Virginia the unique opportunity to integrate care for individuals who receive both Medicare and Medicaid, with the primary goal to improve health outcomes through coordinated care.
Virginia is fully committed to maintaining a robust CCC program through the end of the Demonstration.
CCC lessons learned will continue to inform the CCC Plus implementation going forward:
Value of provider and member outreach and education
Value of transparent/collaborative engagement with plans and CMS
Value of engaging stakeholders throughout the design, development, and implementation process 17

18. CCC Plus Incorporates CCC Best Practices
High quality care in the least restrictive and most integrated treatment setting
Integrated person-centered model focused on individual needs and preferences
Care coordination and health risk assessments for all members
Member assistance through DARS
(VICAP, long-term care ombudsman)
Behavioral health homes that integrate behavioral and physical health services 18

19. Key Differences Between CCC Plus & CCC
Continuity of Care Period is 90 Days
Operates statewide in
six regions
Mandatory Enrollment
Plans may differ by region
CCC Plus
Continuity of care period is 90 days
No exception for nursing home provider
Continuity of Care Period is
180 Days
CCC
Operates in
five of the six regions
Optional Enrollment
3 Health plans across 5 regions
Continuity of care period is 180 days
Allows for any willing nursing home provider
Populations include duals/non-duals, children/adults, NF and five HCBS Waivers
Populations include full dual adults; including NF and EDCD HCBS Waiver
Health plans may vary by region
Coordination of Medicare benefits through companion D-SNP or MA Plan
Coordination of Medicare benefits through same Medicare/Medicaid Plan
Plans may have narrower networks
Any willing provider for LTSS 19

20. CCC Plus Enrollee Benefits
Person centered, individualized support plan
Same standard Medicaid services provided
Choice between at least 2 health plans
Care coordinator for each individual
Assistance with needs related to housing, food and community
Possible additional benefits offered by health plans 20

21. CCC Plus Enrollment Enrollment Broker: Maximus Neutral third party
Broker will assist in determining which providers are contracted with specific health plans.
Broker will answer questions about additional benefits offered by participating health plans.
Enrollment notification begins approximately 45 days prior to effective date. 21

22. Health Plan Assignment
Enrollees will receive an Initial Notice letter with an initial assignment into a health plan (Managed Care Organization or MCO) and a comparison chart of all the MCOs in their region.
Enrollees can change their MCO by calling the enrollment broker Maximus by the “call by date” in their Initial Notice letter or via website.
“Call by dates” will be on or before the 18th of the month prior to the MCO effective date.
A “Confirmation Notice” will be mailed to the member confirming MCO final assignment
Enrollees have 90 days from the Confirmation Notice to change final MCO assignment through Maximus.
Beginning in 2017, an annual open enrollment period will occur in October – December. 22

23. Intelligent Assignment
Initial assignment is based upon the members region
Factors taken into consideration to being assigned to a particular MCO include:
Two month reenrollment process or previously enrolled Medicare Managed care plan (MAC Id).
2-month previous Medicaid managed care enrollment (i.e., CCC+, Medallion 3.0 or CCC)
Nursing Facility, EDCD Waiver or Tech Waiver (if provider participates with more than one MCO within that region, members will be randomly assigned)
If the member has no considerations listed above, members will be randomly assigned to the MCO’s within their region
Exceptions: January 2018 transition: the ABD transition from Medallion 3 to CCC Plus will not consider prior MCO enrollment history in the assignment algorithm. The transition from CCC to CCC Plus does consider the prior MCO enrollment, where the individual will remain with their CCC health plan if their health plan is operating as a CCC+ plan in the member’s locality on 1/1/2018. 23

24. 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
Members in Nursing Facility (NF) at the time of enrollment will not be moved even if the NF doesn’t choose to participate. NF will be paid as an out of network provider 24

25. CCC Plus Provider Benefits
Medicaid rates are the floor for NF, waivers, early intervention and community behavioral health 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 25

26. Provider Enrollment
Providers need to contract with MCOs to serve the CCC+ population
Contact provider relations department of MCOs to discuss joining an MCOs network
Credentialing of providers by MCOs can take 90 – 120 days to complete. 26

27. Service Authorizations and Coverage
MCOs must cover services that are covered in the Virginia Medicaid State Plan
Do not have to adhere to service limits
Can choose to require authorization for services even if DMAS doesn’t require it now
Most MCOs use a portal for service authorizations 27

28. CCC Plus Health Plan Selection
Evaluate, negotiate, readiness, & award
Work with CMS
1915 b/c Waivers
Regulations
Readiness review
MCO Contracts
Systems Enhancements
Connectivity
Transition of Care
Monitoring
Ongoing Stakeholder & Member Engagement/ Outreach & Education
Regional Implementation & Ongoing Monitoring & Program Evaluation
Next Steps . . . 28

29. Ongoing Stakeholder Input
Providers and stakeholders can directly improve the CCC Plus design by communicating what is working well and what needs improvement 1
What are your concerns, worries, questions, and suggestions ? 2
What is working well under CCC and what are the areas of opportunity? 3
What is needed for a successful CCC Plus program launch and a smooth transition from CCC to CCC Plus?
Once CCC Plus health plans have been selected, DMAS will facilitate collaborative meetings between DMAS, the health plans and stakeholders/providers. 4 29

30. Thank You! For More Information . . .
Send CCC Plus questions, concerns, and suggestions to:
Additional CCC Plus information is available at: 30