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Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid.

Published byJennifer Morton Modified over 9 years ago

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Presentation on theme: "Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid."— Presentation transcript:

1 Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid Coordinated Plan (MMCP) Stakeholder Update June 5, 2013

2 Webinar Topics Plan Benefit Package RFP versus Contract Timeline ▫Implementation- phased in approach ▫MOU ▫Readiness Review 2

3 Plan Benefit Package (PBP) The PBP is a list of Medicare and Medicaid benefits Health Plans will offer in the Demonstration All Medicare and Medicaid benefits, unless otherwise carved out as in the case of Developmental Disabilities services, are required CMS required Health Plans to submit a PBP by June 3, 2013 3

4 Plan Benefit Package (PBP) Two Health Plans have submitted PBPs for the Demonstration CMS provided a template to IDHW to provide PBP guidance to Health Plans for services that may have Medicaid benefit limitations greater than Medicare benefit limitations 4

5 Plan Benefit Package (PBP) IDHW posted guidance on Medicaid benefits and answers to PBP-related questions at: www.MedicaidLTCManagedCare.dhw.idaho.gov www.MedicaidLTCManagedCare.dhw.idaho.gov PBP includes benefit limitations, cost sharing information, prior authorization requirements, and other notes. Health Plans must be at least as Enrollee- friendly as Medicaid. ▫Benefit limitations – example: 12 hours/day limitation for adult day health. ▫Cost sharing information – example: possible $3.65 copayments for specified services ▫Prior authorization requirements, if applicable ▫Other notes to clarify the nature of a benefit 5

6 RFP vs. Contract IDHW requested an exemption to the competitive bid process - request approved by the Department of Purchasing This means we move directly to contract negotiations Process will involve release of the contract to the interested health plans for review and bid, along with a questionnaire Plans will submit their bid and their responses to the questionnaire for evaluation by IDHW 6

7 Timeline for Phased-In Enrollment Approach Enrollment in the Demonstration will be phased in by IDHW’s three geographical service areas (Southwest, East and North). Opt-in enrollment in the Southwest geographic area begins on March 1, 2014. ▫All Enrollees in the Southwest geographic area who have not opted-in or out before April 1, 2014 will be passively enrolled on that date. Opt-in enrollment in the East geographic area begins on May 1, 2014. ▫All Enrollees in the East geographic area who have not opted-in or out before June 1, 2014 will be passively enrolled on that date. Opt-in enrollment in the North geographic area begins on July, 1, 2014. ▫All Enrollees in the North geographic area who have not opted-in or out before August, 1, 2014 will be passively enrolled on that date. 7

8 Tasks and Timeline for April 1, 2014 Implementation 8 Key Timeline StepTarget Dates Plans submitted integrated Plan Benefit Packages to CMSJune 3, 2013 Plans submit supplemental formulary files, including the Additional Demonstration Drug (ADD) file, in HPMS June 7, 2013 MOU SignedJuly, 2013 State releases contract and questionnaire for Medicaid only services to interested organizations for review & bid July, 2013 Plans selected by StateAugust, 2013 Readiness ReviewsAug. – Nov. 2013 State submits 1915(c) amendmentsOctober, 2013 State submits 1915(b) waiver applicationOctober, 2013 Contract shared with plans and the State November 15, 2013

9 Tasks and Timeline for April 1, 2014 Implementation cont. 9 Key Timeline StepTarget Dates Health Home SPA submitted if neededDecember 1, 2013 Coordinated Benchmark SPADecember 1, 2013 State and Health Plan Sign contractDecember, 2013 60-day beneficiary notice sent in Area One (State)January, 2014 Plan Marketing beginsFebruary 1, 2014 Opt-in service coverage begins in Area OneMarch 1, 2014 30-day beneficiary notice sent in Area One (State)March 1, 2014 Passive Enrollment takes effect in Area OneApril 1, 2014 Passive Enrollment takes effect in Area TwoJune 1, 2014 Passive Enrollment takes effect in Area ThreeAugust 1, 2014

10 Questions?

11 Email LTCmanagedcare@dhw.idaho.gov Website http://www.MedicaidLTCManagedCare.d hw.idaho.gov Duals Demonstration Feedback 11

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