Sarah Broughton, MSW Outreach and Education CoordinatorPatti Davidson, MSW Program Analyst

Virginia Department of Medical Assistance Services

LTC Medicaid SubcommitteeFebruary 27, 2014

http://dmasva.dmas.virginia.gov 1

Department of Medical Assistance Services

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1Commonwealth Coordinated Care: Program Highlights

Eligibility and Enrollment

Important Contact Information

Overview

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1High-quality, person-centered care for the Dual Eligible that is focused on their needs and preferences

2All the same benefits currently available under Medicaid and Medicare

3Single program with built-in Care Coordination for primary, preventive, acute, behavioral, and long-term services and supports

4Promotes improved transitions between acute and long-term facilities

5Reimbursement – Blended, risk adjusted rate based on Medicaid, Medicare, and Medicare Advantage data

CCC Highlights

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1Three-way contract between CMS, DMAS, and health plans referred to as MMPs (Medicaid-Medicare Plans).

2Same fiscal agent for consumer-directed services to ensure continuity of care

3Extended transition period for previously authorized services

4Behavioral Health Homes created in partnership with CSBs for individuals with Serious Mental Illness (SMI)

5The three MMPs for CCC

CCC Highlights

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Healthkeepers

HumanaVirginia Premier

Who is eligible for CCC?

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• Full benefit Medicare-Medicaid Enrollees (entitled to benefits under Medicare Part A and enrolled under Medicare Parts B and D, and receiving full Medicaid benefits)

• Participants in the Elderly or Disabled with Consumer Direction Waiver

• Residents of nursing facilities

• Age 21 and Over

• Live in designated regions (Northern VA, Tidewater, Richmond/Central, Western/Charlottesville, and Roanoke)

Who is not eligible for CCC?

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Individuals not eligible include those in:ID, DD, Day Support, Alzheimer's, Technology Assisted

HCBS WaiversMH/ID facilitiesICF/IDsPACE (although they can opt in)Long Stay HospitalsMoney Follows the Person (MFP) program HospiceOther Comprehensive Coverage (TPL)

Enrollment

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Enrollment in CCC will be in five regions of the Commonwealth:Central Virginia/RichmondTidewaterNorthern VirginiaRoanoke areaWestern/Charlottesville area

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Virginia’s Service Regions

Enrollment

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Enrollment will be in two phases:The first phase is called “voluntary enrollment” where an

individual proactively enrolls in the program The second phase is called automatic enrollment where the

individual is automatically enrolled into the CCC program. Intelligent Assignment will consider previous enrollment with the

health plans or the health plan network that includes the current adult day health provider or nursing facility (if applicable).

Intelligent Assignment

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Individuals will be automatically enrolled after considering:The Health Plan network that includes their current adult

day health provider The network that includes the enrollee’s nursing facility

(if applicable) An enrollee’s previous enrollment with the health plans

Beneficiary Choice

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Most importantly, if an individual is unhappy with a chosen health plan, he/she may, at any time, request reassignment to another health plan or opt out of the

program and return to traditional Medicare and Medicaid (changes will be made the first of the month)

1One system

to coordinate

care

2One ID card for all care

3Designated

Care Manager

424/7 local call

center with access to

beneficiary records

5Person-

centered care

coordination

6Unified appeals process

Enrollee Benefits

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Supplemental Benefits and Supports

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Varies by health planMay include:

DentalVision, to include eyeglassesPodiatryHearing exams, to include hearing aides

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CCC Ready for Launch

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March April

May

June July Aug

Oct

2014 Implementation Timeline

CCC is Different From Medallion IICCC is for those who are eligible for BOTH

Medicare and MedicaidEnrollees with Medicare are NOT eligible for

Medallion IIIncludes Nursing Facility residents and

individuals in the EDCD waiver

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Overview of Enrollment ProcessVaMMIS identifies a list of CCC eligible Medicaid

recipients and this file is sent to CMSCMS runs VaMMIS list through Infocrossing and identifies

individuals who are not CCC eligible from the Medicare side:ESRDHospiceMedicare A/B/D issues and sends back. 

Those who remain “eligible” are loaded into VaMMIS (by DMAS) with an “E”. 

Individuals eligible for CCC may:Opt-inOr will eventually be automatically enrolled if no choice is

made

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Overview of Enrollment Process cont’dEligible Virginians will receive numerous

letters informing them of their eligibility and providing information on the CCC program

MAXIMUS is the third party enrollment broker

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Important CCC Contact Information

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Phone: 1-855-889-5243 Monday-Friday 8:30-6:00

starting March 3, 2014or

Website: www.virginiaccc.com

Important CCC Contact Information

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Questions about CLAIMS should be referred back to the Medicare-Medicaid

Plan (MMP)

Important CCC Contact Information

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Providers and advocacy groups should send CCC questions and presentation requests to:

Office of Coordinated CareVirginia Department of Medical Assistance

Services600 E. Broad Street, Suite 1300

Richmond, VA 23219CCC@dmas.virginia.gov