Medicare Medicaid Alignment Initiative (MMAI) - PowerPoint Presentation

Slide1

Medicare Medicaid Alignment Initiative (MMAI)The next chapter of HFS Managed CareSlide2

What is Managed Care?

A health care delivery system designed to provide coordinated care that will reduce unnecessary utilization of services, control cost, increase access and maximize qualitySlide3

Benefits of Managed Care

Better health for the member

Choices of doctors, specialists and hospitals

Additional programs and services to help them live a healthy lifeBetter quality of life for the member

Coordination of care with a team of people working with members to help them live an independent and healthy life

Reduction in the cost of the service over timeSlide4

Managed Care Organizations

Have a network of hospitals, physicians, specialists

Are responsible for covering same services as Medicaid

Accept the full-risk capitated paymentsSlide5

Key Terms to Remember

Care Coordination

Determining a person’s needs and creating a care plan

Linking the person to a full range of appropriate services and monitoring the care provided over an extended period of timeMedical Home

The doctor’s office or clinic where clients go to first when seeking healthcare services

The doctor’s office or clinic where a client goes to see their PCP

Primary Care Provider (PCP)

The family doctor, nurse, or other healthcare provider at the clients medical home who takes care of them

Integrated Care Team

A team of health and social care staff working together to offer patients a better quality service and easier access to that service.Slide6

Medicaid Managed Care Programs

Voluntary Managed Care (VMC)

Primary Care Case Management (PCCM)

Integrated Care Program (ICP)

Medicaid Long Term Supports and Services(MLTSS)

Medicare Medicaid Alignment Initiative

(MMAI)Slide7

VMC –at a glance

A

voluntary

programProvides services to All Kids, Moms and Babies, and Family Care clients

Participants choose a Primary Care Provider (PCP) in an MCO for their medical home

Operates in

28

counties throughout the stateSlide8

PCCM –at a glance

A

mandatory

programCalled Illinois Health Connect

(IHC)

Provides services to most individuals covered by an HFS Medical Program

(some exclusions)

Participants choose a medical home and PCP while receiving the advantages of care coordination and case management

Eligible enrollees may opt out of IHC if enrolling with MCO

Operates statewideSlide9

ICP –at a glance

A

mandatory program providing services to older adults and persons with disabilities

Enrollees must be eligible for Medicaid but

not

eligible for Medicare, and must be age 19 and older

Excluded populations:

Children under 19 years of age

Participants eligible for Medicare Part A or enrolled in Medicare Part B

American Indians and/or Natives of Alaska (may voluntarily enroll)

Participants with

Spenddown

All Presumptive Eligibility (temporary benefits) Categories

Participants in the Illinois Breast and Cervical Cancer Program

Participants with high-level private health insurance (Third Party Liability or TPL) Slide10

ICP –at a glance

ICP provides medical, behavioral, and home/community based services

Beneficiaries are locked into their MCO plan for one year and cannot switch health plans until their anniversary month

Operates in

29

counties in the following

5

regions of IL:

Central IL Metro East

Greater Chicago Rockford

Quad CitiesSlide11

MLTSS –at a glanceBegins September 1, 2014

Provides services to those who opt out of

MMAI

but receive LTSS (more about MMAI is coming up on our next slide)Mandatory enrollment in a health plan to receive:

LTSS

Behavioral Health

Transportation

Same health plans as MMAI

MLTSS Program individuals are locked in for their LTSS services for one year and cannot switch health plans until their anniversary monthSlide12

MMAI – a closer lookA

voluntary

program with passive enrollment

Three-way contract between HFS, CMS, and Health PlansRobust care coordination Emphasis on quality measurementSlide13

MMAI – a closer lookHealth plans will provide integrated benefits to full-benefit dual eligible beneficiaries ages 21 and over:

All Medicare and Medicaid services including long-term care institutional and community-based services and supports

Exclusions include individuals receiving institutional developmental disability services or Adults with Developmental Disabilities HCBS waiver services Slide14

MMAI – LTSSLTSS :

Long Term Supports and Services

Under MMAI, the LTSS population includes nursing home residents and those receiving Home and Community Based Services(HCBS) waivers:

Elderly (Community Care Program participants)Traumatic Brain Injury

HIV/AIDS

Physically Disabled

Supportive Living FacilitySlide15

MMAI – Geography

Greater Chicago Counties:

Cook

, Lake, Kane, DuPage, Will, KankakeeCentral Illinois Counties: Knox, Peoria, Tazewell, McLean, Logan , DeWitt, Sangamon, Macon, Christian, Piatt, Champaign,

Vermilion, Ford, Menard, StarkSlide16

MMAI – Number Eligible

Geographic

Region

Number

of Dual

Beneficiaries Eligible

for MMAI

Greater Chicago

128,000

Central Illinois

20,000Slide17

MMAI – Health Plans

Greater Chicago:

Aetna Better Health

Blue Cross Blue ShieldCigna HealthSpring Humana IlliniCare Health PlanMeridian Health PlanSlide18

MMAI – Health Plans

Central Illinois:

Health Alliance

Molina HealthCareSlide19

MMAI – Timeline

March 1, 2014:

Voluntary Enrollment for

Community population BeginsJune 1, 2014: Passive Enrollment for

Community

population Begins

July 1, 2014:

Voluntary Enrollment for

LTSS

population Begins

September 1, 2014:

Passive Enrollment for

LTSS

population BeginsSlide20

MMAI – Enrollment

Announcement Letter

Includes

general information on: Names of health plans participating in their areaCalling the

Illinois Client Enrollment Services (ICES)

for help in explaining their choices

How to enroll

How to opt out

Enrollment Packet

Includes

detailed

information on:

Health plans participating in their area

How to enroll

Reminder Notices

Prior to passive enrollment date, a couple of notices will be mailed to beneficiary, these notices include:

Name of health plan and PCP

Option to change plans or opt-out at any timeSlide21

MMAI – DisenrollmentDisenrollments are effective the

first

day of the month following request

Individuals can disenroll thru ICES or through 1-800-MedicareThose receiving LTSS and who disenroll from MMAI will be

required

to enroll in the MLTSS program.Slide22

How Can Clients Contact ICES?

Eligible clients can contact IL Client Enrollment Services (ICES)

By Phone: Call Illinois

Client Enrollment Services

1-877-912-8880 (TTY: 1-866-565-8576)Slide23

How does MMAI compare to ICP?

ICP

Mandatory Enrollment

Must be 19

and over

Must be Medicaid, but

not

Medicare enrolled

Several MCOs to choose from

Medical, Behavioral Health, & HCBS waiver services covered

(some exclusions)

Developmental Disabilities (DD) waiver/institutional clients

included

Enroll through client enrollment broker

Operates in

5 regions

of the state

MMAI

Passive Enrollment

with Opt-Out option for medical services

Must be

21

and over

Must be Medicaid

and

Medicare enrolled

(duel eligible)

Several MCOs to choose from

Medical, Behavioral Health, & HCBS waiver services covered

(some exclusions)

Developmental Disabilities (DD) waiver/institutional clients

excluded

Enroll through client enrollment broker

Operates in

2 regions

of the stateSlide24

MMAI – a review

MMAI is latest managed care program offered to IL Medicaid clients.

The program is for those dually eligible beneficiaries who receive both Medicare

and Medicaid. MMAI will affect

128,000

people in the greater Chicago region, and

20,000

people in the central IL region.

The beneficiaries will be enrolled in waves rather than all at once. This “rollout” will begin with those in the

community

first, followed by the

LTSS

population, those enrollees that are in LTC facilities and on HCBS waivers.

The member handbook is a valuable resource for SHIP staff including these chapters:

Chapter 2 – important contact numbers for members

Chapter 4 – covered services

Chapter 9 – grievances and appealsSlide25

1. Why would someone want to enroll in this program?10 Questions you might have about MMAI

Care coordination – consumers will have a care coordinator to help them navigate the health care system

Receive all health care from one health plan, no longer fragmented (some from Medicaid and some from Medicare)

Some health plans offer additional servicesSlide26

2. What is the role of the client enrollment broker?10 Questions you might have about MMAI

The role of the client enrollment broker is to provide education in an unbiased manner and enroll individuals into a health plan. They can answer questions about each health plan and help consumers find out which MCO network their PCP, specialists or hospital has joined. Slide27

10 Questions you might have about MMAIThey have the choice to stay with the MA or DSNP Plan or to join an MMP health plan. The plans have similar benefits, but MMAI offers the additional benefit of care coordination and services beyond what Medicaid and Medicare offer.

If they are in Long Term Supports and Services however, they are required to select a health plan for those specific services.

3

. The client is happy with their current health plan (medicare fFS, MA plan or D-snP Plan). Do they have to enroll in

Mmai

?Slide28

4. What is the difference between passive enrollment and voluntary enrollment?10 Questions you might have about MMAI

Passive enrollment means consumers will be enrolled in a health plan UNLESS they call to opt out.

Voluntary enrollment means consumers can voluntarily decide if they would like to enroll in a health plan.Slide29

5. ARE ALL HEALTH PLANS AVAILABLE IN ALL COUNTIES?10 Questions you might have about MMAI

No. Please refer to the Care Coordination Map handout to see which health plans are serving which counties.Slide30

6. When does coverage begin?10 Questions you might have about MMAI

It depends what day of the month the consumer calls to enroll. If they call within the first half of the month, coverage will begin the first day of the next month. For example, if they call on March 12

th

to enroll, the coverage will begin April 1

st

.

If they call in the latter part of the month, it will begin the first day of the

following

month. For example, if they call on March 25

th

to enroll, their coverage will begin May 1

st

.Slide31

7. Can consumers switch from one plan to another?10 Questions you might have about MMAI

Consumers can switch health plans under MMAI. It is best to stay with one health plan as that health plan’s care coordinator will get to know and understand their needs.Slide32

8. What services are provided under this new health plan?10 Questions you might have about MMAI

Consumers get all the services they currently receive plus care coordination under an integrated health care delivery system. In addition, all of the health plans offer additional services at no cost to consumer.Slide33

9. What if the consumer thinks they have been unfairly treated or denied a service BY THEIR MMAI PLAN?10 Questions you might have about MMAI

They should call their health plan. They can grieve or file an appeal with the health plan for things such as a denial of a service or for failure to provide a service in a timely manner. The health plan can help explain how to file an appeal. The information is also in the health plan’s member handbook.Slide34

10. If a consumer disenrolls, where do they get services?10 Questions you might have about MMAI

Consumers would return to services as they had prior to enrolling in MMAI - such as their Medicare Advantage (MA) Plan, Dual Eligible Special Needs Plans (D-SNPs) or Medicare Fee-For-Service.