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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 Coordinated Plan (MMCP) Stakeholder Update June 5, 2013

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

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Page 1: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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 UpdateJune 5, 2013

Page 2: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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Webinar Topics

•Plan Benefit Package

•RFP versus Contract

•Timeline

▫Implementation- phased in approach

▫MOU

▫Readiness Review

Page 3: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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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

Page 4: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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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

Page 5: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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Plan Benefit Package (PBP)• IDHW posted guidance on Medicaid benefits and

answers to PBP-related questions at: 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

http://www.medicaidltcmanagedcare.dhw.idaho.gov/
Page 6: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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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

Page 7: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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Timeline for Phased-In Enrollment ApproachEnrollment 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.

Page 8: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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Tasks and Timeline for April 1, 2014 Implementation

Key Timeline Step Target Dates

Plans submitted integrated Plan Benefit

Packages to CMS June 3, 2013

Plans submit supplemental formulary files, including the Additional Demonstration Drug (ADD) file, in HPMS

June 7, 2013

MOU Signed July, 2013State releases contract and questionnaire for Medicaid only services to interested organizations for review & bid

July, 2013

Plans selected by State August, 2013

Readiness ReviewsAug. – Nov.

2013

State submits 1915(c) amendments October, 2013

State submits 1915(b) waiver application October, 2013

Contract shared with plans and the State November 15,

2013

Page 9: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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Tasks and Timeline for April 1, 2014 Implementation cont.

Key Timeline Step Target Dates

Health Home SPA submitted if needed December 1, 2013

Coordinated Benchmark SPA December 1, 2013

State and Health Plan Sign contract December, 2013

60-day beneficiary notice sent in Area One

(State)January, 2014

Plan Marketing begins February 1, 2014

Opt-in service coverage begins in Area One March 1, 2014

30-day beneficiary notice sent in Area One

(State)March 1, 2014

Passive Enrollment takes effect in Area One April 1, 2014

Passive Enrollment takes effect in Area Two June 1, 2014

Passive Enrollment takes effect in Area Three August 1, 2014

Page 10: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

Questions?

Page 11: Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals Idaho Medicare-Medicaid

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•[email protected]•Websitehttp://www.MedicaidLTCManagedCare.dhw.idaho.gov

Duals Demonstration Feedback

mailto:[email protected]
http://www.medicaidltcmanagedcare.dhw.idaho.gov/
http://www.medicaidltcmanagedcare.dhw.idaho.gov/

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