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MICHIGAN’S INTEGRATED CARE MICHIGAN’S INTEGRATED CARE PLAN FOR PEOPLE WHO ARE PLAN FOR PEOPLE WHO ARE MEDICARE-MEDICAID ELIGIBLE MEDICARE-MEDICAID ELIGIBLE A Discussion with MPCA Membership March 19, 2012

Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

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Page 1: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

MICHIGAN’S INTEGRATED MICHIGAN’S INTEGRATED CARE PLAN FOR PEOPLE CARE PLAN FOR PEOPLE WHO ARE MEDICARE-WHO ARE MEDICARE-MEDICAID ELIGIBLEMEDICAID ELIGIBLE

A Discussion with MPCA Membership

March 19, 2012

Page 2: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Purpose of Today’s Purpose of Today’s WebinarWebinarDevelop a common

understanding of the components of Michigan’s plan

Develop a list of questions health centers would like to have clarified

Discuss potential implications for health centers and the patients we serve and MPCA’s response

Page 3: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Michigan’s Integration Michigan’s Integration GoalsGoals• Seamless delivery of services• Reduce fragmentation • Reduce barriers to home and

community-based services• Improve quality of services• Simplify administration for

beneficiaries & providers• Cost effectiveness aligning

financial incentives

Page 4: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

The Plan Development The Plan Development ProcessProcess• Planning Contract received (April, 2011)• Multiple stakeholder input activities

(July – December)• Interviews, forums, request for input,

workgroups, written comments• Proposed Plan Issued (March 5, 2012)• Public Input on Plan (30 days)• MDCH forums (March 20th, March 29th)• Submission to CMS – April 26, 2012• Implementation begins July 2013

Page 5: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

The ProposalThe ProposalChange financing model for ~

200,000 persons who are dually covered by Medicare and Medicaid.◦Move from the current Fee For

Service model to an organized system of care.

Page 6: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Integrated Care Flow of Funds

Page 7: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Plan StructurePlan StructureIntegrated Care Organizations (ICOs)

Prepaid Inpatient Health Plans (PIHPs)

• ICOs will contract with:• Physical Health

Providers• Long Term Care

Providers

• PIHPs will contract with:• CMHSPs• Behavioral Health

Providers

Page 8: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Integrated Care Integrated Care Organizations (ICOs)Organizations (ICOs)

The ICO is responsible for financing and coordinating benefits:Medicare Part A & B (primary & acute care).Pharmacy Part DLong term care services & supports including community based and nursing facility, both skilled and custodialManagement of person-centered medical homeCare and supports coordination team

Page 9: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Prepaid Inpatient Health Plans (PIHPs)

The PIHP is responsible for financing and coordinating benefits for all behavioral health services for persons with:

Intellectual/developmental disabilities Serious mental illness substance use disorders Care and supports coordination team

Page 10: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

• A services or supports coordinator leads a multidisciplinary team to coordinate services & supports for the beneficiary according to a self determined, person centered plan of care.

• The services or supports coordinator has 24/7 contact responsibility for the beneficiary

• Leading coordinating entity (ICO or PIHP) is defined by beneficiary and highest care need.

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How Integration Happens –How Integration Happens –The Care BridgeThe Care Bridge

Page 11: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Passive enrollment - beneficiary enrolled unless they indicate a choice to opt out

Open enrollment for two months during phased implementation and subsequent enrollment

Post enrollment there will be a single person-centered screening and assessment tool and process

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Enrollment processEnrollment process

Page 12: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Quarterly Phase In-Quarterly Phase In-GeographicGeographic• Beginning July, 2013 – all beneficiaries in plan by June, 2014• People enrolled at quarterly Intervals using several regional

areas• Regions developed based on potential for enrollment volume

and other readiness factors• First group of counties will be selected to assure sufficient # of

enrollees to demonstrate the plan, but will include less than ½ the population

• Remaining counties grouped along logical geographic and health care market lines

Page 13: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

1st Quarter – Persons with:• Physical disabilities• Serious mental illnesses• Substance use disorders• Older adults not in nursing facilities

2nd Quarter– Persons using long term care services in:• Nursing facilities• MI Choice Waiver

3rd Phase– Persons with intellectual/developmental disabilities

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Quarterly Phase In-Quarterly Phase In-PopulationsPopulations

Page 14: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Copy of Plan at: www.michigan.gov/mdch

MDCH Forums • March 20th, 1:30 – 4:00 p.m.; Best Western

Hotel (Causeway Bay), Lansing• March 29th, 1:30 – 4:00 p.m.; Greater Grace

Temple, Detroit

Comments by email at: [email protected] no later than close of business April 4, 2012

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Public Input Opportunities Public Input Opportunities

Page 15: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

Impact on Michigan CHCsImpact on Michigan CHCsMichigan CHCs are currently serving

approximately 22,600 Dual Eligible Individuals.The number of duals in CHCs should continue

to grow with Medicaid expansion and the aging of the baby boomers.

Health Centers currently contract with many of the likely ICOs.

We will need to be sure the Medicaid provisions that require contracts with FQHCs are included.

Maintenance of Medicaid PPS will be critical and Michigan Medicaid’s share of PPS will be greater for duals.

Page 16: Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

DISCUSSIONDISCUSSION


C MEDICARE MEDICAID SERVICES

C MEDICARE MEDICAID SERVICES

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