Transcript Medicare/Medicaid Alignment Initiative (MMAI)

Medicare Medicaid Financial
Alignment Initiative (MMAI)
Webinar
November 18, 2013
Who We Are: Leadership
• AgeOptions
–Area Agency on Aging (AAA) for suburban
Cook County
• Health & Disability Advocates
–Policy and advocacy group
• Progress Center for Independent Living
–Cross-disability, non-residential – suburban
Cook County
MMW work is supported by grants
from:
• The Chicago Community Trust
• Michael Reese Health Trust
• The Retirement Research Foundation
What We Do
• Gather and create practical, accessible information
and materials
• Educate Medicare consumers, service providers and
policymakers
• Problem solving – individual and systemic
• Provide training and technical support for
professionals and volunteers
• Advocate for consumer focused laws and policies
• Target underserved groups
What We Will Cover Today
• Background of Illinois Managed Care
Transitions
• Medicare Medicaid Financial Alignment
Initiative
– Program eligibility
– Services covered under MMAI
– Enrollment & Disenrollment
Background of
Illinois Managed
Care
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Background - Illinois Managed Care
Transitions
• State Initiatives
– Public Act 96-1501, January 2011: Illinois must
move 50% of all Medicaid recipients into “riskbased care coordination” by 2015
– Save Medicaid Access and Resources Together Act
(SMART Act), May 2012: Save $16.1 million by
integrating care for most complex Medicaid
beneficiaries (acute, primary, behavioral, and longterm services and supports)
Background - MMAI
• Centers for Medicare and Medicaid Services (CMS)
issued demonstration project to increase care
coordination for dual eligibles (people with Medicare
and Medicaid)
• Illinois application approved February 22, 2013
• Memorandum of Understanding between CMS and
state of Illinois available here:
http://www.cms.gov/apps/media/press/factsheet.asp?C
ounter=4547
Illinois Managed Care Initiatives
• Integrated Care Program (ICP)
– Seniors and Persons with Disabilities with Medicaid ONLY (no Medicare)
– Phase 1 began in May 2011, Phase 2 in February 2013
– Currently only in suburban Cook, DuPage, Kane, Kankakee, Lake, and Will
Counties and the following regions: Rockford, Central IL , Quad Cities and
Metro East. Scheduled to begin in Chicago February 2014.
• Medicare/Medicaid Alignment Initiative (MMAI)
– Target start date: voluntary enrollment in February 2014
– 135,000 dual eligibles in Chicago region and Central Illinois
• Innovations Project
– Demonstration projects – provider-based networks testing innovative
models of care coordination
– Targeted to begin summer 2013 (4 in Chicago area, 2 downstate), but
projects have not yet begun
Medicare/Medicaid
Financial Alignment
Initiative
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Who Will MMAI Affect?
• Full benefit dual eligible beneficiaries (people with
Medicare and full Medicaid benefits – not
“spenddown”) who are:
– Over the age of 21 and in the “Seniors and Persons with
Disabilities (SPD)” Medicaid category (also known as AABD)
– Living in Chicago area or Central Illinois:
• Chicago: Cook, Lake, Kane, DuPage, Will, and Kankakee counties
• Central IL: Knox, Peoria, Tazewell, McLean, Logan, DeWitt, Sangamon,
Macon, Christian, Piatt, Champaign, Vermilion, Ford, Menard, and
Stark counties
• About 135,000 people
How Will MMAI Work?
• HFS will contract with managed care companies to
coordinate all medical, pharmaceutical, behavioral
health, and long term services and supports (like Phase
1 and 2 of the ICP combined).
– One plan will cover all services (Medicare Parts A, B, D, and
Medicaid) - members will no longer need to find providers
who accept Medicare and Medicaid (will need to use plan’s
network instead)
How Will MMAI Work?
• Plans may not charge higher cost-sharing than
traditional fee-for-service Medicaid
• Consumers must use plan network providers
• 180 day transition period
• Must cover out of network emergency care
• Plans will have some flexibility to provide services
that are not currently covered by Medicare and
Medicaid (if they choose)
How Will MMAI Work?
• Managed care companies will use a “medical home”
model
– Team-based approach; focus on integrating primary,
behavioral health, and acute care services across providers
– Plans will use several components to coordinate care,
including health information technology (HIT), risk
assessments, care management, and multi-disciplinary
care teams
– Members will choose a “medical home” and Primary Care
Provider (PCP)
MMAI Enrollment
• Enrollment will be conducted through the Client
Enrollment Broker (just like ICP)
– Will be able to view minimal information about the
MMAI plans on the Medicare Plan Finder, but cannot
enroll on the Plan Finder
– Must use Enrollment Broker website or phone number
to enroll
• Enrollment will be “voluntary” and “passive”
Voluntary Enrollment
• Begins February 2014
• Clients begin receiving letters about 30 days before
voluntary enrollment begins explaining the program
and their options
• Clients can respond to letter by:
1) Choosing to voluntarily enroll in an MCO of their
choice, OR
2) Wanting to opt out of the program entirely (for
all care besides LTSS)
Passive Enrollment
• Begins May 2014 for those who did not respond to Voluntary
Enrollment letters
• Passive enrollment is expected to be conducted in phases (with a
maximum enrollment of 5,000 beneficiaries/month in the Chicago area, and a
maximum of 3,000 beneficiaries/month in Central Illinois)
• Clients will begin receiving a notice about 60 days before they are
passively enrolled into a plan. Clients have the option to…
1) Not respond to the letter and be automatically enrolled in the MCO listed on
the notice
2) Respond to the letters by choosing an MCO of their choice
3) Opt out of the program entirely to continue to receive regular Medicare and
fee-for-service Medicaid (unless receiving LTSS)
Once Enrolled
• Once a client is enrolled into an MCO, they can
change plans on a monthly basis throughout year
– will not be “locked” into a plan (unless
receiving LTSS)
• Can opt out of the program at any time of the
year to receive regular Medicare and fee-for-service
Medicaid (unless receiving LTSS)
• Can change PCP at any time (changes will occur
within 30 days)
MMAI & LTSS
• Individuals receiving LTSS services will be “locked in” to
whatever plan they choose for one year after an initial 90
day election period and will not be able to switch their
MCO throughout the year
• They can opt out for medical services at any time of the
year, but not for their LTSS services
• If a client chooses to opt out of their MCO, they will
receive Medicare and Medicaid (fee-for-service) for all of
their hospital and medical care claims, but their LTSS
services will be paid by the MCO.
MMAI Plans
• Illinois Department of Healthcare and Family Services has
chosen 8 plans to provide MMAI services:
• Chicago area (Chicago and surrounding suburbs):
– Aetna Better Health
– IlliniCare (Centene)
– Meridian Health Plan of Illinois
– HealthSpring
– Humana
– Blue Cross/Blue Shield of Illinois
• Central Illinois:
– Molina Healthcare
– Health Alliance
For More
Information
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For More Information
• Illinois Department of Healthcare and Family Services (HFS) Care
Coordination Roll-Out Plan:
http://www2.illinois.gov/hfs/SiteCollectionDocuments/CareCoorPlan.pdf
• HFS website on Care Coordination:
http://www2.illinois.gov/hfs/PublicInvolvement/cc/Pages/default.aspx
(MMAI proposal and information, information about Innovations Initiative)
MMW Website
• Please visit our website at
http://www.ageoptions.org/services-andprograms_makemedicarework.html to...
– Access our materials on Medicare, Medicaid, and
the Affordable Care Act
– Sign up for our e-mail list to receive registration
information for our webinars, trainings, and
meetings and to receive our alerts, bulletins, and
other healthcare related materials
– View our Calendar of Events
Thank you!
If you have questions, contact:
AgeOptions
(800)699-9043
TTY: (708)524-1653