Transcript Slide 1

Community Care Medical Home
Enrollment
For
Adult Care Homes
Hosted by:
In conjunction with:
north carolina
medicaid
Medicaid
Medicaid is a health
insurance program for
low-income individuals
and families


As of September 2012, there are
nearly 1.6 million beneficiaries of
Medicaid
Medicaid budget exceeds
$11Billion
Medical Home Enrollment Project

Goal:


To enroll each eligible Medicaid beneficiary with
a Community Care of North Carolina medical
home to improve their overall health and ensure
their access to high quality, medically
necessary health care in the most cost effective
manner.
Project Focus


Increase the number of beneficiaries enrolled
with a medical home
Increase enrollment among the Aged, Blind, and
Disabled (ABD) beneficiaries to 75% of the total
ABD population.
Medicaid Managed Care
Programs
Carolina ACCESS (CA)
and
Community Care of
North Carolina (CCNC)
Community Care of NC
Benefits to the beneficiary and ACH:
 Primary Care Doctor who will lead their medical
home team
 24-hour medical advice
 A care manager to help manage the health care
needs of the beneficiary
 Follow-up appointments
 Beneficiary education on self management
 Special help monitoring and managing
medications
 Help when patients are transitioning from the
hospital back to the facility
Community Care of NC
Medical Home Referrals:
 Required when seeking care for most
specialty services.
 Made at the discretion of the Community
Care medical home.
 Made by telephone or in writing
 Should be obtained as needed prior to
rendering services
Additional Information regarding Community Care of North Carolina / Carolina
ACCESS is available at http://www.ncdhhs.gov/dma/basicmed/Section4.pdf
Community Care of NC
Primary Goals

Improve the care of Medicaid population while
controlling costs

A “medical home” for beneficiaries,
emphasizing primary care

Community networks capable of managing
beneficiary care

Local systems that improve management of
chronic illness in both rural and urban settings
Community Care of NC
How it Works:

Coordination of local community providers
(hospitals, health departments, LMEs and others)
and primary care physicians

Provides clinical and performance improvement
data through CCNC Informatics Center

Provides support for physician driven quality
improvement initiatives regionally and statewide

Each network provides local care managers, and at
least one pharmacist, psychiatrist, and medical
director to improve local health care delivery
Community Care of NC
Alleghany
Ashe
Stokes
Granville
Caldwell Alexander
Rutherford
Graham
Jackson
Clay
Macon
Cleveland
Gaston
Nash
Tyrrell
Edgecombe
Washington
Randolph
Wilson
Chatham
Rowan
Pitt
Cabarrus
Stanly
Mecklenburg
Union
Johnston
Lee
Harnett
Montgomery
Wayne
Moore
Richmond
Anson
Lenoir
Hoke
Cumberland
Craven
Pamlico
Sampson
Jones
Duplin
Onslow
Robeson
Beaufort
Greene
Scotland
Bladen
Pender
Hanover
Columbus
Brunswick
Legend
AccessCare Network Sites
Community Care Plan of Eastern Carolina
AccessCare Network Counties
Community Health Partners
Community Care of Western North Carolina
Northern Piedmont Community Care
Community Care of the Lower Cape Fear
Northwest Community Care
Carolina Collaborative Community Care
Partnership for Community Care
Community Care of Wake and Johnston Counties
Community Care of the Sandhills
Community Care Partners of Greater Mecklenburg
Community Care of Southern Piedmont
Carolina Community Health Partnership
Source: CCNC September 2012
Dare
Martin
Lincoln
Henderson
Polk
Cherokee
Catawba
Durham
Davidson
Burke
McDowell
Bertie
Franklin
Orange
Wake
Iredell
Buncombe
Guilford
Davie
Madison
Haywood
Alamance
Yadkin
Forsyth
Swain
Hertford
Halifax
Wilkes
r
Gates
a
Rockingham Caswell Person
Chowan
Watauga
Northhampton
Warren
Surry
Hyde
Community Care of NC
Networks:



Provide resources for care management, quality
improvement, and cost containment
Seek to incorporate all providers, including safety
net providers
Have Medical Management Committee oversight
Community Care of NC
Disease Management
ED Utilization Management
Behavioral Health Integration
Care Coordination for Children
Chronic Care Program (ABD)
Palliative Care
Pharmacy Management
Pregnancy Care Management
Pain Management
High Cost –High Risk Care
Management
Dental Screening and Fluoride
Varnish
Person Centered Medical Home
Additional Information available at http://www.communitycarenc.org/
Medicaid Managed Care
Programs
Enrollment Process
Enrollment
Prior to rendering services:
 Verify the beneficiary’s eligibility for Medicaid
 Use online verification tools like NCECS Webtool
Enrollment
 Determine if the beneficiary is enrolled with
a medical home
 If yes, verify that the medical home is correct
Enrollment
If the beneficiary is not linked to a medical
home:
 Determine the beneficiary’s Medicaid
Coverage Category.
 Are they eligible for CCNC enrollment?
Enrollment
MANDATORY
OPTIONAL
INELIGIBLE
AAF/WorkFirst
MPW
MQB
MIC (N and 1)
HSF
MIC-L
MAF
IAS
RRF/MRF
MAABD (w/o Mcare)
MAABD (w/ Mcare)
“D” status beneficiaries
SAD /SAA(w/o Mcare)
SAD/SAA (w/ Mcare)
MAF-D
MICA, MICJ, MICK, MICS
(NC Health Choice)
End Stage Renal Disease
beneficiary
CAP cases w/ monthly
deductible
SSI under age 19
Aliens eligible for
emergency Medicaid
Special Needs (SelfIdentified
Nursing Facility residents
Native Americans
MAF-W
Yes
No
Benefit Diversion
Enrollment
Once you confirm eligibility
for Medicaid:
 If the beneficiary is not enrolled with a medical home:




Explain the benefits of managed care
Ask for information about their primary care provider
Complete the enrollment form
Fax the enrollment form to DMA at 919-715-0844
Enrollment
Once you confirm eligibility
for Medicaid:
 If the beneficiary does not have a medical home:
 Explain the benefits of managed care
 Use the provider directory to help them choose a primary
care provider
 Complete the enrollment form
 Fax the enrollment form to DMA at 919-715-0844
Enrollment
 Start by locating the county where your ACH is
located.
 Use the provider name and demographic information
to identify a provider and complete the enrollment
form.
Enrollment
Once you confirm eligibility
for Medicaid:
 If the beneficiary’s medical home is incorrect :
 Obtain information about the correct medical home
 Complete the enrollment form
 Fax the enrollment form to DMA at 919-715-0844
Enrollment
Enrollment
 For residents with
both Medicare
and Medicaid.
 Explains benefits
and options of
Community Care
enrollment.
Enrollment
 When a resident chooses a new medical home, it is
imperative that they establish a relationship with that
new provider
 Immediately call the new medical home to make an
appointment to establish a relationship, complete
paperwork, and transfer records
 If a resident has not seen their chosen medical home
within the past year, also call to make an
appointment to maintain that relationship
Enrollment Resources
 Community Care of North Carolina
http://www.communitycarenc.org/
 Link to webinar presentation and enrollment form
 DMA CCNC/CA webpage
http://www.ncdhhs.gov/dma/ca/ccncproviderinfo.htm
 CCNC/CA Recipient Handbook
 http://www.ncdhhs.gov/dma/ca/carechandbook.pdf
 email: [email protected]
 Benefits of Being a CCNC/CA Member
 http://info.dhhs.state.nc.us/olm/forms/dma/dma-9016.pdf
 Additional questions:
 [email protected]
 828-304-2345