Transcript Document

Annual Developmental
Disabilities Conference
 MI Health Link Program Implementation Update
(dual eligible demonstration program)
Tuesday, April 21, 2015
Outline of Presentation
 MI Health Link Overview
 Eligibility Criteria
 Benefits of MI Health Link
 Covered Services
 Enrollee Protections
 Enrollee Engagement in Policy
 Enrollment and Beyond
What is MI Health Link?
(dual eligible demonstration program)
 New program that will integrate Medicare and
Medicaid benefits, rules and payments into one
coordinated delivery system
Who Will Administer the Services?
 Health plans with experience providing Medicare
and/or Medicaid services will manage acute, primary,
pharmacy, dental, and long term supports and
services
 Regional PIHPs will continue to coordinate services
for people with mental illness,
intellectual/developmental disabilities and substance
use disorders
Region 7- Wayne County
MI Health Link health plan options
 Aetna Better Health of Michigan
 AmeriHealth
 Fidelis SecureCare
 HAP Midwest Health Plan
 Molina Healthcare
Pre-Paid Inpatient Health Plan
 Detroit-Wayne Mental Health Authority
Who is Eligible?
People who
 Are age 21 or over AND are eligible for full benefits
under both Medicare and Medicaid
 Reside in one of the four demonstration regions
 Are not enrolled in hospice
People enrolled in PACE and MI Choice are eligible but will not
be passively enrolled in MI Health Link and must leave their
programs before joining MI Health Link
Who is Eligible?
The following populations will be excluded from enrollment in
the Demonstration:
 Individuals previously dis-enrolled due to Special




Disenrollment from Medicaid managed care
Individuals not living in a Demonstration region
Individuals without full Medicaid coverage (spend downs or
deductibles)
Individuals with Medicaid who reside in a State psychiatric
hospital
Individuals with commercial HMO coverage
Benefits of Joining
Benefits of
 No co-payments or deductibles for in-network
services, including medications
 One health plan to manage all Medicare and
Medicaid covered services
 One card to access all services
Benefits of
 Person-centered care with a focus on supports for
community living, not just doctor-driven medicine
 ∗Access to a 24/7 Nurse Advice Line to answer questions
Benefits of MI Health Link
Each enrollee will have a care
coordinator who will:
 work with them to create a personal care
plan based on the enrollee’s goals
 answer questions and make sure that health
care issues get the attention they deserve
 connect people to supports and services
needed to be healthy and live where they
want
Benefits of
 Each participant will have access to an Integrated Care
Team that will: include doctors, providers, and anyone
else they would like to include :
 work with them to identify goals and preferences for care
and services
COVERED SERVICES
Covered Services
All health care covered by Medicare and Medicaid
including: Medications – without co-pays
 Dental and vision services
 Equipment and medical supplies
 Physicians and specialists
 Emergency and urgent care
Covered Services
All health care covered by Medicare and Medicaid
Hospital stays and surgeries
 Diagnostic testing and lab services
 Nursing home services
 Home health services
 Transportation for medical emergencies and medical
appointments
Covered Services
Long Term Supports and Services (LTSS) Personal care
 Equipment to help with activities of daily living
 Chore services
 Home modifications
 Adult day program
 Private duty nursing
 Preventive nursing services Respite
 Home delivered meals
 Community transition services
 Fiscal intermediary services
 Personal emergency response system
 Nursing home care
Covered Services
Behavioral Health Services
 Behavioral health services are those that are provided to
individuals who have a mental illness,
intellectual/developmental disability or substance use
disorder
 Behavioral Health services are accessed through
DWMHA- Access Center 800-241-4949
 If currently receiving services through the DWMHA,
services will not change or be interrupted
Covered Services
 Behavioral health services are medically necessary
services. Examples include:
∗Individual, group and/or family therapy
∗Medication review
∗Supported employment
∗Community living supports (meal
preparation, laundry, chores, food shopping)
∗Substance use disorder services (prevention,
treatment, recovery- assessment, treatment
planning, stage-based interventions, referral
and placement)
Part D and MI Health Link
 How do I know what drugs are covered by
the plan’s drug formulary?
 https://www.medicare.gov/find-a-plan
 You can go online and enter your prescriptions to see which
plans cover your drugs.
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ENROLLEE PROTECTIONS
Enrollee Protections
 MI Health Link follows the current grievance and appeal
processes for Medicare and Medicaid services
 Enrollees are offered appropriate appeals rights and
notice letters will direct them to the entity they should
contact if they wish to appeal an action
 A MI Health Link Ombudsman Program will be available
to help resolve problems and answer questions
Continuity of Care
 MI Health Link participants:
 Can continue to see current doctors and providers,
including those who are out-of-network, during the
transition period
 Choose personal care service providers including paying
family members or friends to provide the service
 Continue current medications during transition period
Continuity of Care
 The MI Health Link health plans will
 Honor current authorizations for services
Participant can report authorizations to the plan
 Personal Care authorization information is provided to the
plan by MDCH
 Health plans must offer a choice of providers and care
coordinators
 Health plans must honor the continuity of care
requirements
Enrollee Engagement in Policy
 Every MI Health Link health plan is required to have an
Advisory Council specific to their program
 The State will form a MI Health Link Advisory
Committee for enrollees, allies, and advocates to give
input and suggestions to help improve MI Health Link
 Participants are encouraged to be involved Advisory
groups
Enrollee Engagement in Policy
 Application forms for the MDCH Advisory Committee can
be found here: http://www.Michigan.gov/MIHealthLink
Call 517-241-4293, if you need the form mailed to you
 A completed application form is required for
consideration. Completed applications can be sent to
MDCH by email, fax or regular mail
 Email: [email protected]
-MME can OptIn
-MME can OptOut
- The MI Health
Link Program
Begins
(MME can OptOut, Opt-In,
Change ICO at any
point)
July 1, 2015
- MMEs who
have Opt- In
Nno earlier than...
Enrollment
Begins for the
MI Health Link
Program
May 1, 2015
-Voluntary
No earlier than...
No earlier than ...
March 1, 2015
Enrollment- Phase 2- Wayne & Macomb
IF......
- MME has not Opt-In
-MME has not Opt-Out
- Have not been
passively enrolled into a
M’Care Part D
MME will be
passively enrolled
into the MI Health
Link ProgramIncludes 60-day and
30-day notification
letters
 No earlier than, July 1, 2015 remaining MMEs will be passively assigned to an ICO
 State will use Michigan ENROLLS to enroll beneficiaries
 Call the Michigan Medicare/Medicaid Assistance Program (MMAP) office to talk
about your health care options. MMAP can be reached Monday through Friday
from 8AM – 5PM ET at 1-800-803-7174.
Calling Michigan ENROLLS
http://www.michigan.gov/documents/mdch/MI_Health_Li
nk_Calling_Michigan_ENROLLS-FINAL_482931_7.pdf
When will my enrollment in MI Health Link be effective?
Can someone else call on my behalf?
What if the person I am calling for is not able to answer the
verifying the questions?
What Happens After Enrollment?
After Enrollment Care Coordination
MME agrees
to participate
in the MI
Health Link
Program,
Selects an ICO,
and Completes
an Initial
Screen (in 15
days of
enrollment)
ICO Care
Coordinator
completes (in 45
days of
enrollment)
LEVEL I
ASSESSMENT
(HRA)
CONTINUOUS CARE
COORDINATION
with communication, alerts of
ER, Hospitalizations through the
Care Bridge (Health Information
Exchange platforms)
LEVEL II ASSESSMENT
Behavioral Health
Needs
- PIHP completes
Appropriate Assessments
and/or
- ICO Care Coordinator
completes NFLOC
Long Term Supports
Services Identified
INTEGRATED
INDIVIDUAL CARE &
SUPPORTS PLAN
develop to support the
health and quality of
life goals of the MME.
(within 90 days of
enrollment)
(within 60 days of
enrollment)
INTEGRATED CARE TEAM
MEETING
(MME, ICO Care
Coordinator, PCP, BH Case
Manager/LTSS Care
Coordinator, other
Natural Supports) to
develop Integrated Care
Plan.
Technology to Share Data
is on the Horizon
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http://www.micareconnect.com/demo
Resources
www.michigan.gov/mihealthlink
Question & Answers
Audrey E. Smith, MPH
Director, Integrated Healthcare Initiatives
[email protected]
313-316-7733
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