Department of Medical Assistance Services

An Introduction to Managed Long Term Services and Supports (MLTSS)

Department of Medical Assistance Services May 2016 1 http://dmas.virginia.gov

Agenda

           Background and Key Facts Legislative Mandates National Trends Vision and Goals Populations, Services and Regions Proposed Launch MLTSS and CCC Comparison Delivery System Reform Incentive Payment (DSRIP) Next Steps Ongoing Opportunity for Stakeholder Input MLTSS and DSRIP References http://www.dmas.virginia.gov

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Virginia Public Procurement Act

Presently we are operating under a competitive procurement and we may not be able to respond to all of your questions

• • DMAS must operate under strict Code of Ethics Rules until successful completion of the MLTSS competitive procurement process (also known as the RFP process), in accordance with the Virginia Public Procurement Act, §2.2‐4300 of the Code of Virginia DMAS published the MLTSS RFP on April 29, 2016 and it is available at: http://www.dmas.virginia.gov/Content_pgs/rfp.aspx

http://www.dmas.virginia.gov

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Virginia’s Medicaid Program Key Facts

1 Million + 1 in 8

Virginians covered by Medicaid/CHIP Virginians rely on Medicaid

50%

Medicaid beneficiaries are children

1 in 3

Births covered in Virginia

2 in 3

Residents in nursing facilities supported by Medicaid - Primary payer for LTSS

58%

Long-Term Services & Supports spending is in the community

Behavioral Health

Medicaid is primary payer for services http://www.dmas.virginia.gov

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Medicaid Population and Expenditures

Medicaid expenditures are disproportionate to covered populations. Older adults and individuals with disabilities make up over 25% of the total population, yet almost 70% of expenditures are attributed to this group.

http://www.dmas.virginia.gov

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Medicaid Expenditure Breakdown

Virginia’s Medicaid Expenditures Breakdown

http://www.dmas.virginia.gov

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MLTSS: Legislative Mandates

Consistent with Virginia General Assembly and Medicaid reform initiatives, DMAS is moving forward transitioning individuals from fee-for-service delivery models into managed care General Assembly Directives beginning 2011 through 2015 Continue to transition fee for-service populations into managed care Phase 3 of Medicaid Reform Initiatives Move forward with managed long term services and supports (MLTSS) initiatives Value of Managed Care Timely access to appropriate, high quality care; comprehensive care coordination; and budget predictability http://www.dmas.virginia.gov

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MLTSS and National Trends

Many states are moving LTSS into managed care programs and towards payment/outcome driven delivery models

– LTSS spending trends are unsustainable – Managed care offers flexibility not otherwise available through fee-for-service – Affordable Care Act emphasis on care coordination/integration of care

Virginia’s MLTSS efforts are consistent with National trends

http://www.dmas.virginia.gov

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Benefits of Managed Care

Managed Care Basics

• • • • • DMAS contracts with managed care organizations (MCO) DMAS pays a per-member per month (PMPM) MCOs contract with providers and pay claims 75% of Virginia Medicaid Enrollees currently enrolled State-wide for Medallion 3 program

Benefits of Managed Care

• • • • • • • Improves quality of care Broader provider network More flexible – can include services that cannot be provided in fee-for service Actuarial soundness to ensure rates are not too low Care coordination assists member with navigation through system Medicaid no longer a “welfare program” – it is health coverage Private sector shares risk with government http://www.dmas.virginia.gov

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MLTSS: Vision and Goals

VISION: To implement a coordinated system of care that builds on lessons learned and focuses on improved quality, access and efficiency

1

Provide individuals with high-quality, person centered care and enhanced opportunities to improve their lives

2

Improve community-based infrastructure and community capacity to enable/ support care in the least restrictive and most integrated setting

3

Promote innovation and value based payment strategies

4

Provide care coordination and better accommodate progressive needs of members

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Better manage and reduce expenditures; reduce service gaps and the need for avoidable services, such as hospitalizations and emergency room use http://www.dmas.virginia.gov

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MLTSS Person Centered Delivery Model

Intensive Care Coordination/ Integration with Medicare Timely Access & Enhanced Community Capacity Integrates Physical, Behavioral, SUD, & LTSS Improved Quality Management Rewards High Quality Care with Value Based Payments Fully Integrated & Person Centered Model Improved Efficiency and Fiscal Stability http://www.dmas.virginia.gov

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MLTSS Populations

Approximately 212,000 Individuals

Duals (Full Medicaid) with and without LTSS 113,000 Non Duals with LTSS 20,000 Non Dual /Non LTSS aged, blind or disabled Individuals 79,000

Not CCC Enrolled

45,000 excluded; 39,000 eligible/ not enrolled

FFS

11,000

FFS Aged, Blind, Disabled (ABD)

3,000

CCC Enrolled

29,000

will transition 1/2018

Medallion 3.0 HAP*

9,000

Medallion 3.0

Aged, Blind, Disabled (ABD)

76,000

will transition 1/2018 Approximations based upon March 2016 MMIS Data

http://www.dmas.virginia.gov

*HAP http://www.dmas.virginia.gov/Content_pgs/mc-home.aspx

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MLTSS Excluded Populations and Services

        Excluded Populations Limited Coverage Groups (Family Planning, GAP, QMB only, HIPP, etc.) ICF-ID Facilities Veterans Nursing Facilities Psychiatric Residential Treatment Level C Money Follows the Person Hospice and ESRD (

MLTSS enrolled individuals who elect hospice or have ESRD will remain MLTSS enrolled)

Medallion 3.0 and FAMIS MCO PACE    Carved-Out Services Dental School Health Services Community Intellectual Disability Case Management  ID, DD, and DS Waiver Services, including waiver related transportation services, until after the completion of the ID/DD redesign  Individuals and Families Developmental Disability Services Support Coordination  Preadmission Screening

Excluded Populations are not MLTSS eligible; coverage will continue through fee-for-service (or through the Medallion 3.0/FAMIS MCO or PACE provider for MCO/PACE enrolled individuals)

http://www.dmas.virginia.gov

MLTSS carved-out services are paid through fee-for-service for MLTSS enrolled individuals

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Coordination with Medicare

      

MEDICARE COVERS

Hospital care Physician & ancillary services Skilled nursing facility (SNF) care Home health care Hospice care Prescription drugs Durable medical equipment      

MEDICAID COVERS

Medicare Cost Sharing Hospital and SNF (when Medicare benefits are

exhausted)

Nursing home (custodial) HCBS waiver services Community behavioral health and substance use disorder services, Medicare non-covered services, like OTC drugs, some DME and supplies, etc.

    MLTSS plans must operate (or obtain approval to operate ) as Medicare Dual Special Needs Plans (DSNP) DSNPs operate under contract with Medicare and Medicaid Once DSNPs are operational, MLTSS individuals will have the option to choose the same plan for Medicare and Medicaid coverage DMAS Contracts (DSNP and MLTSS) will facilitate care coordination across the full continuum of care http://www.dmas.virginia.gov

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Proposed MLTSS Regions

MLTSS will operate statewide, across 6 regions, and will offer individuals choice between at least 2 health plans per region MLTSS Health Plans will be competitively procured (RFP) A list of MLTSS regions by locality is available at: http://www.dmas.virginia.gov/Content_pgs/mltss-proinfo.aspx

http://www.dmas.virginia.gov

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Proposed MLTSS Launch Timeline

MLTSS Implementation Phases Date

July 1, 2017 September 1, 2017 October, 2017 November 1, 2017

Regions

Tidewater Central Charlottesville/Western Roanoke/Alleghany and Southwest

Regional Launch

17,395 23,573 16,481

All Populations

42,910 54,275 29,614 23,665 47,291 December 1, 2017 Northern/Winchester 25,099 37,964 January 2018 January 2018

Total

CCC Demonstration (Transition plan is to be determined with CMS) Aged, Blind and Disabled (ABD) (Transitioning from Medallion 3.0)

All Regions

29,510 76,331

212,054

Source – VAMMIS Data; *Approximate totals based upon MLTSS targeted population as of March 2016 A list of MLTSS regions by locality is available at: http://www.dmas.virginia.gov/Content_pgs/mltss-proinfo.aspx

http://www.dmas.virginia.gov

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MLTSS Builds on CCC Lessons Learned

   CCC allows Virginia the unique opportunity to integrate care for individuals who receive both Medicare and Medicaid, with the primary goal to improve health outcomes through coordinated care Virginia is fully committed to maintaining a robust CCC program through the end of the Demonstration CCC lessons learned will continue to inform the MLTSS implementation going forward o Value of provider and member outreach and education o Value of transparent/collaborative engagement with plans and CMS o Value of engaging stakeholders throughout the design, development, and implementation process http://www.dmas.virginia.gov

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MLTSS Incorporates CCC Best Practices

High quality care in the least restrictive and most integrated treatment setting Integrated person-centered model focused on individual needs and preferences Care coordination and health risk assessments for all members Member protections through DARS (VICAP, long-term care ombudsman) Behavioral health homes that integrate behavioral and physical health services http://www.dmas.virginia.gov

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Key Differences Between MLTSS & CCC

MLTSS CCC Operates statewide in six regions Operates in five of the six regions Mandatory Enrollment Optional Enrollment Populations include duals/non-duals, children/adults, NF and five HCBS Waivers Health plans may vary by region Continuity of Care Period is 90 Days Any willing provider for LTSS http://www.dmas.virginia.gov

Populations include full dual adults; including NF and EDCD HCBS Waiver 3 Health plans across 5 regions Continuity of Care Period is 180 Days 19

Delivery System Reform Incentive Payment (DSRIP)

DSRIP is a Medicaid innovation waiver focused on transforming how care is delivered and paid for in Virginia’s Medicaid delivery system

Opportunity to Improve Care to Members DSRIP

Alignment of MLTSS and DSRIP creates a powerful opportunity to strengthen and integrate care delivery 1. Virginia Medicaid’s community delivery structure (One Community) 2. Payment reforms toward value-based purchasing

MLTSS

http://www.dmas.virginia.gov

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DSRIP Key Takeaways

Increasing awareness of DSRIP program will help communities:

•

Leverage Benefits

DSRIP will strengthen community capacity across the continuum • •

Engage

Now is the time to learn more about delivery system reform You may be approached by a coordinating entity to participate in a Virginia Integration Partnership (VIP) DMAS will invest in provider infrastructure and supports in order for providers, payers, health plans, and the Department to succeed in the shift toward a new model of care and Medicaid payment models. • •

Continue Learning

DSRIP is in early development and design stage Information posted to DMAS webpage: •

http://www.dmas.virginia.gov/Content_pgs/ dsrip.aspx

http://www.dmas.virginia.gov

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Next Steps . . .

Work with CMS • 1115 Waiver • Regulations • Readiness review • MCO Contracts Systems Enhancements • Connectivity • Transition of Care • Monitoring Ongoing Stakeholder & Member Engagement/ Outreach & Education MLTSS Health Plan Selection • Evaluate, negotiate, readiness, & award Regional Implementation & Ongoing Monitoring & Program Evaluation http://www.dmas.virginia.gov

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Ongoing Stakeholder Input

Providers and stakeholders can directly improve the MLTSS design by communicating what is working well and what needs improvement

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What are your concerns, worries, questions, and suggestions ?

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What is working well under CCC and what are the areas of opportunity? What is needed for a successful MLTSS program launch and a smooth transition from CCC to MLTSS?

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Once MLTSS health plans have been selected, DMAS will facilitate collaborative meetings between DMAS, the health plans and stakeholders/providers http://www.dmas.virginia.gov

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Thank You! For More Information . . .

Send MLTSS questions, concerns, and suggestions to: [email protected]

Additional MLTSS information is available at: http://www.dmas.virginia.gov/Content_pgs/mltss-home.aspx

Additional DSRIP information is available at: http://www.dmas.virginia.gov/Content_pgs/dsrip.aspx

http://www.dmas.virginia.gov

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