3. 4/23/2014
3
• Eligibility
– StateDetermines
• 5 MCOs – Texas
– UHC
– Amerigroup
– HealthSpring
– Molina
– Superior
SenateBill -7
• MCOs - Distribute Enrollment Packets
• Plans - Provide Care Coordinator
• No Admission Pre-Certification
• 100% Medicaid RUGs Reimbursement
• Pay For Performance
SenateBill -7
What Does This Mean
To Referral Sources??
• Education:
– Marketing
– DischargePlanners
– Physicians
4. 4/23/2014
4
What Does This
Mean To Me?
• Understanding
– Change
– AppropriatePlacement
– Pre-CertificationRequirements
• Prepare List – Facility Providers
• Be Available - MCO Site Visits
• Coordinate MCO Facility Orientation
• Host Resident Council
• Host Open House – Families
• Review Admission Process
• Review Documentation
What Do I Need
To Do Now?
• Collaboration With Payors
• Care Coordinator Involvement
– CarePlanning & Family Meetings
– DischargePlanning
• HigherAcuity
– Beds ToFill
The Future?
5. 4/23/2014
5
• Current ClinicalSkills
• Needed Resources
– IVCertification
– TPN
– 24/7 RNs
– Complex Wounds
– Resp. Therapy
– Pulmonary Unit - Vents
The Future?
Dual DemonstrationProject
• Targets Traditional Medicare Beneficiaries and
Medicaid Recipients
• Effective 3-1-15
• Passive Enrollment to Medicare HMO over 6
Months
• Goal: ↑ Care Coordination
We Shall Overcome!!