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Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible


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Michigan's Integrated Care Plan for People who are Medicare-Medicaid Eligible

  2. 2. Purpose of Today’s Webinar Develop a common understanding of the components of Michigan’s plan Develop a list of questions health centers would like to have clarified Discuss potential implications for health centers and the patients we serve and MPCA’s response
  3. 3. Michigan’s Integration Goals• Seamless delivery of services• Reduce fragmentation• Reduce barriers to home and community- based services• Improve quality of services• Simplify administration for beneficiaries & providers• Cost effectiveness aligning financial incentives
  4. 4. The Plan Development Process• Planning Contract received (April, 2011)• Multiple stakeholder input activities (July – December) • Interviews, forums, request for input, workgroups, written comments• Proposed Plan Issued (March 5, 2012)• Public Input on Plan (30 days)• MDCH forums (March 20th, March 29th)• Submission to CMS – April 26, 2012• Implementation begins July 2013
  5. 5. The Proposal Change financing model for ~ 200,000 persons who are dually covered by Medicare and Medicaid. ◦ Move from the current Fee For Service model to an organized system of care.
  6. 6. Integrated Care Flow of Funds
  7. 7. Plan StructureIntegrated Care Prepaid Inpatient HealthOrganizations (ICOs) Plans (PIHPs)• ICOs will contract with: • PIHPs will contract with: • Physical Health • CMHSPs Providers • Behavioral Health • Long Term Care Providers Providers
  8. 8. Integrated Care Organizations(ICOs)The ICO is responsible for financing and coordinatingbenefits:Medicare Part A & B (primary & acute care).Pharmacy Part DLong term care services & supports including communitybased and nursing facility, both skilled and custodialManagement of person-centered medical homeCare and supports coordination team
  9. 9. Prepaid Inpatient Health Plans (PIHPs)The PIHP is responsible for financing andcoordinating benefits for all behavioral healthservices for persons with:  Intellectual/developmental disabilities  Serious mental illness  substance use disorders  Care and supports coordination team
  10. 10. How Integration Happens –The Care Bridge• A services or supports coordinator leads a multidisciplinary team to coordinate services & supports for the beneficiary according to a self determined, person centered plan of care.• The services or supports coordinator has 24/7 contact responsibility for the beneficiary• Leading coordinating entity (ICO or PIHP) is defined by beneficiary and highest care need. 10
  11. 11. Enrollment process Passive enrollment - beneficiary enrolled unless they indicate a choice to opt out Open enrollment for two months during phased implementation and subsequent enrollment Post enrollment there will be a single person-centered screening and assessment tool and process 11
  12. 12. Quarterly Phase In-Geographic• Beginning July, 2013 – all beneficiaries in plan by June, 2014• People enrolled at quarterly Intervals using several regional areas• Regions developed based on potential for enrollment volume and other readiness factors• First group of counties will be selected to assure sufficient # of enrollees to demonstrate the plan, but will include less than ½ the population• Remaining counties grouped along logical geographic and health care market lines
  13. 13. Quarterly Phase In-Populations1st Quarter – Persons with: • Physical disabilities • Serious mental illnesses • Substance use disorders • Older adults not in nursing facilities2nd Quarter– Persons using long term care services in: • Nursing facilities • MI Choice Waiver 3rd Phase– Persons with intellectual/developmental disabilities 13
  14. 14. Public Input OpportunitiesCopy of Plan at: Forums • March 20th, 1:30 – 4:00 p.m.; Best Western Hotel (Causeway Bay), Lansing • March 29th, 1:30 – 4:00 p.m.; Greater Grace Temple, DetroitComments by email at: IntegratedCare@michigan.govDue no later than close of business April 4, 2012 14
  15. 15. Impact on Michigan CHCs Michigan CHCs are currently serving approximately 22,600 Dual Eligible Individuals. The number of duals in CHCs should continue to grow with Medicaid expansion and the aging of the baby boomers. Health Centers currently contract with many of the likely ICOs. We will need to be sure the Medicaid provisions that require contracts with FQHCs are included. Maintenance of Medicaid PPS will be critical and Michigan Medicaid’s share of PPS will be greater for duals.
  16. 16. DISCUSSION