MMW Webinar Managed Long Term Services and Supports … · 6/2/2016 · (MMAI) program began in...
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MMW Webinar Managed Long Term Services and Supports (MLTSS) Implementation Webinar Logistics: • Audio: Listen through your computer speakers or call in using a telephone. To get call-in information, click “telephone” under “audio”. • Because there will be a large number of people on the call, all lines will be muted to ensure good audio quality. • If you have a question during the webinar, please type your question into the question box. Questions will be answered at the end of the webinar. • The webinar slides and recording will be sent to all registrants within approximately one week of the webinar.
Transcript of MMW Webinar Managed Long Term Services and Supports … · 6/2/2016 · (MMAI) program began in...
MMW Webinar Managed Long Term Services and Supports (MLTSS) Implementation
Webinar Logistics:• Audio: Listen through your computer
speakers or call in using a telephone. To get call-in information, click “telephone” under “audio”.
• Because there will be a large number of people on the call, all lines will be muted to ensure good audio quality.
• If you have a question during the webinar, please type your question into the question box. Questions will be answered at the end of the webinar.
• The webinar slides and recording will be sent to all registrants within approximately one week of the webinar.
Medicaid Managed Long Term Services and Supports (MLTSS) Implementation
Presentation by Laura Phelan, Bureau of Managed Care, Illinois Department of Healthcare and Family Services (HFS)Make Medicare Work Coalition Webinar – June 2, 2016
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MMW work is supported by grants from local and regional foundations:
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Retirement Research
Foundation
Chicago Community
Trust
Michael Reese
Health Trust
Who We Are: MMW Leadership• AgeOptions
–Area Agency on Aging (AAA) for suburban Cook County
• Health & Disability Advocates –Policy and advocacy organization
• Progress Center for Independent Living –Cross-disability, non-residential – suburban Cook County
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What We Do• Gather and create practical, accessible
information and materials • Educate Medicare consumers, service
providers and policymakers • Problem solving – individual and systemic • Provide training and technical support for
professionals and volunteers • Advocate for consumer focused laws and
policies • Target underserved groups
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www2.illinois.gov/hfs 66
Illinois Department of Healthcare and Family Services
Medicaid Managed Long Term Services and Supports
(MLTSS) Implementation
www2.illinois.gov/hfs 7
Medicaid Programs for Dual Eligibles• Beginning July 1, 2016, Illinois will have two
care coordination programs for individuals with full Medicaid and Medicare benefits:
• Medicare Medicaid Alignment Initiative (MMAI)‒ Health plan provides care coordination and covers all Medicaid
and Medicare benefits
• Medicaid Managed Long Term Services and Supports (MLTSS) – New Program‒ Health plan provides care coordination and covers LTSS,
behavioral health, and non-emergency transportation Medicaid benefits
www2.illinois.gov/hfs 8
About MMAI• The Medicare Medicaid Alignment Initiative
(MMAI) program began in March 2014 in the Greater Chicago and Central Illinois Regions
• MMAI covers Medicare, Medicaid, and prescription drug benefits under one health plan• Most MMAI plans also offer extra benefits
like more dental care and lower prescription co-pays
www2.illinois.gov/hfs 9
About MMAI (cont.)• MMAI members have a care coordinator
and care plan with member-driven goals• Care coordinators help MMAI members
manage all of their health care, including primary care, mental health care, hospital care, specialty care, long term services and supports, and care from other providers
• HFS and federal CMS have seen great MMAI successes through care coordination
www2.illinois.gov/hfs 10
MMAI Success Stories• When a 57 year old female joined MMAI, she was visiting the
ER on a weekly basis, typically following a fall in her home
• The care coordinator learned that her current apartment was infested with bed bugs and that her husband was abusive
• The care coordinator and PCP worked with the member to move her to a short-term SLF for rehab for her falls and to keep her safe while exploring living options
– A referral also was made to Adult Protective Services– Through her relationship with her care coordinator the member agreed to
engage in counseling services
• The care coordinator also worked with the landlord to take care of the bed bug infestation
• The member is returning home alone with homemaker services and said she feels optimistic for the first time in a long time
www2.illinois.gov/hfs 11
MMAI Success Stories• Prior to engaging in case management through MMAI, Hank
was visiting the ER about twice a month
• Deanna, Hank’s care coordinator, worked with him to utilize his PCP and the plan’s behavioral health crisis line and nurse line
• Hank reported living with intense pain, so Deanna connected him to a pain specialist and ensured he received the medication he needed
• When Hank expressed ambivalence about his CMHC providers, Deanna assisted Hank in evaluating this ambivalence and empowering him to change treatment teams if he so chooses
• Hank has not been in the ER since last June
www2.illinois.gov/hfs 12
About MLTSS• Medicaid Managed Long Term Services and
Supports (MLTSS) is a “sister program” to MMAI
• The MLTSS Program is for dual eligible individuals receiving full Medicaid and Medicare benefits who opt-out of MMAI and live in a nursing facility or receive waiver services
• MLTSS plans will cover long term care, waiver services, some behavioral health services, and transportation to medical appointments
• MLTSS members will have care coordinators to help manage their health care, including servicescovered through MLTSS and Medicare
www2.illinois.gov/hfs 13
Health Plans Serving MLTSS Clients• Aetna Better Health
• BlueCross BlueShield
• IlliniCare
• Meridian
www2.illinois.gov/hfs 14
MLTSS Enrollment• Dual eligibles who opt-out of MMAI and live in a
nursing home or receive waiver services will need to choose a MLTSS plan‒ MLTSS members will receive Medicare benefits from Medicare
Advantage, Medicare Part D, and/or Medicare fee-for-service
• In June 2016, HFS will begin mailing MLTSS enrollment letters in the Greater Chicago Region with an auto-assignment algorithm that considers:‒ The client’s current Medicare Advantage plan,‒ The long term care facility the client is currently admitted to,‒ The client’s most recent prior MLTSS enrollment,‒ The client’s most recent prior ICP enrollment, and ‒ A random plan selection when an assignment cannot be made
based on any of the previous criteria.
www2.illinois.gov/hfs 15
MLTSS Enrollment (cont.)• The enrollment letters will include a 60 day choice
period and provide the Client Enrollment Services (CES) phone number for help picking a health plan‒ The letter will include plan comparison charts to help clients
compare the extra benefits being offered by each MLTSS plan and information about the client’s option to enroll in MMAI instead
• After enrollment, MLTSS enrollees will have a 90-day switch period and then will be “locked in” for one year‒ MLTSS enrollees can opt-in to MMAI at any time
‒ For continuity of care, new enrollees will receive a 180-day transition period and enrollees switching from another health plan will receive a 90-day transition period
www2.illinois.gov/hfs 16
Enrollment ProjectionsTotal Greater Chicago MMAI LTSS Opt-Outs as of 4/1/16
(will receive MLTSS enrollment letters beginning June 2016)
Region CountyNursing Facility
Aging Waiver
TBI Waiver
HIV/AIDS Waiver
Phys. Disabled Waiver
SLF Waiver
Total (NF + Waivers)
Greater Chicago Cook 8,114 11,207 503 207 2,085 1,175 23,291Greater Chicago DuPage 752 458 12 7 79 13 1,321Greater Chicago Kane 342 213 7 3 61 151 777Greater Chicago Kankakee 97 99 3 0 28 34 261Greater Chicago Lake 506 422 14 2 70 87 1,101Greater Chicago Will 360 256 20 6 122 30 794Total Greater Chicago MMAI LTSS Opt-Outs 10,171 12,655 559 225 2,445 1,490 27,545
Total Greater Chicago MMAI LTSS Enrollees as of 4/1/16(will not receive MLTSS enrollment letters)
Region CountyNursing Facility
Aging Waiver
TBI Waiver
HIV/AIDS Waiver
Phys. Disabled Waiver
SLF Waiver
Total (NF + Waivers)
Greater Chicago Cook 7,387 7,009 228 124 1,014 1,635 17,397Greater Chicago DuPage 620 468 6 2 61 49 1,206Greater Chicago Kane 334 131 13 10 61 156 705Greater Chicago Kankakee 465 95 2 0 44 39 645Greater Chicago Lake 644 195 0 0 55 103 997Greater Chicago Will 302 256 11 3 80 62 714Total Greater Chicago MMAI LTSS Enrollees 9,752 8,154 260 139 1,315 2,044 21,664
www2.illinois.gov/hfs 17
Provider Education• HFS released two provider notices in May:
• Nursing Facility Participation in the Managed Long Term Services and Supports (MLTSS) Program (http://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn160519c.aspx)
• Supportive Living Program (SLP) and certain Home and Community-Based Services (HCBS) Provider Participation in the Managed Long Term Services and Supports (MLTSS) Program (http://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn160519d.aspx)
• HFS will continue working with health plans, provider associations, and advocates to educate providers
www2.illinois.gov/hfs 18
Next Steps• Letters to clients will be mailed in June, July, and
August ‒ Depending on call volume to Illinois Client Enrollment Services, the
roll out may be slowed with letters mailed in September too
• Please help us spread the word about MLTSS, MMAI, and the benefits of care coordination
• You also can provide feedback at MAC meetings or via [email protected]
Note: MLTSS will not be implemented in Central Illinois until there are at least two plans participating in MMAI in the Central Illinois Region
MMW Resources on MMAI/MLTSS• Topical Brief on MLTSS Rollout• FAQ for Professionals on MMAI and MLTSS• Consumer Materials on MMAI (currently being
revised to add MLTSS information – revised copies will be sent to MMW email list soon!)
• Videos in American Sign Language about MMAI (do not contain information about MLTSS)
http://www.ageoptions.org/services-and-programs_MMW-MedicaidandManagedCare.html#ManagedCareToolkit
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MMAI/MLTSS Questions/Issues/StoriesMMW wants to hear from you about the experiences your clients are having with MMAI and MLTSS. We communicate regularly with HFS, CMS, and the MMAI/MLTSS Managed Care Organizations, and we want to help you get answers to your questions and advocate for consumer needs.
Please submit MMAI/MLTSS Issues to Bryce Marable at Health & Disability Advocates here:
https://docs.google.com/forms/d/1GTRjQBPcLujYxwZXt7oz2y8hNmR5HoyBHCXAQxgRZHc/viewform
Please contact us with questions about MMAI/MLTSS:
Thank You!
To download MMW Materials, see our 2016 calendar of events and join the MMW email list, visit:
http://www.ageoptions.org/services-and-programs_makemedicarework.html
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