Commonwealth Coordinated Care Plus CCC Plus Waiver CCC

Commonwealth Coordinated Care Plus CCC Plus Waiver & CCC Plus Managed Care The Arc of Virginia 2147 Staples Mill Road Richmond, VA 23230 T 804. 649. 8481 www. thearcofva. org Lucy Cantrell lcantrell@thearcofva. org 7. 1. 17

AGENDA Agenda: • Introduction to The Arc of Virginia • Virginia Medicaid • Commonwealth Coordinated Care Plus Waiver - Eligibility Determination Process - Services and Supports • Commonwealth Coordinated Care Plus Managed Care • Advocacy! 2

About The Arc of Virginia is a state chapter of The Arc of the United States, the nation’s oldest and largest organization of and for people with intellectual and developmental disabilities (I/DD) and their families. The Arc’s mission is to promote and protect the human rights of people with or at risk of developmental disabilities and actively support their full inclusion and participation in the community throughout their lifetime. 3

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About The Arc of Virginia What We Do: • Public Policy Advocacy • Individual and Family Support • New Path for families in Early Intervention • Grow the Movement • Annual State Convention August 7 -9, 2017 • Chapter Support 5

Virginia Medicaid Introduction Medicaid Program Oversight State Federal Department of Medical Centers for Medicare & Assistance Services Medicaid (DMAS) (CMS) 6

Virginia Medicaid • General Assembly determines State funding $ 8 Billion in Fiscal Year 2016 (includes Federal and State funding) 50% from state funds 50% from federal funds 7

Medicaid Mandated Services All States • • • EPSDT Family Planning Health Clinics Home Health Service Hospital Services Lab and X-Ray Services • Medicare Premiums • Nurse-Midwife Services • Nurse Practitioner • Nursing Facilities • Physician Services • Transportation 8

Medicaid Optional Services Selected by Virginia • Case Management • Home and Community Based Waivers • Home Health • Hospice • ICF-DD • Mental Health Services • Optometry • PT, OT, Speech Therapy • Podiatry • Prescribed Drugs • Prosthetics • Psychology 9

Home and Community Based Waivers States apply for Medicaid Waivers to the federal Medicaid agency known as the Centers for Medicare and Medicaid Services (CMS). This enables states to waive the requirements that individuals must reside in an institution in order to receive Medicaid funding for services. With a waiver, people who meet qualifications may have their services in their home rather than an institution. 10

Medicaid Benefits Once enrolled in a Medicaid Waiver … • Medicaid card • All Waiver and State Plan (Mandatory and Optional Services) services you are eligible for • May be enrolled in a Medicaid managed care plan 11

Early & Periodic Screening Diagnosis & Treatment EPSDT Medicaid benefits for children under the age of 21 Must be eligible for Medicaid Monitor to prevent health and disability conditions from occurring or worsening ®Treatment to “correct or ameliorate conditions, ” including maintenance services EPSDT Fact Sheet: http: //www. dmas. virginia. gov/Content_atchs/mch/mc h-epsdt_fs. pdf 12

HIPP • Health Insurance Premium Payment (HIPP) for Kids • May pay a portion or total health insurance premium • Application separate from Medicaid eligibility and filed with Dept. of Medical Assistance Services • Call 800 -432 -5924 http: //www. dmas. virginia. gov/content_pgs/rcphipp. aspx 13

Medicaid Works • • People with disabilities who work Available to people enrolled in Waivers Enroll before income goes above $804/month Complete an agreement, then work – – Income (gross earnings) up to $75, 000 a year – Resources up to $35, 684 – http: //www. dmas. virginia. gov/Content_pgs/rcpmbi. aspx 14

Patient Pay $ People may have to pay for some Waiver services if they have income over $1, 212 per month $ No patient-pay for Alzheimer’s and Tech Waivers $ Some exceptions for persons who are working 15

Medicaid Appeal Rights Individuals have the right to challenge decisions and actions regarding Medicaid. For example denial of the waiver may be appealed to the VA Dept. of Medical Assistance Services (Medicaid). • Fair Hearing • Appeal must be requested within 30 days of the decision or action that you disagree with • Decision should be issued by the Hearing Officer within 90 days For more information about Medicaid appeal rights go to: http: //www. dmas. virginia. gov/Content_pgs/appeal-home. aspx 16

Home & Community Based Care Waivers give States the flexibility to develop and implement alternatives to institutionalization. 17

Home & Community Based Medicaid Waivers 18

CCC Plus Waiver Commonwealth Coordinated Care(CCC) Plus Medicaid Waiver Effective July 1, 2017 19

Combination of Existing 1915 c Waivers ▪ Combines Elderly or Disabled with Consumer Direction and Technology Assisted Waiver ▪ Expands current services to both populations ▪ Waiver becomes Commonwealth Coordinated Care Waiver ▪ Effective 7/1/2017 EDCD Waiver Tech Waiver CCC Plus Waiver

CCC Plus Waiver Services will automatically continue through CCC Plus Waiver No Changes to FFS waiver processes Pre-admission screening processes unchanged Enrollment and service authorization process unchanged Current service authorizations will continue No action is required by providers

Criteria for CCC Plus Waiver Functional Needs Category Combination of: Activities of daily living Behavior and orientation Mobility Joint motion Medication administration Nursing or Medical Needs Category Risk of Placement in a Nursing Facility within 30 days 22

Long-Term Care Medicaid Eligibility Process for Waivers • Screening First • Financial Eligibility Second • Screening for all Waivers must be provided without any charge to the individual 23

Screening for CCC Plus Waiver • Preadmission Screening Teams of the Dept. of Health and/or Dept. of Social Services OR Hospitals • Screening tool-UAI (Uniform Assessment Instrument) • No waiting list if found eligible • Can receive services through the CCC Plus Waiver while on waiting list for DD Waiver. 24

Long-Term Care Medicaid Waivers Must Need Long-Term Care Assessment / screening • • Financial Thresholds Monthly income limit $2, 205 Resource limit $2, 000 adults Parent income & resources do NOT count regardless of child’s age Disability determination at age 18 25

Special Needs Trusts & ABLE Accounts • Maintain assets for future needs • Protects from disqualifying for public benefits - www. commonwealthcommunitytrust. org - www. thearcofnovatrust. org - https: //www. able-now. com/ -For attorneys skilled in benefits planning: http: //www. specialneedsalliance. org/ 26

CCC Plus Waiver Services Adult Day Health 27 Care Personal Assistance Services Private Duty Nursing Respite care Services Facilitation Assistive Technology (AT) Environmental Modifications (EM) Personal Emergency Response System Transition Services

CCC Plus Waiver Services AT and EM • Limited to $5000 per year for each service 28 Private Duty Nursing • Must meet current Tech waiver criteria Respite • Limited to 480 hours/ fiscal year • Increase from 360 hours for Tech waiver

CCC Plus Waiver Services Adult Day Health Care • Group setting • Social and recreational activities • Typically used by people who are elderly and cannot be left alone 29

CCC Plus Waiver Services Assistive Technology • Process: • Prescription for AT evaluation • Evaluation by a qualified Medicaid professional • Quote by a Medicaid AT provider • Delivery after authorization • Limited to $5, 000 per calendar year 30

CCC Plus Waiver Services Environmental Modifications • Modifications to primary home • Ramps and other access features • Fences and other security measures • Modifications to primary vehicle • Lifts, ramps, hand controls • Limited to $5, 000 per calendar year 31

CCC Plus Waiver Services Nursing • Private Duty Nursing • Continuous care up to 16 hours/day • Only if not covered by private health insurance • Must meet specific criteria (previous Tech Waiver criteria) • Home Health Nursing provided for periodic support and maintenance 32

CCC Plus Waiver Services Personal and Attendant Care • Assistance with activities or daily living (ADLs) and Instrumental ADLs • Can be provided in any environment • Supervision for up to 8 hours/day when the primary caregiver(s) are working or going to school for all ages • Consumer Directed or Agency service 33

CCC Plus Waiver Services Personal Emergency Response System • Can include a medication management system • Individual must: • Not be able to use a phone in an emergency • Be 14 years or older • Left alone for a portion of the day • Have the cognitive ability to use the device 34

CCC Plus Waiver Services Respite • Must have a primary caregiver • Caregiver does not have to live with the individual receiving services • Can be provided in any environment • 480 hours per year – July 1 -June 30 • Consumer Directed or Agency service 35

AN INTRODUCTION TO COMMONWEALTH COORDINATED CARE PLUS A Managed Care Long Term Services and Supports Program

Overview of Commonwealth Coordinated Care Plus (CCC Plus) Primary goal is to improve health outcomes New statewide Medicaid managed care program beginning Aug 2017 for over 216, 000 individuals Participation is required for qualifying populations Integrated delivery model that includes medical services, behavioral health services and long term services and supports (LTSS) Care coordination and person centered care with an interdisciplinary team approach 37

Virginia Legislative Mandates General Assembly directed DMAS to transition individuals from the Fee-For-Service delivery model into the Managed Care Model to achieve high quality care and budget predictability. 2017 2011 38

Managed Care Basics DMAS MCO Providers Contracts with MCOs contract with providers Care for Enrollees Pays MCO permember-per-month Pay claims submitted by providers Bill MCOs for enrollee care 39

CCC Plus Populations 65 and older Adults and children living with disabilities Individuals living in Nursing Facilities (NFs) Individuals in Tech Assisted Waiver Individuals in EDCD Waiver Individuals in the 3 waivers serving the DD populations for their acute and primary services *CCC and Medallion 3 ABD populations transition to CCC Plus 40

Excluded Populations 41 Limited Coverage Groups Other Programs • Governor’s Access Plan (GAP) • Family Planning • Qualified Medicare Beneficiaries only • Special Low-Income Medicare Beneficiaries • Qualified Disabled Working Individuals • Members of Medicaid Medallion and FAMIS managed care • PACE (Program of All –Inclusive Care for the Elderly) • Money Follows the Person (MFP) • Alzheimer’s Assisted Living Waiver (AAL) • Health Insurance Premium Payment (HIPP)

Excluded Populations Specialized Settings • Intermediate Care Facilities for Individuals with Intellectual Disability • Veterans Nursing Facilities • VA Home • Psychiatric Residential Treatment (Level C) • State facilities: Piedmont, Catawba and Hancock CCC Plus Excluded Local Government. Owned Nursing Facilities 42 • Bedford County Nursing Home • Birmingham Green • Dogwood Village of Orange County Health and Rehabilitation • Lake Taylor Transitional Care Hospital • Lucy Corr Nursing Home Special Conditions • Hospice and End Stage Renal Disease • (CCC Plus enrolled individuals who elect hospice or have ESRD will remain CCC Plus enrolled)

Developmental Disabilities Waiver Users Commonwealth Coordinated Care Plus • If you receive supports through one of the DD Waivers – Building Independence Waiver, Community Living Waiver or the Family & Individual Supports Waiver – your Waiver services will not be impacted by any of the CCC Plus changes. • However, your Medicaid medical services may be administered by one of the CCC Plus managed care organizations/health care plans. 43

6 Health Plans Contracted Statewide Aetna Better Health of Virginia Anthem Health. Keepers Plus Magellan Complete Care of Virginia Optima Health United Healthcare Virginia Premier Health Plan To learn details about the Health Plans: https: //cccplusva. com/choose 44

1 -855 -652 -8249 TTY 711 1 -855 -323 -4687 TTY 711 1 -800 -424 -4524 TTY 711 1 -877 -512 -3171 or 1 -757 -552 -8360 TTY 711 1 -866 -622 -7982 TTY 711 1 -877 -719 -7358 TTY 711 www. aetnabetterhealth. com/virginia www. anthem. com/vamedicaid www. MCCof. VA. com www. optimahealth. com/communitycare www. uhccommunityplan. com www. vapremier. com Added benefits: Adult dental 2 exams and cleanings and 1 set of x-rays each year, plus fillings, extractions, root canal and dentures (up to $525 each year) Adult hearing aid each year (up to $500 each year) Adult vision Adult hearing 1 exam and up to $1, 000 for hearing aids and unlimited visits for fitting frames, glasses or contacts each year Phone services minutes each month, data and free unlimited texting Memory alarms and devices Community health or contact lenses every two years texts and appointment reminders Smartphone with free Rewards for healthy behaviors More than 25, 000 providers statewide to choose from 12 rides to community events, grocery stores, hair salons and more Healthy Rewards worker to help with housing, food, employment, community resources and more $150 for glasses Wellness programs Online peer support services Home home rental Adult hearing Adult vision Phone services Other benefits Like grants for modifications and assistance Gift Card program $50 for assistive devices and $50 for walker and wheelchair accessories HEPA-grade air purifier Help to quit smoking discharge, day for 7 1 hearing aid for each ear every 36 months Discounts on eye glasses Phone services Free cell phones with 350 minutes and unlimited texting Fresh meals delivered Help to quit smoking to your home after discharge Weight management and home modifications Online, interactive cognitive behavioral therapy support Community online community organizations Wellness rewards Other benefits Supportive employment services Connections directory of services and Enhanced short-term services for all members, when needed Personal care attendant Individualized, fullyintegrated program with a state-wide network of providers Assistive devices Extended respite for caregivers Diabetic foot care Memory alarms and devices Adult vision Eye exams plus up to frames and lenses every 2 years if needed $100 for lenses or frames Phone services delivered to your home after discharge from inpatient hospital or nursing facility, 2 meals each day for 7 days Wellpass program with minutes each month, unlimited texting, and preprogrammed contacts for benefit and Nurse. Line support free smartphone, unlimited texting, and minute and data packages Wellness programs Alere Quit For Life program Exercise at YMCA, and resources to quit smoking or tobacco use Weight Watchers: meeting vouchers year, resources healthy eating weight loss YWCA and Curves Smoking cessation 10 each for and services and resources Healthy Heartbeats prenatal and postpartum wellness program Other benefits Baby Blocks prenatal Chronic disease care rewards for attending prenatal and baby’s appointments Health 4 Me ® free mobile app for health tips, reminders and care team secure messaging Meals Pest control Meals and x-rays each year Adult vision Free smartphone with 350 Wellness programs Environmental 1 set of x-rays each year Eye exam each year and Annual hearing exam Other benefits Respite care Diabetic shoes or inserts X For a list of doctors and hospitals that work with each plan, go to the plan’s website or call their toll-free number listed Caregiver training and support Meals delivered to your above. home after 2 meals each days Exams, cleanings and set of x-rays each year Annual exam and refraction food, jobs and more Other benefits 2 exams and cleanings and Free smartphones for Online search tool to find Regional wellness center Adult dental 1 exam, cleaning $100 for glasses Wellness programs Wellness rewards card 1 set of x-rays each year (up to $1, 500 each year) Added benefits: Adult dental Adult vision Mobile app to use on the go Wellness programs 2 exams and cleanings and Added benefits: Adult dental Phone services minutes, data, texts and calls Free cell phone with 350 Adult dental Added benefits: Adult vision (lenses and frames) each year Eye exam and $100 for Place 1 set of x-rays each year 60 hearing aid batteries Exam and 1 hearing No 2 exams and cleanings and Added benefits: delivered to your home after discharge from inpatient hospital or nursing facility, 2 meals each day for 7 days management including self-management education classes Gift card rewards for wellness and preventive activities Online tools for accessing health plan services Meals delivered to your home after discharge from hospital or nursing facility X For a list of basic benefits that all plans offer, see the brochure in this for up to 14 days packet. CCC PLUS Added benefits:

CCC Plus Regions CCC Plus will operate statewide, across 6 regions A list of CCC Plus regions by locality is available at: http: //www. dmas. virginia. gov/Content_pgs/mltss-proinfo. aspx 46

CCC Plus Enrollment by Region & Launch Date Regions Regional Launch Aug 1, 2017 Tidewater 20, 404 September 1, 2017 Central 23, 102 October 1, 2017 Charlottesville/Western 17, 133 November 1, 2017 Roanoke/Alleghany 10, 974 November 1, 2017 Southwest 12, 772 December 1, 2017 Northern/Winchester 26, 262 January 2018 CCC Demonstration (Transition plan determined with CMS) 28, 785 January 2018 Persons who are Aged, Blind, Disabled (ABD) (Transitioning from Medallion 3. 0) 76, 607 Total All Regions 216, 039 Source: VAMMIS Data; totals are based on CCC Plus target population data as of March 2017 47

CCC Plus Enrollee Benefits Person centered, individualized support plan Same standard Medicaid services provided Choice of health plans Care coordinator for each individual Team of health care professionals working together Assistance connecting to housing, food and community resources Possible additional benefits offered by health plans 48

Coordination with Targeted Case Managers Ø Targeted Case Management (TCM) Services assist individuals in gaining access to specific services Ø TCM services include: early intervention, developmental disabilities, mental health, treatment foster care, addiction and recovery treatment services (ARTS), and high risk prenatal and infant case management services Ø CCC Plus Care Coordinators will incorporate but not duplicate services provided by the TCM 49 CCC Plus Care Coordinator Targeted Case Manager

Enrollee Protections • During the continuity of care period of 90 days, MCOs have to pay existing providers • MCO must go out of network to provide a service that they don’t have in network • Individuals in Nursing Facility (NF) at the time of enrollment will not be moved even if the NF does not choose to participate. NF will be paid as an out of network provider. 50

Enrollee Resources Options for MCO Problem Resolution MCO Contact Care Coordinator Submit a complaint Appeal any adverse action or medical decision DMAS After MCO appeal process … can appeal through the State Fair Hearing Process Ombudsman Contact the Office of the State Long -Term Care Ombudsman for assistance 51

Initial Enrollment Package Letter Brochure Comparison Chart Town Hall Invitation 52

Changing Health Plans • 90 days from effective date in CCC Plus • Open enrollment in 2018 -Oct/Nov/Dec • “Good Cause” at any time (e. g. for continuity of care or due to poor quality care) • Exemptions – PACE 53

Enrollment Letters – Enrollee Choice of Health Plan “Initial Assignment Letter” “Confirmation Letter” 1. Enrollees will receive an initial assignment into a health plan along with a comparison chart of all of the health plans available in their region. 2. Enrollees can change their health plan by contacting the CCC Plus Helpline by the “call by date” identified in their Initial Assignment Letter or by using the website. 3. Enrollees will be informed of the potential option of PACE. 1. A Confirmation Letter will be mailed to the enrollee confirming their Health Plan assignment. 2. Enrollees have 90 days from their effective date to change their final health plan assignment by contacting the CCC Plus Helpline. 3. In 2018, an annual open enrollment period will occur October through December, effective for January 1. 54

MCO Assignment Process CCC Plus Eligible Individuals Previous Medicare MCO Y Previous MCO Assigned Y Matching MCO Assigned N Previous Medicaid MCO N MCO affiliation with: Nursing Facility EDCD / Adult Day Health Provider Tech Private Duty Nursing Provider N MCO Randomly Assigned 55 Medallion 3. 0 ABD population transition in Jan 2018 will use a different process

CCC Plus Enrollment CCC Plus Helpline: Maximus – Enrollees change plans by calling the CCC Plus Helpline or via the website. – Neutral third party – Assist in determining which providers are contracted with specific health plans. – Answer questions about additional benefits offered by participating health plans. – Can field complaints about health plans, access to care or services and reports to DMAS – Toll-free number: 1 -844 -374 -9159 TTY: 1 -800 -817 -6608 Hours of operation: Monday – Friday, 8: 30 a. m. – 6: 00 p. m. 56

Carved Out Services for CCC Plus enrolled individuals that are paid for through fee-for-service. *Carved-out services are Dental Services (Smiles for Children) School Health Services paid by DMAS or a DMAS Contractor for managed care enrolled individuals Preadmission Screening Developmental Disabilities (DD) Waivers – Carve out includes waiver services, related transportation, case management and support coordination. Also includes waiver services covered through EPSDT for DD Waiver enrolled individuals. (DD Waiver services covered through EPSDT includes: Private duty nursing, Skilled nursing, Personal care, Assistive Technology, Center-based Crisis, Community-based Crisis. ) Non-waiver services are covered under CCC Plus program. 57

Carved Out Services Community Mental Health Rehabilitation Services will be carved out until Jan 1, 2018. These services will be covered by Magellan, the behavioral health services contractor for DMAS. Services include: 58 Mental Health Case Management Therapeutic Day Treatment (TDT) for Children Day Treatment/ Partial Hospitalization for Adults Crisis Intervention and Stabilization Intensive Community Treatment Mental Health Skill-building Services (MHSS) Intensive In-Home Psychosocial Rehab Level A and B Group Home Treatment Foster Care Case Management Behavioral Therapy Mental Health Peer Supports

Commonwealth Coordinated Care Plus 59

Member Town Hall – 2 per region Agenda - Introductions - DMAS program overview - Each Health Plan will present on benefits, care coordination, contact information. - Question and Answer 60

CCC Plus Member Conference Calls Ask Your Questions, Make Your Comments • Dates: Every Tuesday starting on July 11, 2017 through December 2017 • Time: 12: 00 p. m. – 12: 30 p. m. • Participants: Calls are open to the first 100 callers 1. Call 1 -800 -832 -0736 2. Press *1095279# 3. Follow the voice prompts. 61

More Information For More Information. . . Additional CCC Plus information is available at: http: //www. dmas. virginia. gov/Content_pgs/mltsshome. aspx Send CCC Plus questions, comments, and suggestions to: CCCPlus@dmas. virginia. gov 62

Got It? Let’s Recap, shall we? ? !!? 63

CCC Plus Waiver Recap 1 Commonwealth Coordinated Care Plus Waiver • Replaced the Technology Assisted Waiver and the Elderly or Disabled with Consumer-Directed Waiver on July 1, 2017. • If already on EDCD or Tech Waivers, no need to do anything. • New CCC Plus Waiver services may be available to you! 64

CCC Plus Managed Care Program Recap 2 Commonwealth Coordinated Care (CCC) Plus Managed Care Program • Includes many people with disabilities, but not all. • Starts in different parts of the state at different times across the state. • If you are enrolled in the CCC Plus managed care program, your CCC Plus Waiver services will also be administered by your managed care company. The timeline for this will be based on where you live in Virginia. 65

CCC Plus Managed Care and Developmental Disability Waivers Recap 3 If you receive supports through one of the Developmental Disability (DD) Waivers (BI, FIS, CL), your Waiver services will not be impacted by the CCC Plus changes. A managed care organization will NOT administer your waiver services. However, your Medicaid medical services may be administered by one of the CCC Plus managed care organizations/health plan care plans. 66

Stay Current • State Regulations being revised • Provider Manuals being revised • Green Waiver Guide being revised vawaivers@endependence. org • Va. Waivers-subscribe@yahoogroups. com • Join The Arc of VA, Follow us on Facebook 67

CCC Plus Waiver CCC Plus Medicaid Manual being developed Follow current Medicaid Manuals for EDCD and Tech until the new manual is posted 68

Be Informed! • Sign up for The Arc of VA Email Updates: http: //www. thearcofva. org/about-the-arc/join-the-mailinglist/ • Visit our website: http: //www. thearcofva. org/ • “Like” us on Facebook: www. facebook. com/The. Arcof. VA • Follow us on Twitter: www. twitter. com/The. Arcof. VA 69

Communicate to your State and Federal Legislators! Every Voice and Face Matters! • Share your story • Include a picture • Find your legislators 70

Advocate for Community Services! Stay informed about issues, policy, legislation that affects people with disabilities Join your local Arc and The Arc of VA to learn about issues and advocate with others. Know your elected representatives in the VA General Assembly and US Congress. Tell your story Prepare your 3 minute elevator speech Write, Call, Visit your representatives. Attend Virginia’s Public Budget Hearings in January 71

Questions? Contact The Arc of Virginia Email: lcantrell@thearcofva. org Tel: (804) 649 -8481 More info about Waivers on our website 72