Special Needs Basic. Care Program ____________________________________________________________ DHS, Health Plans, and Counties June 18, 2013 Age and Disabilities Odyssey
Acronyms l l l l l l BI- Brain Injury CAC- Community Alternative Care Waiver CADI – Community Alternatives for Disabled Individuals Waiver CBP – County Based Purchasing CMS - Centers for Medicare and Medicaid Services COC- Certificate of Coverage DD – Developmental Disability Waiver Dual Eligible – Person eligible for both Medicare and Medicaid DHS – Department of Human Services EW- Elderly Waiver Program FFS – Fee For Service HMO – Health Maintenance Organization MCO- Managed Care Organization MHCP- Minnesota Health Care Program MSC+- Minnesota Senior Care Plus MSHO - Minnesota Senior Health Option NF – Nursing Facility PMAP - Prepaid Medical Assistance Plan PIN - Preferred Integrated Network QMB – Qualified Medicare Beneficiary SLMB - Specified Low-Income Medicare Beneficiary SNBC – Special Needs Basic. Care SNP – Special Needs Plan VADDTCM – Vulnerable adult/developmental disability targeted case management services 2
Special Needs Basic. Care (SNBC) A Managed Care Option for People with Disabilities l l l A voluntary option open to all Medicaid dually eligible and non-dually eligible individuals with disabilities who are certified disabled and eligible for Medical Assistance. Emphasis on preventive and primary care. Health plans provide additional care coordination and navigation help. Access to health plan’s dentists. Access to health plan’s networks. 3
Purpose of SNBC l To provide additional health care delivery options for people with disabilities by coordinating Medicare and Medicaid primary and acute care services. l To improve access to primary and preventive care for people with disabilities. l To improve care for enrollees with chronic conditions. 4
SNBC Covered Services l l l l l Adult Mental Health Rehab Services: Crisis Services, Assertive Community Treatment (ACT), Adult Rehabilitative Services (ARMHS), Intensive Residential Treatment Services (IRTS) Advanced Practice Nurse Services Cancer Clinical Trials Care Management Services - (Acute Medical) Chemical Dependency Treatment Services Child and Teen Checkups Children’s Residential Mental Health Treatment Chiropractic Services Clinic Services Dental Services Disease Management Family Planning Services Home Care Services - Specified: l Home Health Aid (HHA), Skilled Nurse Visit (SNV), Home Care Therapies (PT, OT, RT, ST) Hospice Services Inpatient Hospital Services Interpreter Services Laboratory, Diagnostic and Radiological Services Medical Emergency, Post-Stabilization Care, and Urgent Care Services Mental Health Targeted Case Management l l l l l Medical Supplies and Equipment Medical Transportation Services Mental Health Services including: diagnostic assessment and testing, crisis assessment and intervention, day treatment/partial hospitalization, individual and family group therapy, inpatient and outpatient treatment, neuropsychological assessment and rehab, medication management Nursing Home services (100 days for people admitted from the community) OBRA Level 1 (NF) OBRA Level 2 assessments for Mental Health Obstetrics and Gynecological Services Outpatient Hospital Services Physician Services Podiatric Services Prescription and Over-the-Counter Drugs Not Otherwise Covered by Part B or D Prosthetic and Orthotic Devices Public Health Services Reconstructive Surgery Regional Treatment Centers (under certain circumstances) Rehabilitation and Therapeutic Services l (PT, OT, RT. ST) Transplants Tuberculosis-Related Services Vaccines and Immunizations 5 Vision Care Services
Services That Remain Covered Under Fee-for-Service BASIC CARE SERVICES l Abortion Services, as specified by State and Federal law l Child Welfare Targeted Case Management l Circumcision for Newborns, as specified by State law l Individual Education Plan (IEP) and Individual Family Service Plan (IFSP) Services l ICF-DD Services l Long Term Nursing Home services (post 100 days) l OBRA Level 2 assessments for Developmental Disabilities l Personal Care Assistance Services (PCA) l Private Duty Nursing (PDN) l Vulnerable Adult - Developmental Disability (VADD) Targeted Case Management HOME AND COMMUNITY BASED SERVICES WAIVER SERVICES l Community Alternative for Disabled Individuals (CADI) l Community Alternative Care (CAC) l Brain injury (BI-NF, BI-NB) l Developmental Disabilities (DD) l Waiver Case Management l Long Term Care Coordination (LTCC) l OBRA assessments, Level 1 and 2 (waivers) l Relocation Service Coordination (RSC) SERVICES COVERED ELSEWHERE l Group Residential Housing (GRH) l Medicare l SSI l SSDI l IV-E l Section 8 Housing 6 l Food Stamps
How Does SNBC Work? l l l l Voluntary – people choose to enroll Can disenroll at any time – effective the 1 st of the next month – written request to State or health plan No premiums or additional costs for enrolling Members get an initial health risk screening and additional assessments to identify health needs Navigation assistance and case management to help members use the health care system SNBC plans are required to assist members to receive primary and preventive care physician visits. 24 hour RN lines are available for members to call with health issues. 7
What are the SNBC Health Plan Options in 2013? Health Plan SNBC Program Name Medica MHP Prime. West Health SCHA UCare Access. Ability Solutions Cornerstone Solutions Prime Health Complete Ability Care UCare Connect 8
Is there a difference between SNBC Health Plans? Yes, there can be a difference. § SNBC Health Plans are currently available in 78 Minnesota counties – map is form DHS-5218. § Different SNBC Health Plans are available depending upon the county you live in. § There are differences in the benefit set for each SNBC Health Plan. § For more information on the differences between the SNBC Health Plans contact the Disability Linkage Line and visit the SNBC web site www. dhs. state. mn. us/SNBC. § RFP in June 2013 to reprocure for SNBC statewide for adults (to re-contract with health plans) 9
Enrollment Exclusions Some people are not eligible to enroll in SNBC. DHS applies the current managed care enrollment exclusions to SNBC: l people with monthly medical spenddowns l people with other cost effective insurance or other HMO coverage l people who are QMBs or SLMBs only, without MA l people with only Medicare Part A or B l people living in IMD/RTCs l Other small groups such as people with ESRD, terminally ill individuals, torture victims, non-citizens, and American Indians in certain circumstances. 10
Outreach and Marketing l l l Health plans and DHS are responsible for outreach and marketing to potential enrollees. Health plans must follow all CMS and DHS marketing requirements. All member materials must be reviewed and approved by CMS and DHS. County / tribal staff are not responsible for enrollment and marketing, but may be consulted by potential enrollees and may assist them if requested. County / tribal staff should be careful of conflict of interests in providing Part D marketing advice to clients and must not interfere with client choices. Unless they are the guardian, a county / tribe cannot “opt out” or “disenroll” a SNBC member. 11
SNBC l Legislation passed in 2011 (256 B. 69, subd, 28) requires that adults and children with disabilities receiving Medical Assistance (MA) be assigned to a Special Needs Basic. Care (SNBC) health plan unless individuals choose to opt out of enrollment. l People may choose to opt out or disenroll at any time and return to MA fee-for-service (FFS) the 1 st day of the next month. l At this time, only people ages 18 through 64 are being enrolled in SNBC. 12
What happens at 65? Enrollees may remain in the SNBC plan when they turn 65, unless: • They lose MA eligibility for a period of time and a new enrollment needs to be completed, or • They choose to become a participant in the Elderly Waiver program (EW) and receive Home and Community Based Services through EW. Things to consider: • SIS-EW budget allows the recipient to retain more of their income • EW may not have all the services provided through CAC, CADI, DD, or BI waivers • The SNB service area is not the same as the MSC+ or MSHO service area. The same health plan may not be available. 13
SNBC l SNBC is still considered a “voluntary” program under federal regulations due to the opt out provision. l People enrolling through the Medical Assistance (MA) program are not required to enroll in the Medicare SNP portion of SNBC, but if eligible they could do so at any time if that is available in their county. l As of 4/1/2013: About 51, 079 people were eligible to enroll in SNBC. About 15, 000 of the eligible group were receiving services under the CAC, CADI, BI, or DD waivers. Many chose to opt out in 2012. 14
Enrollment Process l l l Enrollments are processed at DHS by DHS managed care staff. Counties are not currently involved in SNBC enrollments. Current process: send enrollment information as people become eligible for SNBC. The initial mailings are sent by DHS. l Letter and Enrollment / Opt Out Form “Open enrollment” letter to current SNBC members will be sent this fall – with annual Rights Notice The Disability Linkage Line is available for consultation for people seeking help with SNBC enrollment: 1 -866 -333 -2466 15
SNBC Enrollment http: //www. dhs. state. mn. us/dhs 16_141529#. pdf Over 38, 000 people enrolled in SNBC between January 2012 and May 2013. Dec-11 Jan-12 Jul-12 Dec-12 May-13 6, 530 10, 738 40, 507 36, 268 45, 460 Thanks to you all! During this expansion, there has been remarkable collaboration, communication, and coordination between counties, tribes, health plans, providers, advocates, and DHS. 16
What health plans have learned What is going well? l l l Stakeholder meetings & other public workgroups County / Tribe / Health Plan Communication Improvement Group Stakeholder discussions and consensus on processes, forms, who to call MCOs were prepared to support enrollment growth Disability Linkage Line support Ombudsman Office support MCOs 17
What is going well? l l Strengthened working relationships between DHS, DLL, counties, providers, advocacy groups, MCOs and tribes. Utilization and demographic data provided by DHS to the plans MCOs dedicated resources and developed creative ideas for improving internal processes to support members with special needs. New Care Coordination partnerships developed with entities who have history in serving the disability community MCOs 18
What opportunities still exist? l l l Broader program awareness and training among key stakeholders including fee-for-service providers. Broader participation in DHS workgroups. Broader program education for program participants (and their families) who chose to optout based on incorrect information. Minimize changes to enrollment processes. Continued collaboration and planning among DHS, MCOs, counties, tribes, providers, advocates, etc. MCOs 19
Opportunities l Continued efforts to coordinate care and communication especially for enrollees receiving HCBS waiver services for people with disabilities, or people receiving PCA and PDN services. l l l DHS Bulletin 13 -25 -01 New report for lead agency case managers and managed care organization care coordinators Check your Mn. ITS mailbox weekly! Developing “best practices” for transitions between FFS and managed care based on lessons learned from the various 2012 enrollment phases. 20
Opportunities • Ongoing need for policy / process training for front-line staff across all stakeholders, with focus on working with people with special needs. • Mn. CHOICES – health plans will be able to see county / tribe assessment information (now cannot see all of MMIS) 21
What Counties and Tribes have learned § § § Different case management models between plans Varied subcontracting of case management and services “New players” Don’t always know about enrollment into health plan Vulnerable clients - changes, new people, new plan County / tribe staff unaware of new people, new partnerships Counties and Tribes 22
Challenges and Opportunities § § Often, health plan call centers instead of a case manager for enrollees County-dedicated lines at health plans are sometimes overwhelmed Assumptions that county / tribe know SNBC and how it interacts with other services Assumptions that SNBC care coordinators knew HCBS waivers and other county / tribe administered services Counties and Tribes 23
Challenges and Opportunities Interaction between health plan and county/tribe for MA home care services § Communication between health plans and counties about mutual clients § MMIS screening documents § Mn. CHOICES § Counties and Tribes 24
Success stories DHS, MCOs, county - - Communication tools Who to contact at plan or county/tribe Case manager/ navigator for all Better access to behavioral health services County does not pay a share for MH-TCM for people in a health plan 25
Going forward l Ongoing public workgroups and opportunities for input – always want consumer & public input l Stakeholders group at each SNBC health plan l Sign up to receive updates from DHS at DHS. SNBC@state. mn. us or call 651 -431 -2514 TTY: 711 or 800 -627 -3529 speech-to-speech relay: 711 or 877 -627 -3848 26
Enrollment Assistance l Disability Linkage Line: a free, statewide information, referral, and assistance service for people with disabilities, chronic illnesses, and their representatives. l 1 -866 -333 -2466 l www. minnesotahelp. info/ l Medicare: answers questions about Original Medicare coverage. l 1 -800 -633 -4227 27
Health Plan Enrollment Medica – Access. Ability Solution www. medica. com Enrollment: 952 -992 -2030 or 1 -800 -266 -2157 TTY: 1 -800 -855 -2880, ask to be transferred to 1 -800 -266 -2157 Metropolitan Health Plan – Cornerstone Solutions www. mhp 4 life. org Enrollment: 1 -888 -562 -8000, select option 2 TTY: 1 -800 -627 -3529 or 711 Prime. West Health – Prime. West Complete www. primewest. org Enrollment: 1 -866 -431 -0801 TTY: 1 -800 -627 -3529 or 711 South Country Health Alliance – Ability. Care Enrollment: 1 -866 -567 -7242 TTY: 1 -877 -824 -5611 www. mnscha. org UCare – UCare Connect www. ucare. org enrollment information: (612) 676 -3554 or 1 -800 -707 -1711 TTY: (612) 676 -6810 or 1 -800 -688 -2534 28
Resources l www. dhs. state. mn. us/SNBC l MCO service authorization information: l l http: //www. dhs. state. mn. us/dhs 16_139506 To find the person’s case manager or care coordinator: l l DHS-6581 County / tribal contacts for case manager information DHS-6851 A Health plan contacts for care coordinator or navigator information 29
DHS Special Needs Plans Staff Contacts Pam Parker, Manager 651 -431 -2512 pam. parker@state. mn. us Sue Kvendru, Seniors Programs in Managed Care Policy 651 -431 -2517 sue. kvendru@state. mn. us Deb Maruska, People with Disabilities in Managed Care Policy 651 -431 -2516 deb. maruska@state. mn. us Susan Kennedy, SNBC Coordinator 651 -431 -4895 susan. kennedy@state. mn. us Maggie Friend, Policy Specialist 651 -431 -2515 maggie. friend@state. mn. us Cindy Czech, Stakeholders Workgroup 651 -431 -2514 cindy. czech@state. mn. us Jo. Ann Jones, Lead Worker Service Implementation 651 -431 -2524 joann. q. jones@state. mn. us 30
Thank you for attending! Together, we make health care work for people. Do you have any questions or suggestions? 31
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