Duals Update Kijuana Wright May 21, 2014. Arizona Dual Eligible Enrollment 2 Reaching across Arizona to provide comprehensive quality health care for

Duals Update

Kijuana WrightMay 21, 2014

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Arizona Dual Eligible Enrollment

Reaching across Arizona to provide comprehensive quality health care for those in need

44%!

Strategic Duals Alignment • Integration of all services – single

accountable entity better capacity for care coordination

• Payment modernization – single entity capable of better aligning incentives

• Enhanced appropriate community placement for members at risk of institutionalization

• Bends cost curve and improves member outcomes

3Reaching across Arizona to provide comprehensive quality health care for those in need

Dual Alignment Effort• Goal to increase member alignment (same

health plan for delivery of Medicare and Medicaid services)

• Planning passive enrollment for Acute members in August 2014, with October effective date

• Move member to match Medicare plan with opportunity to opt-out

• Approximately 7,500 members affected

4Reaching across Arizona to provide comprehensive quality health care for those in need

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Dual Alignment Effort, continued

• New process allows for better tracking and identification of members

• Members will be notified by mail and have 60 days to call and opt-out if they do not wish to change health plans

• All members who decline to move will not be included in future alignment efforts


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Ongoing Efforts• Future ongoing endeavors to align duals into the

same plan planned for 1-2 times per year (acute and ALTCS in HBCS)

• Incorporate plan best practices for Medicare-Medicaid eligible memberso Contractual requirementso Operational reviews

• Measurement of operational efficiencies and care coordinationo Member satisfactiono Clinical outcomes


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Seamless Conversion• is an existing statutory and regulatory

enrollment mechanism that permits organizations that offer both a Medicare Advantage (MA) plan and a non-MA health plan (e.g., Medicaid, employer) to seamlessly convert individuals in the non-MA plans into the MA plan when those individuals first become Medicare eligible.

o See additional information in section 40.1.4 of Chapter 2 in the Medicare Managed Care Manual


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Seamless Conversion, continued

• AHCCCS will identify members who will be newly eligible for Medicare for both ‘age-in’ and disability reasons at least 90 days in advance of eligibility date

• Plans will learn of this prospective eligibility via the monthly 834 file

• Newly eligible members coded ‘PM’• Plans notify members within 60 days of eligibility

giving them an opportunity to opt-out• Plans must submit proposal to CMS to signal their

intent to participate in this process


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General Mental Health/Substance Abuse

Benefit for Duals• Acute plans will be responsible for delivery of

general mental health and substance abuse benefits for dual members effective 10/1/2015

• This population will be acute dual members who are eligible for Medicare Part A or B

• Will not include members with SMI• As AHCCCS is the payer of last resort, the acute

plans are not the primary payers of these members

• Acute plans should discuss operational issues internally and report any concerns to AHCCCS


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Questions?


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Thank You


Documents

Duals Update Kijuana Wright May 21, 2014. Arizona Dual Eligible Enrollment 2 Reaching across Arizona to provide comprehensive quality health care for