1 / 13

MassHealth Demonstration to Integrate Care for Individuals with Dual Eligibility

MassHealth Demonstration to Integrate Care for Individuals with Dual Eligibility. Open Public Meeting June 28, 2011 12 – 2 pm Transportation Building Conference Rooms 2 & 3. Meeting Goals. Provide brief update of MassHealth demonstration proposal and project status

cais
Télécharger la présentation

MassHealth Demonstration to Integrate Care for Individuals with Dual Eligibility

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MassHealth Demonstration to Integrate Care for Individuals with Dual Eligibility Open Public Meeting June 28, 2011 12 – 2 pm Transportation Building Conference Rooms 2 & 3

  2. Meeting Goals • Provide brief update of MassHealth demonstration proposal and project status • Follow up on RFI response themes • Gather input on proposed demonstration model • Focus on areas with range of viewpoints • Review next steps 2 2

  3. Development Opportunity • One of 15 states awarded a $1M planning contract from CMS Center for Medicare and Medicaid Innovation • Funding is to support the development of a design proposal for a State Demonstration to Integrate Care for Dual Eligible Individuals • Purpose is to identify, support and evaluate person-centered models that integrate the full range of acute, behavioral health, and long term supports and services • MassHealth’s design proposal submission target date is October 2011 • Design Contract award is the path to possible implementation funding

  4. Proposed Demonstration Model • Target population • 115,000 dual eligibles ages 21-64 with full MassHealth and Medicare benefits • Delivery Model • Medicare would provide funding directly to MassHealth to cover a defined set of services for Dual Eligible members enrolled in the new model • MassHealth would combine the Medicare and Medicaid funding streams and pay the integrated care entities using a global payment method which provides incentives for quality care • Statewide integrated care model would be procured by MassHealth

  5. Proposed Demonstration Model • Integrated care entity baseline requirements: • Foundation of primary care practices with person-centered medical home core competencies • Highly developed acute, primary care, behavioral health, and LTSS provider networks • Health Information Technology • Global payment for all MassHealth and Medicare services would cover acute and primary care, and a broader continuum of behavioral health and community support services • Contracted entities must demonstrate experience and competencies in serving individuals with disabilities, chronic behavioral health diagnoses, and chronic medical problems

  6. Opportunities for Input & Engagement • Member Focus Groups • 4 focus groups with cross-disability dual eligible MassHealth members selected randomly from the caseload • Boston (June 2), Greenfield (June 9), Fall River (June 16), Lawrence (June 23): one rural, one in Spanish • Consumer Meetings • Open Public Meetings

  7. RFI Responses • RFI responses and analysis • 55 respondents • All responses posted publicly; summary of themes will be made public • Broad range of type of respondents • Thoughtful input • Overall support for the proposed model • Areas of broad census • Areas of varied viewpoints

  8. RFI Themes Topics for today’s discussion • Program Design and Care Delivery • Program Sustainability • Aligning Medicare and Medicaid

  9. Discussion Guidelines: • State your name and your organization • Keep your comments brief • Focus your input on ways to address issues and move the project forward • Remember that we are all working toward the same goal: Building a model of care which best serves the needs of dually eligible members

  10. Program Design and Care Delivery Suggested Areas for Discussion: • Benefits • Person-Centered Planning • Care Coordination and Care Teams • Member Protections

  11. Program Sustainability Suggested Areas for Discussion: • Achieving Adequate Enrollment • Financing and Risk Adjustment • Quality Measurement and Incentives • Delivery Models and Requirements • Provider Networks • Technology

  12. Aligning Medicare and Medicaid Suggested Areas for Discussion: • Interaction of State and Federal Rules • Flow of Medicare and Medicaid Funds • Outreach and Marketing • Administrative Practices

  13. Next Steps Information andOpportunities foradditional input: • Website www.mass.gov/masshealth/duals • Upcoming meetings • Related materials • Duals@state.ma.us • Next meetings • Consumer Focused Meeting July 21, 10am – 12pm, 1 Ashburton Place, Boston Matta Conference Room, 11th floor • Open Public Meeting August 31, 10am – 12pm Worcester Public Library

More Related