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Virginia’s Blueprint for the Integration of Acute and Long-Term Care Services The Second National Medicaid Congress

Virginia’s Blueprint for the Integration of Acute and Long-Term Care Services The Second National Medicaid Congress. Cindi B. Jones, Chief Deputy Director Department of Medical Assistance Services. June 14 , 2007. The Elderly And Disabled Represent 30 Percent of Program Recipients.

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Virginia’s Blueprint for the Integration of Acute and Long-Term Care Services The Second National Medicaid Congress

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  1. Virginia’s Blueprint for the Integration of Acute and Long-Term Care ServicesThe Second National Medicaid Congress Cindi B. Jones, Chief Deputy Director Department of Medical Assistance Services June 14, 2007

  2. The Elderly And Disabled Represent 30 Percent of Program Recipients Demographics Of Recipients In Virginia’s Medicaid Program Adults Aged 13% 10% 30% Blind & 20% Disabled 57% Children Note: Unduplicated count of recipients in FY 2005

  3. …Yet They Account For Three-Quarters Of Program Spending Recipients Expenditures Aged 10% 30% 26% Aged Blind & Disabled 20% 71% Adults 13% 45% Blind & Disabled 57% Children 9% Adults 21% Children Notes: FY 2005 recipient and expenditure data

  4. This Obviously Means The Cost Of Serving The Elderly and Disabled Is Substantially Greater Than The Cost Of Care For Children $12,000 $11,595 $10,831 $10,000 $8,000 $4,720 $6,000 $4,000 $3,109 $1,725 $2,000 $0 Blind & Disabled All Recipients Aged Children Adults Notes: FY 2005 recipient and expenditure data

  5. 131,246 $112,558 $112,558 $98,485 $56,116 $27,537 $27,947 $18,305 Virginia’s Waiver Programs For The Elderly And Disabled Are Expensive But Still Less Costly Than Comparable Institutional Care Per Person Institution $ Per Person Waiver $ $29,705 $23,904 Waiver Programs DD Tech Assisted EDCD AIDS MR

  6. DMAS’ Key LTC Performance Measure Focuses on Community Based Care

  7. Governor Kaine and General Assembly Directs DMAS to Develop A Blueprint for the Integration of Acute and Long Term Care2006 Virginia Acts of the General Assembly (Item 302, ZZ) This plan shall • explain how the various stakeholders will be involved in the development and implementation of the new program model(s); • describe the various steps for development and implementation of the program model(s), include a review of other States’ models, funding, populations served, services provided, education of clients and providers, and location of programs; and • describe the evaluation methods that will be used to ensure that the program provides access, quality, and consumer satisfaction.

  8. DMAS Held a Series of Three Meetings on Acute and Long Term Care Integration Models and Issues (during Summer/Fall 2006) • First Meeting: Provided an overview of Medicaid funded acute and long term care services in Virginia and across the United States. • Second Meeting: Facilitated a meeting with stakeholders so they could provide input on the options for developing an integrated acute and long term care program in Virginia. • Third Meeting: Heard public comment on the integration of acute and long term care.

  9. Current System—fee for service and fragmented Primary and Acute Care Services Physician Hospital Pharmacy Labs Disease Management Long Term Care Services Nursing Homes Home and Community Based Care Waiver programs (7) Case Management New System—Managed care and coordinated Combines all acute and long term care services (except for certain waiver programs) under one capitated rate Combines Medicare and Medicaid funding ONE CALL—ALL CARE NEEDS Right Services at Right Time What is Integration?

  10. Two Models for Integration • Community Model: Program of All Inclusive Care for the Elderly or PACE. Combines Medicaid and Medicare funding to provide all medical, social, and long term care services through an adult day health care center. • Six communities actively pursuing PACE—6 were awarded start up grants ($250,000 each). • Hampton Roads (2) • Richmond (1) • Lynchburg (1) • Far Southwest (2)

  11. Two Models for Integration(continued) • Regional Model: Could range from a capitated payment system for Medicaid (potentially integrating Medicare funding) for acute care costs with care coordination for long term care services, to a fully capitated system for all acute and long term care services

  12. Medicaid Only (non-duals) 86,732 clients Don’t use long term care services (79,045 clients) Use long term care services (7,687 clients) Medicaid and Medicare (dual eligibles) 148,213 clients Don’t use long term care services (115,152 clients) Use long term care services (33,061 clients) Development of a Plan:Populations CoveredAll 234,945 Low-Income Seniors and Persons with Disabilities (ABD)

  13. Development of a Plan:Services Included • All Medicaid and Medicare primary, acute and long term care services (including nursing facility care and home and community based waiver services) • Home health and personal care services will continue to be the cornerstone to keeping clients in their homes • Services carved out: • Behavioral Health Services (state plan option only) • Certain waiver programs (MR, DS, DD, Technology Assisted)

  14. Development of a Plan:Enrollment Options • Community Model/PACE: Enrollment will be voluntary • Regional Model: Enrollment will be mandatory for managed care programs for acute care needs only; enrollment will be voluntary for managed care program for both acute and long term care needs (clients will be enrolled and have the opportunity to opt out).

  15. Development of a Plan:Providers • Community Model: Federal and state approved PACE sites • Regional Models: Current managed care organizations and/or Medicare Advantage Plans, Special Needs Plans

  16. Integration Models WillBe Phased In • Community Model/PACE • Current System: One Pre-PACE site more than 10 years (Sentara Senior Community Center) • Phase I (2007-2008): Six full PACE sites • Two in Hampton Roads, One in Richmond, Two in the far Southwest, One in Lynchburg • Phase II (2007-2009): • DMAS determines underserved areas of the state and issues a Request for Application for additional PACE sites. Next site location is Northern Virginia

  17. Integration Models WillBe Phased In (continued) • Regional Models • Current System: Managed care for acute care needs only—49,000 ABDs with no Medicare and with no long term care services. • Phase I (2007-2008): Expands managed care for primary and acute care needs only to the ABDs with no Medicare but who have long term care needs. LTC services remain fee for service. • Will not include nursing facility residents • Will not include Technology Assisted Waiver clients • Will not move currentLTC waiver clients into managed care.

  18. Integration Models WillBe Phased In (continued) • Regional Models • Phase II (2008-2010): Fully integrates acute and long term care services and combines Medicaid and Medicare funding. Excludes certain home and community-based care waiver program services (MR, DS, DD, Tech) but does include the clients for coordination of acute and primary care services. • Next Steps • Will include stakeholder input throughout the development and implementation of this phase • Will develop a Request for Proposals in 2007 • Will start as a pilot/regional program in 2008 • Movement of populations, services, and funding sources likely to be phased in over time

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