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Virginia’s Blueprint for the Integration of Acute and Long-Term Care Services The Second National Medicaid Congress PowerPoint Presentation
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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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slide1

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

the elderly and disabled represent 30 percent of program recipients
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

yet they account for three quarters of program spending
…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

slide4
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

slide5

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

slide7

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.
slide8
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.
what is integration
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?
two models for integration
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)
two models for integration continued
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
slide12
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)
development of a plan services included
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)
development of a plan enrollment options
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).
development of a plan providers
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
integration models will be phased in
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
integration models will be phased in continued
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.
integration models will be phased in continued1
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