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Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals . Idaho Medicare-Medicaid Coordinated Plan (MMCP) Stakeholder Update June 5, 2013. Plan Benefit Package RFP versus Contract Timeline

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Idaho Medicare-Medicaid Coordinated Plan (MMCP) Stakeholder Update June 5, 2013


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idaho medicare medicaid coordinated plan mmcp stakeholder update june 5 2013

Centers for Medicare & Medicaid Services & Idaho Department of Health and Welfare Demonstration to Integrate Care for Dual Eligible Individuals

Idaho Medicare-Medicaid Coordinated Plan (MMCP) Stakeholder Update

June 5, 2013

webinar topics

Plan Benefit Package

  • RFP versus Contract
  • Timeline
    • Implementation- phased in approach
    • MOU
    • Readiness Review
Webinar Topics
plan benefit package pbp

The PBP is a list of Medicare and Medicaid benefits Health Plans will offer in the Demonstration

All Medicare and Medicaid benefits, unless otherwise carved out as in the case of Developmental Disabilities services, are required

CMS required Health Plans to submit a PBP by June 3, 2013

Plan Benefit Package (PBP)
plan benefit package pbp1

Two Health Plans have submitted PBPs for the Demonstration

CMS provided a template to IDHW to provide PBP guidance to Health Plans for services that may have Medicaid benefit limitations greater than Medicare benefit limitations

Plan Benefit Package (PBP)
plan benefit package pbp2

IDHW posted guidance on Medicaid benefits and answers to PBP-related questions at: www.MedicaidLTCManagedCare.dhw.idaho.gov

  • PBP includes benefit limitations, cost sharing information, prior authorization requirements, and other notes. Health Plans must be at least as Enrollee-friendly as Medicaid.
    • Benefit limitations – example: 12 hours/day limitation for adult day health.
    • Cost sharing information – example: possible $3.65 copayments for specified services
    • Prior authorization requirements, if applicable
    • Other notes to clarify the nature of a benefit
Plan Benefit Package (PBP)
rfp vs c ontract

IDHW requested an exemption to the competitive bid process - request approved by the Department of Purchasing

This means we move directly to contract negotiations

Process will involve release of the contract to the interested health plans for review and bid, along with a questionnaire

Plans will submit their bid and their responses to the questionnaire for evaluation by IDHW

RFP vs. Contract
timeline for phased in enrollment approach

Enrollment in the Demonstration will be phased in by IDHW’s three geographical service areas (Southwest, East and North).

  • Opt-in enrollment in the Southwest geographic area begins on March 1, 2014.
    • All Enrollees in the Southwest geographic area who have not opted-in or out before April 1, 2014 will be passively enrolled on that date.
  • Opt-in enrollment in the East geographic area begins on May 1, 2014.
    • All Enrollees in the East geographic area who have not opted-in or out before June 1, 2014 will be passively enrolled on that date.
  • Opt-in enrollment in the North geographic area begins on July, 1, 2014.
    • All Enrollees in the North geographic area who have not opted-in or out before August, 1, 2014 will be passively enrolled on that date.
Timeline for Phased-In Enrollment Approach
duals demonstration feedback

Email

LTCmanagedcare@dhw.idaho.gov

Website

http://www.MedicaidLTCManagedCare.dhw.idaho.gov

Duals Demonstration Feedback