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SCDuE Weekly Update | April 30, 2013

The proposed model of the South Carolina Dual Eligible (SCDuE) Demonstration has been changed to reflect a carve-in of home and community based services (HCBS). These changes will be outlined in the Memorandum of Understanding (MOU) between the State and CMS (e.g., transition of HCBS authority to the Coordinated and Integrated Care Organization (CICO) during the Demonstration period). Some implementation details are subject to change pending a fully executed MOU; therefore, the State will not issue a procurement solicitation until such time.
 

INTEGRATED CARE WORKGROUP | EDUCATION SESSION

Integration of Long Term Care Supports and Services in the SCDuE Demonstration

On Wednesday, April 24, 2013, the SCDuE team conducted its second education session, Integration of Long Care Support and Services in the SCDuE Demonstration.  The primary focus of the session was the introduction of the proposed plan for the transition of HCBS authority during the demonstration period.  The team’s proposal outlined detailed readiness standards necessary for the CICO to retain certain components of HCBS authority.  Joining the SCDuE team were Jim Verdier, senior fellow at Mathematica Policy Research of the Integrated Care Resource Center, and Sarah Barth, JD, director of long-term services at the Center of Health Care Strategies.  Jim provided an overview of national trends in the integration of HCBS in managed care plans. His presentation helped stakeholders gain a national perspective relative to the recent changes in South Carolina’s proposed model.  The SCDuE team will receive public comments for the transition proposal through Monday, May 6th.  Pending CMS approval, the final transition plan will be published along with the executed MOU.
 

SCDUE STAKEHOLDER SCHEDULE SPRING 2013
 

Education Session #3: Consumer Engagement
Wednesday, May 22, 2013, 10am – 12:30pm

South Carolina Department of Health and Human Services
1801 Main Street

Columbia, South Carolina 29212
Facilitators: Integrated Care Resource Center (CMS Technical Assistance Team)
 

GUIDANCE TO INTERESTED ORGANIZATIONS

Plan Benefit Package & Additional Demonstration Drug File
The SCDuE team and SCDHHS program staff are working together to develop comprehensive guidance for interested organizations on how to represent Medicaid and Demonstration specific benefits in the plan benefit package (PBP).  Additionally, the team will also provide guidance on the additional demonstration drug (ADD) file that must be submitted for the CY 2014 Part D supplemental files.  This file will include non-Part D products (whether prescription or over-the-counter) or medications required by the Medicaid program.  The ADD guidance will also include any requirements to lower Part D cost-sharing below the statutory low-income subsidy cost-sharing amounts.
The team will provide a draft of both PBP and ADD guidance the first week of May.  Final guidance will be provided no later than mid-May.  In absence of an executed MOU between CMS and the State as well as final rate payment information, CMS anticipates that there will be opportunities to resubmit the PBPs after CMS and the State have conducted their initial reviews.  This would occur primarily so that MMPs can modify supplemental benefits.   Initial reviews by CMS and the State will begin in early June following the PBP submission deadline with reviews completed by late summer 2013.

State Model of Care Review
Please review the Cure I deficiency notice and model of care (MOC) report for deficiencies on the South Carolina specific elements. All interested organizations will be required to address any deficiencies identified by the State in the organization’s Cure II submission. Note, although an organization may have passed the CMS portion of the MOC review, interested organizations will need to review the Cure I deficiency notice and MOC report for any deficiencies on state specific elements.
 

OTHER STATE DEMONSTRATIONS | ARIZONA & NEW YORK

New York
On April 18th, New York published an addendum to its May 22, 2012 proposal modifying its target population and timeline.  According to the addendum, New York will expand its Fully Integrated Duals Advantage (FIDA) program target population to include:

  • Full benefit duals requiring 120 or more days of community-based long-term supports and services (LTSS); and
  • Full benefit duals requiring Medicaid covered facility-based LTSS.

Passive enrollment of these populations will be phased-in beginning with the community-based LTSS population followed by the Medicaid covered facility-based LTSS population.  The modified implementation timeline is April 2014 – December 2017.

  • Addendum to NYSDOH’s May 25, 2012 Demonstration Proposal to Integrate Care for Dual Eligible Individuals and Request for Public Comment | PDF

Arizona
On April 10th, Arizona announced its withdrawal from the financial alignment demonstration.  Among the factors for this decision, outlined in a letter to CMS-MMCO’s Melanie Bella, Arizona’s Medicaid director cited the challenges facing the State in the midst of multiple managed care procurements, as well as political and operational challenges associated with restoring coverage for childless adults.  The State will continue to pursue alignment through the D-SNP platform.

  • Letter to Melanie Bella | PDF

 
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Medicare-Medicaid FAQs (Frequently Asked Questions) | PDF
Contact CMS for any questions or concerns regarding the meetings, guidance, or the MMP application. Emails can be directed to MMCOcapsmodel@cms.hhs.gov
Contact the SCDuE Team for more information, questions, and/or comments related to the SCDuE Demonstration by email at scdue@scdhhs.gov.
For additional assistance, please contact the SCDuE Program Coordinator, Teeshla Curtis by email at curtist@scdhhs.govor by telephone at (803) 898-0070.
Visit the SCDuE Website at https://msp.scdhhs.gov/scdue/
Visit the CMS-MMCO Website at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/index.html
 

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