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SCDuE Weekly Update | March 22, 2013

As of Friday, March 22, 2013, the proposed model of the South Carolina Dual Eligible (SCDuE) Demonstration continues to be reviewed by the Centers for Medicare and Medicaid Services (CMS). Since August 2012, the State has participated in three rounds of requests for additional information. The goal of our discussions is to move forward with the clearance of our model and subsequent development of a Memorandum of Understanding (MOU) between the State and CMS.  The SCDuE team will provide updates as negotiations continue with CMS. Some implementation details are subject to change pending a fully executed MOU between the state and CMS; therefore, the State will not issue a procurement solicitation until such time. 
 

INTEGRATED CARE WORKGROUP MEETING

March 27, 2013, 10:00am – 12:30pm

Phillips Market Center at the South Carolina State Farmers Market

3501 Charleston Highway

West Columbia, South Carolina

Directions
The next Integrated Care Workgroup will be Wednesday, March 27th, 10am – 12:30pm, at the Phillips Market Center.  Members of the Integrated Care Workgroup (ICW), as well as other stakeholders will receive a formal invitation via email. 
Our guest speaker is Lynda Flowers, a Strategic Policy Advisor in the Public Policy Institute at AARP.  Ms. Flowers will present information on consumer protection and its impact on the Demonstration.  She will also share examples of how other states have integrated such protections in their program design.  Ms. Flowers’ presentation will be followed by a discussion of this topic and its application in South Carolina’s Demonstration. 
 

IMPLEMENTATION TIMELINE
Although South Carolina continues to progress with planning activities based on its initial timeline, CMS is offering states a choice of four timeframes in which each plan may conduct its first phase of passive enrollment:  January 1, April 1, July 1 or September 1, 2014.   These timeline options offer states opportunities to monitor and mitigate any hindrances to operations or beneficiary access during the initial stages of implementation.  Further, the State is considering the inclusion of an opt-in period which would require revising the initial timeline for passive enrollment.  The State will not formally adjust its timeline until there is an executed MOU with CMS.
 

GUIDANCE TO INTERESTED ORGANIZATIONS

MMP APPLICATION AND MODEL OF CARE (MOC) REVIEW
 
CMS will issue its first round of deficiency notices to plans this week; however, South Carolina will provide comments on state specific elements during the second round of deficiencies notices.
Please review the Cure I deficiency notice and 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. 
 

CICO Contracts
In order to enroll the target population of dual eligible members, CICOs must enter into a contractual arrangement with SCDHHS through the RFP process, as well as the three-way agreement with CMS.   The RFP contains the state-specific language related to the Demonstration and serves as the legal agreement between the State and the CICO.  Existing MCOs currently serving in South Carolina will maintain their current contractual arrangement to serve other populations.

 
 

CICO PROVIDER NETWORK
Subcontractors and delegated vendors of CICOs must have MMP language in contracts with downstream providers if those providers are rendering Medicare services.  Contract amendments may be issued to subcontractors and delegated vendors to ensure the appropriate MMP provisions are incorporated into contracts.

Additional information regarding provider networks can be found in the CMS 2014 Guidance Document and March 2013 SCDHHS Managed Care Policies and Procedures Guide.

  • 2014 CMS Guidance Document | PDF
  • 2013 SCDHHS Managed Care Policies and Procedures Guide | PDF

 

 

PLAN SELECTION PROCESS
The MMP application process and South Carolina’s procurement process are both confidential.  Neither CMS nor the State will release the names of organizations that are pursuing these contracts.  Once contracts have been formalized and signed, both CMS and the State will release the names of those entities.
 
 

AHIP DUAL ELIGIBLE SUMMIT | March 12, 2013

State Strategies for Streamlining and Aligning Initiatives
During the AHIP Dual Eligible Summit, Nathaniel Patterson, MHA, Policy Director, Managed Care, South Carolina Department of Health and Human Services, participated in a panel discussion on State Strategies for Streamlining and Aligning Initiatives. Other state representatives included Suzanne Gore, JD, MSW, Senior Executive Advisor, Virginia Department of Medical Assistance Services; and Julian J. Harris, MD, MBA, MSc, Medicaid Director, Executive Office of Health and Human Services, Commonwealth of Massachusetts.  The panel was moderated by Matt Salo, Executive Director, National Association of Medicaid Directors (NAMD).  

  • AHIP Presentation March 12, 2013 | 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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