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SCDuE Weekly Update | May 5, 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 | LONG TERM SUPPORTS AND SERVICES TRAINING SERIES
In an effort to facilitate our current discussions related to the integration of HCBS in the Demonstration, the SCDuE team is offering a series of training sessions on South Carolina’s long term supports and services (LTSS).  This training will be held in addition to the on-going education series related to the Demonstration’s implementation.
Members of the Integrated Care Workgroup, as well as other stakeholders, are invited to attend these sessions either in person or by webinar.  Webinar information will be provided prior to the meeting. 

TRAINING SERIES SCHEDULE

Long Term Care Overview
Thursday, May 9, 2013, 9am – 10am

South Carolina Department of Health and Human Services

1801 Main Street, Columbia, South Carolina 29212
Facilitators: SCDuE Team and SCDHHS Community Long Term Care Staff
This session will provide an overview of South Carolina’s long term care (LTC) system, including its history and background, a description of the LTC continuum, and SCDHHS’s strategies and goals related to LTC. Special emphasis will be devoted to transitions within the continuum of care and the impact these transitions have on care coordination.

Medicaid Nursing Facility Care
Tuesday , May 14, 2013, 9am – 10:30am

South Carolina Department of Health and Human Services

1801 Main Street, Columbia, South Carolina 29212
Facilitators: SCDuE Team and SCDHHS Nursing Facility Staff 
Medicaid nursing facility care will be described in this segment including the admissions process, complex care, the State’s new nursing facility bed locator system and the survey and certification process.

Home and Community Based Services, Part 1
Thursday, May 16, 2013, 9am – 10am

South Carolina Department of Health and Human Services

1801 Main Street, Columbia, South Carolina 29212
Facilitators: SCDuE Team
South Carolina’s Medicaid Home and Community Based Services (HCBS) will be featured in this two-part series. Highlights will include how the HCBS system operates, the array of services offered, the role of case management, and a description of the provider network.

Home and Community Based Services, Part 2
Thursday, May 16, 2013, 10am – 11am

South Carolina Department of Health and Human Services

1801 Main Street, Columbia, South Carolina 29212
Facilitators: SCDHHS Community Long Term Care Staff
South Carolina’s Medicaid Home and Community Based Services (HCBS) will be featured in a two-part series. Highlights will include how the HCBS system operates, the array of services offered, the role of case management, and a description of the provider network.

Phoenix/Care Call Demonstration
Thursday, May 16, 2013, 11am – 12:30pm

South Carolina Department of Health and Human Services

1801 Main Street, Columbia, South Carolina 29212
Facilitators: SCDHHS Community Long Term Care Staff
Phoenix and Care Call are the State’s key IT systems for HCBS case management, service authorization, monitoring and reporting.  Key features of the system will be illustrated and connectivity with other IT systems will be addressed.

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)
This session will focus on strategies to engage consumers in the Demonstration.  This session will be facilitated by staff from the Integrated Care Resource Center.

Consumer Directed Care in the Demonstration
Thursday, June 6, 2013, 9am – 10am

South Carolina Department of Health and Human Services

1801 Main Street, Columbia, South Carolina 29212
Facilitators: SCDHHS Staff 
Consumer directed care is an important part of the Demonstration model.  Information about South Carolina’s self-directed care options including paid family caregivers will be discussed.  Staff from SCDHHS will be joined by the State’s contractor for oversight of attendant care.

How a Multidisciplinary Team Functions
Tuesday, June 18, 2013, 10am – 12noon

South Carolina Department of Health and Human Services

1801 Main Street, Columbia, South Carolina 29212
Facilitators: To Be Determined 
The multidisciplinary care team is an important component of care coordination in the Demonstration.  This session will cover how the team can best function to integrate care.
 

INTEGRATION OF LONG TERM 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.
 

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 | New York & Arizona

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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