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Prime Weekly Update | February 7, 2014

AMENDMENTS TO THREE COMMUNITY LONG TERM CARE (CLTC) WAIVERS

South Carolina Healthy Connections Medicaid intends to file amendments with CMS to three of its home and community-based waiver programs operated through the Community Long Term Care (CLTC) Program.  These waivers are:  (1) SC.0186 HIV/AIDS Waiver, (2) SC.0405 Community Choices Waiver, and (3) SC.40181 Mechanical Ventilator Dependent Waiver.  These amendments will allow eligible waiver participants to enroll in Healthy Connections Prime and to participate in one of the CLTC waivers.  There will be substantive and technical changes in many sections of each waiver to allow this, but no adverse changes are anticipated for participants who are enrolled in Healthy Connections Prime and a CLTC waiver. | Link to Waiver Amendment Public Notice

PRIME TEAM SPEAKS AT WOMEN'S MISSIONARY SOCIETY AND AAA DIRECTORS MEETING

Kicking off Prime education and outreach in the New Year, members of the Prime team spoke at the annual Women’s Missionary Society conference and the Area Agency on Aging (AAA) Directors Meeting.  The goals of both sessions were to provide an overview of Healthy Connections Prime as well as identify advantages of this new program for older adults in South Carolina.  The educational sessions also addressed how these important groups can be involved and how they can help with consumer education and outreach. | Link to WMS Presentation| Link to AAA Directors Presentation

NATIONAL EVALUATION OF DUAL ELIGIBLE DEMONSTRATION

CMS contractor RTI International (formally Research Triangle Institute) will monitor the implementation of all dual eligible financial alignment demonstrations and assess the outcome over time in regards to beneficiary experience, quality, utilization, and cost.  A report was recently published detailing the Aggregate Evaluation Plan, which will guide the overall evaluation process.  RTI will develop separate State Evaluation Reports for each individual state participating in the Financial Alignment Initiative. | Link to Aggregate Evaluation Plan

TEXAS FINALIZING DUAL DEMONSTRATION PROJECT DETAILS

Texas Health and Human Services Commission (HHSC) announced at a stakeholder engagement session on January 21, 2014 that the state and CMS were finalizing details for the duals demonstration project, with expectations to sign an MOU by the end of February.  Texas plans to execute a fully integrated, capitated model with a three-way agreement between CMS, HHSC, and MCOs.  MCOs eligible to participate include those who currently have existing contracts as a Medicare Advantage Special Needs Plan or a STAR+PLUS contract.  Texas plans to implement the three-year duals project on January 15, 2015 in the following six counties:  Bexar (San Antonio), Dallas, El Paso, Harris (Houston), Hidalgo, and Tarrant (Ft. Worth). | Link to Texas Dual Eligibles Integrated Care Demonstration Project

ILLINOIS ANNOUNCES DUALS DEMONSTRATION MCO COUNTY PARTICIPATION

The Department of Healthcare and Family Services in Illinois announced on January 10, 2014 important updates for the dual eligible demonstration.  Plan participation by county was announced, with Humana and Blue Cross Blue Shield (BCBS) of Illinois identified as the only health plans to pass readiness review for all counties in the greater Chicago area.  The implementation date for voluntary enrollment is March 1, 2014, with passive enrollment delayed to June 1, 2014.  | Link to Illinois Financial Alignment Demonstration

NEW YORK FULLY INTEGRATED DUALS ADVANTAGE UPDATE

New York will implement the Fully Integrated Duals Advantage (FIDA) duals demonstration program in eight (8) downstate counties on October 1, 2014, beginning with an opt-in enrollment period.  Individuals will be passively enrolled in a FIDA plan starting in January 2015.  Based on stakeholder feedback, New York has made policy changes regarding the Interdisciplinary Team (IDT) to allow for more flexibility.  Changes to the IDT policy include allowing the nurse who conducted the consumer initial assessments to participate as a member of the IDT, delaying the assessment requirement for long-term care enrollees to sixty (60) days, and postponing provider credentialing requirements to year two (2) of the demonstration.  Twenty-three (23) plans are currently undergoing the readiness review process, including review for network adequacy. | Link to New York Fully Integrated Duals Advantage

HEALTHY CONNECTIONS PRIME WEBSITE EFFECTIVENESS SURVEY

In October 2013, Healthy Connections Prime launched a new consumer friendly website.  This new website was created to provide easier navigation and usability for a variety of audiences.  Additionally, specific areas were created to house information for consumers, caregivers, advocates, providers and CICOs.  The provider and CICO sections were launched first with the opening of the site in October 2013.  New areas of the website have launched in January 2014, including areas for advocates, consumers, and caregivers.  We would like to survey the effectiveness of the new website as we continue to add new content.  This brief survey will provide us with essential feedback on how we can revise and enhance our new site as it continues to be accessed by new visitors.  We appreciate the time taken to fill out the new survey and all feedback provided. | Link to Survey

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