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SCDuE Weekly Update | September 16, 2013

SCDUE PROSPECTIVE CICOS

As part of this Demonstration, the State wants to ensure that every prospective Coordinated and Integrated Care Organization (CICO) is qualified to accept enrollments, to protect and provide the necessary continuity of care, to ensure access to the spectrum of Medicare,  Medicaid and pharmacy providers most frequently utilized by the Medicare-Medicaid population, and to fully meet the diverse needs of the Demonstration’s target population.  As such, every prospective CICO must meet both State and Federal requirements in order to participate in the Demonstration. As part of its application process, the State has identified specific qualifications based on the  current managed care organization application requirements along with elements of the Demonstration currently under negotiation between CMS and the State.  Each prospective CICO must provide supporting documentation for the requirements and standards, including relevant policies and procedures.

The State will utilize its external quality review organization, The Carolinas Center for Medical Excellence (CCME) to validate state-specific requirements.  All prospective CICOs must also pass a comprehensive joint CMS/State readiness review prior to the start of marketing or enrollment activities. The readiness review will  further evaluate the capacity of each potential CICO and its ability to meet all Demonstration requirements, including having an adequate network that addresses the full range of beneficiary needs, and the capacity to uphold all beneficiary safeguards and protections.

The following organizations have submitted both a letter of application along with the required documentation for validation:

Absolute Total Care, Inc.

Advicare

Humana Health Plan, Inc.

Molina Healthcare of South Carolina, Inc.

Select Health of South Carolina

WellCare of South Carolina

 

SCDUE UPDATE WITH LEADING AGE SOUTH CAROLINA

Members of the SCDuE team met with staff and leadership at LeadingAge South Carolina on Thursday, September 5, 2013 to provide an update on the SCDuE Demonstration. The session explored the impact of the Demonstration on the nursing facility (NF) industry. Information was delivered on specific areas of interest including rates, contracting and care coordination.  Additionally, the impact of blending two federal payment streams on nursing facilities was addressed.

 

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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 Manager, 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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