January 15, 2014 J 15 2014 Presented by: West Central Florida Area Agency on Aging (WCFAAA) 1 Introductions Program Updates ADRC Information and Referral Overview SHINE Overview SSMC LTC and Medicaid Waiver Overview SSMC LTC d M di id W i O i Enrollment Management Adult Protective Service SGR Case Narratives Performance Outcome Measure Overview Client Satisfaction Q & A 2 Jacquee LaFrance, Information & Referral and Quality Assurance Manager 3 1
o Our I&R Specialists assist people in finding the services they need while explaining the clients options. o Empower them to make good decisions for themselves. Information & Referral is o The I&R Department is the art, science and the “front door” to the practice of bringing West Central Florida people and services together. Area Agency on Aging 4 o CIRS-A was obtained by most of the specialists in the I&R department. o I&R specialists can provide information on o I&R specialists can provide information on community resources such as housing, transportation, food pantries, SNAP, & volunteer associations (when available) etc. o The Information & Referral Department can be reached directly at 1.800.336.2226 5 The database used by our I&R Department is available online via the agency’s website www.agingflorida.com If you have knowledge on any potential resources please refer to the inclusion and exclusion criteria handout for application criteria and guidelines. Refer to Handouts 2, 3, and 4. 6 2
Dani Gray 7 What can SHINE do for your clients? ◦ Unbiased Medicare counseling and plan comparisons ◦ Assist with Medicare appeals and billing issues ◦ Prescription Assistance ◦ LIS and MSP Applications ◦ Provide Medicare education to groups 8 Call 1-800-963-5337 All calls are screened by Data Entry Operators and then assigned to a counselor SHINE counselors can counsel over the phone or by appointment at designated counseling or by appointment at designated counseling sites 9 3
10 SMMC LTC Planning and Preparation SMMC LTC Overview and Specifics Continuing Care for MW Consumers C i i C f MW C Ways to Ensure a Smooth Transition Additional Resources 11 CURR CURRENT FUTURE FUTU • Referral • Consolidation of Waivers • Intake • Referral • (Financial + Medical) Screening • Screening & Wait Listing • Funding Approval • Funding Approval • Case Management and g care planning • Enrollment, Eligibility & QA Activities • Providers bill Medicaid & Medicaid pays the • Ongoing Case Provider Management for ALL recipients via MCOs • WCFAAA Medicaid Waiver Specialists • DOEA Monitors Monitor • Start Date Feb. 2014 (PSA 6) 12 4
Current ADRC SMMC LTC Functions: Information, referral and awareness Options counseling, advice and assistance Streamlined eligibility determination for public programs public programs Person-centered transition support Quality assurance and continuous Improvement 13 New ADRC SMMC LTC Functions: LTC Program Education Utilization of new HCBS Client Intake and Screening Assessment Nursing Home Placement Assistance for community (Screening, 3008, RFA, etc.) Waiting List Release LTC Program Education and Screening (in home) Medicaid Eligibility Application Assistance Assist Recipients with Grievances/Complaints Annual Re-Screening for waiting list individuals 14 January 2013 – Enrolling in MW programs commences, 1. DOEA Reporting March - May: Training 2. June: New Service Provider Enrollment Deadline 3. July: Screening DCF Under 60 for Waiver waitlist, 4. R f Referral Agreement for MW programs amended l A f MW d d September: Halt CDC Enrollment, begin Waiver 5. monitoring upload October: Staffing Plan due October 1 st , AHCA begins 6. mailing SMMC LTC recipients letters, Active Client files uploaded to FTP site, Enrollment halt (excluding NHTR) December 2013: NHTR Enrollment Halt 7. 15 5
In preparation for SMMC LTC, WCFAAA has performed the following. Development of a Transition and Staffing Plan Involvement of Board and Community Stakeholders Communication with ADRC Partners Updates to Referral Agreements and MOUs Realignment and training of staff for new duties 16 February 1, 2014 is a big day. It is the PSA 6 SMMC LTC “Go Live” date. WCFAAA staff changes will occur for p purposes of SMMC LTC. p DOEA Reporting for Medicaid Waiver Programs will end. 17 What is it? It stands for Statewide Medicaid Managed Care Long Term Care (SMMC LTC). A new system through which Medicaid recipients who qualify and become enrolled will receive long- term care services from a managed care plan. It has two key components: Long Term Care (implemented August 2013 – March 2014) and Managed Medial Assistance (implementation in mid 2014) 18 6
It is not Part of National Health Care Reform or the Affordable Care Act passed by the US Congress SMMC LTC will not change Medicare benefits. 19 Recipients are mandatory for enrollment if they are: 65 years of age or older and need a nursing home level of care OR level of care OR 18 years of age or older and are eligible for Medicaid by reason of disability, and need a nursing home level of care 20 Recipients must enroll in SMMC LTC if they are 18 or older and enrolled in the following: Assisted Living Waiver Aged and Disabled Adult Waiver Consumer-Directed Care Plus Program (CDC+) g ( ) Channeling Services Waiver Frail Elder Program Long Term Care Community Diversion Waiver Or, they live in a nursing home and have Medicaid as the primary payer. 21 7
Recipients who may choose to enroll in a Long Term Care Program (but are not required to enroll) include: Medicaid recipients enrolled in the Developmental Disabilities home and community based services y waiver, and Medicaid recipients waiting for waiver services Medicaid recipients enrolled in the Program of All Inclusive Care for the Elderly (PACE). 22 A recipient currently residing in a nursing facility cannot be enrolled until they have Received proper level of care from Comprehensive Assessment and Review for Long Term Care Services (CARES) Been approved for Medicaid Been approved for Medicaid A recipient cannot be enrolled to receive home and community based services until they have: Received proper level of care from CARES Been released from the wait list Filed a Medicaid application 23 October 2013: Pre-Welcome Letters sent by Enrollment Broker (EB/Automated Health Systems (AHS)) November 2013: AHCA sends Welcome Letters regarding selecting managed care provider through EB. December 2013: AHCA sends Reminder Letters to all clients. December 2013/January 2014: Clients counseled by EB/AHS regarding managed care options. February 1, 2014: Clients enrolled in managed care plans. 24 8
Mandatory recipients will receive a letter that includes: ◦ Available plans in their region ◦ Which plans they will be assigned to if they don’t make a choice, called an “auto assignment” ◦ Guidance about obtaining more information Guidance about obtaining more information ◦ Ways to enroll Recipients have a least 30 days to choose a plan from those available in their region If no plan is chosen by the date provided in the notification letter, the auto assignment will take place on the specified date. 25 After joining a plan, recipients will have 90 days to choose a different plan in their region. After 90 days, recipients are locked in and After 90 days, recipients are locked in and cannot change plans unless: ◦ They have a state approved good cause reason, or ◦ It is 60 days prior to the recipient’s plan enrollment effective date, known as the open enrollment period. 26 ADRC is the gatekeeper for all new clients needing home and community based services. ADRC conducts Intake & Screening for eligibility education on managed care eligibility, education on managed care options and other program and service resources. Clients are prioritized based on greatest need and placed on waitlist (Assessed Priority Consumer List). 27 9
Client information is sent to DOEA who maintains statewide waitlist and approves clients for release. Once client is released, ADRC assists clients(if needed) to file application for clients(if needed) to file application for 7 7 financial eligibility w/DCF, and obtains 3008 from Doctor. Concurrently, ADRC refers cases to CARES to complete the Level of Care (LOC). CARES also completes the 701(b). 28 CARES feeds LOC via Client Tracking System to EB. DCF will also be expected to electronically upload the eligibility information to the EB. Once financial eligibility and medical Once financial eligibility and medical eligibility are approved, the client is enrolled by the EB with their voluntary choice or mandatory assignment to a managed care organization for services. 29 Enroll Online at www.flmedicaidmanagedcare.com Call the choice counseling call center at 1- 877-711-3662, and speak to a choice counselor counselor Request an in-person meeting ◦ This can be done by calling the call center or selecting “schedule an appointment” on the above website. 30 10
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