Download Integrated Care/Dual Eligibles Demonstration – `MI Health Link`

Integrated Care/Dual Eligibles Demonstration – ‘MI
Health Link’
Michigan’s Proposal
Michigan submitted and was competitively selected to receive funding from the Centers for Medicare
& Medicaid Services (CMS) for a demonstration project to create an integrated delivery system for
individuals who are dual eligible for both Medicare and Medicaid. There are approximately 9 million
people in the United States that are covered by both Medicare and Medicaid. When fully implemented,
Michigan anticipates having 200,000 enrollees. These individuals include low-income seniors as well
as the younger population with disabilities. Due to this dual eligibility, care is often complex,
inconsistent, and costly.
Michigan received planning funding from CMS in 2011and has been working on the proposal for a new
structure to increase quality, improve coordination, and increase cost-effectiveness for the dual
eligible population. Michigan’s project attempts to create a seamless delivery system for these
individuals through the creation of a care bridge (i.e. a care coordinator) and a web-based portal to
increase communication between providers and care coordinators.
The project develops separate contracts between the federal government, the state, and Integrated
Care Organization (ICOs) and Prepaid Inpatient Health Plans (PIHPs). ICOs will act as the health plan
for all physical health and long term care services, including both institutional and community-based
services and supports. The PIHP will cover all behavioral health services including those for people
who have an intellectual/developmental disability, who have a serious mental illness and/or who have
a substance use problem, this also included the individuals currently categorized as having a ‘mild to
moderate’ mental illness. Individuals currently enrolled in Medicaid and Medicare in the
demonstrations regions, including those currently served by health centers, will be enrolled in the
demonstration. Health Centers wishing to continue to serve as the provider for these beneficiaries will
need to enter in to contracts with ICOs and PIHPs in their region, who will be managing both the
Medicare and Medicaid benefit. The beneficiaries that are in the dual eligible pilot communities for
Integrated Care will be included at settlement time and MSA is currently working on an update to the
MMF and settlement system. Many ICOs are currently reaching out to health centers with contracts to
participate in their provider networks.
Michigan’s Demonstration proposal can be found here: State Demonstrations to Integrate Care for
Dual Eligibles – Demonstration Proposal
Current Status
The demonstration project has been officially named MI Health Link. Michigan signed a Memorandum
of Understanding (MOU) with the Centers for Medicare & Medicaid Services (CMS) on April 3rd, which
solidifies the implementation agreement for January 1, 2015 for four regions. The MOU outlines the
responsibilities of the federal and state governments, as well as the rollout and administration of MI
Health Link.
Current work continues on the development of the web-based care bridge, flow charts for the public
(i.e. the flow of funds, the flow or contracts between entities), and marketing materials. Testing is still
ongoing for the web-portal to determine capacity and ensure enrollment and accessing patient
information will not be delayed because of technical inefficiencies.
Eligibility
Eligibility for the demonstration has been determined to include individuals who are:
 21 years of age or older
 Eligible for both Medicare and Medicaid
 Live in one of the 4 regions
 NOT enrolled in hospice care
 NOT enrolled in PACE or MI Choice
Enrollment Process
The rollout will be implemented in two phases, involving two different types of enrollment. The state
will use Michigan ENROLLS to enroll beneficiaries into the demonstration. Enrolls can use this to optout or change plans on a monthly basis.
Phase 1 will be in Regions 1 & 4 and will allow for a period of Opt-in Enrollment that will start
December 1, 2014 and allow for services to start January 1, 2015. Eligible individuals will receive a 30
& 60 day enrollment notification and unless they actively decline they will be enrolled and services
will start April 1, 2015.
Phase 2 will be in Regions 7 & 9 and will allow for a period of Opt-in Enrollment that will start March 1,
2015 and allow for services to start May 1, 2015. Eligible individuals will receive a 30 & 60 day
enrollment notification and unless they actively decline they will be enrolled and services will start
July 1, 2015.
Integrated Care Organizations by Region
Region 1
(Entire UP)
Upper Peninsula
Health Plan, LLC
Region 4
(Barry, Berrien,
Branch, Calhoun,
Cass, Kalamazoo, St.
Joseph and Van Buren
Counties)
CoventryCares of
Michigan, Inc.
Meridian Health Plan
of Michigan
Region 7
(Macomb County)
Region 9
(Wayne County)
UnitedHealthcare
UnitedHealthcare
Community Plan, Inc.
Community Plan, Inc.
Molina Healthcare of
Molina Healthcare of
Michigan
Michigan
CoventryCares of
CoventryCares of
Michigan, Inc.
Michigan, Inc.
AmeriHealth Michigan, AmeriHealth Michigan,
Inc.
Inc.
Midwest Health
Midwest Health
Plan
Plan
Fidelis SecureCare of
Fidelis SecureCare of
Michigan, Inc.
Michigan, Inc.
Care Coordinators
Each enrollee will have a care coordinator assigned to them through the ICO. If the patient already has
one through the PIHP and prefers to maintain that relationship then the care coordinator from the ICO
will work closely with the PIHP coordinator and allow the patient to maintain their current
relationship. The communication between coordinators from both plans will reduce the silos that
already exist between the entities and will be through a MDCH hosted ‘hub’ that is still in development.
The Individual Care Bridge Record (ICBR) will be stored on this secure, web-based portal with other
documents that can be shared with the enrollee and the Integrated Care Team (ICT). This portal will
hold the enrollee’s medical history, lab results, medications, assessments, Individual Integrated Care &
Support Plan (IICSP), progress notes, and status change updates.
Care coordination will include screening and assessments of physical and behavior health measures,
the creation of an initial (ICBR), the development of an IICSP, and ongoing communication about the
treatment plan and compliance, and medication review.
Resources from Public Forum – April 8, 2014
MI Health Link Forum Presentation 4.08.14
Patient-Centered Care and Person-Center Planning: What’s the Different?
Michigan Voices for Better Health: A consumer Perspective on Integrated Care for People Eligible for
Medicaid and Medicare
Next Public Forum
Wednesday, June 4th at the Macomb Intermediate School District, 44001 Garfield Rd., Clinton
Township, 1:00 -3:00pm in rooms 100A, B, and C.