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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.