Updated April 25, 2013
On April 12, MassHealth announced some changes in auto-enrollment: high need group will be delayed til January 2014 and possibly those in C2. C3 reflects people who have 4 or more activities of daily living needs OR 2 or more activities of daily living needs plus 3 days of skilled nursing needs. C2 covers individuals who have behaviorial health needs which require significant staffing.
We also updated the powerpoint below the following paragraph- family forums powerpoint.
The Arc is encouraging individuals and families to either actively participate or to opt out. In other words, if you do feel this demonstration will be positive then you should choose the right ICO for you. They will be reaching out to you in the coming months too. If you do NOT wish to be part of the demonstration at the present time, you should make sure you fill out the form that MassHealth will send you and state that you “opt out”. Persons enrolled in the home and community based waivers at DDS, MRC and elder services are not affected by the demonstration at the present time.
Go here to download our family forums presentation.
In other related news, The Arc of Massachusetts is concerned about the rates that have been issued to these ICOs. We are concerned that the rates are NOT adequate. In fact there is universal agreement on this issue among advocates, providers and ICOs. We hope that the new Secretary takes a fresh look at the demonstration rates. Recommendations have been shared with Secretary Polanowicz.
The Arc also strongly supports a transparent process to track utilization and funding of all supports and services but particularly long term supports and services (LTSS). Given the goals of the project it’s key to track the use of LTSS.
Two more training sessions are scheduled by The Arc – Northeast on March 26 (deadline for registration this week) and Southeast on April 29 or 30 (more out soon on that date and registration).
You can read a little more about the upcoming change here.
MassHealth has a duals site located here.
January 17, 2013 --
Below are updates related to the Medicare-Medicaid or Duals Demonstration. This demonstration will change how many people will obtain adult family care, personal care attendant services, day habilitation or other community supports. Will I be affected by the demonstration? Training sessions in Jan/early February noted below. You are affected if you are a person with a disability:
• eligible for or receive both Medicare and Medicaid
• are between ages of 21 years and 64 years
You are not included right now if:
• enrolled in a home/community based waiver (you would receive a plan of care-POC if you are on the waiver). Call your state or provider case manager
• reside in one of the state schools
• have comprehensive private or public health insurance
For organiztions which provide long-term support services, you should be addressing your working relationships with some or all of the six ICOs (Intermediate Care Organizations) at any time. They are all preparing for evaluations of their readiness to be ICOs by CMS (Center on Medicare/Medicaid Services) and MassHealth.
See the timeline here. Please note that starting dates have been revised. MassHealth also announced another stakeholder open meeting for January 22 at 10am. See information on that meeting at the timeline link.
Updated January 2, 2013 --
In the coming year, major changes will take place for nearly 114,000 people with disabilities. Our constituents will be included in this change. As we have previously reported, most individuals between the ages of 21-64 years who have both Medicare and Medicaid will have their health and community services managed in the near future through private entities. This project is called the Dual Eligible Demonstration. Click here to read the rest of this article and to get information about our education trainings for individuals, families and staff on this Demonstration.
On December 17, 2012, The Arc announced two trainings on the dual eligible demonstration for individuals, families, and staff on January 17 and February 7. See locations and dates here.
On October 1, we added two new papers to this stie. The first is a technical assistance document from 50 national orgnaizations including The Arc on rehabiitative and habilitative befenfits required by the Affordable Care Act (ACA). The second is an updated and shorter joint memo regarding concerns related to the duals demonstration discussed below.
Technical Assistance Paper on Essential Benefits
Memo on Key Corrective Actions Required for Duals
On August 22, 2012, Massachusetts and the Center on Medicare and Medicaid Services (CMS) signed a memorandum of understanding (MOU) on the Duals Demonstration Project on August 22, 2012. This signifies CMS’s official approval of the Massachusetts Duals Demonstration.
The Arc of Massachusetts has published a position paper specifically in relation to how long term supports and services (LTSS) are covered in the memorandum. The Arc’s position is that there are several gaps in the demonstration related to LTSS that need to be addressed before the program can begin enrolling participants. The gaps in the areas of assessment, quality management practices and measures and ensuring scope and duration of services are significant enough to delay contract development with the new integrated care organizations.
You can see the position paper here.
The Arc also has developed its first education fact sheet that reviews several state plan services including rate information. These fact sheets are for individuals with disabilities, family members, friends and professionals. You can read a summary of the MassHealth/CMS Memorandum prepared by National Senior Citizen Law Center here.
You can connect to the fact sheet here.
You can read MassHealth and CMS’s memorandum here. Pick memorandum of understanding in word or pdf.