True Blue Special Needs Plan (HMO SNP) Medicare-Medicaid - - PowerPoint PPT Presentation

True Blue Special Needs Plan (HMO SNP) Medicare-Medicaid Coordinated Plan June 2020

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Star Rating System

• The Centers for Medicare and Medicaid Services (CMS) created a

five-star quality rating system to help consumers, their families and caregivers compare the performance of Medicare Advantage (MA) Health Plans.

• The overall star rating is an indicator of the plan’s quality and

performance for the types of services offered.

• True Blue HMO Special Needs Plan (SNP) is rated 4.5 Stars

DIVIDER SLIDE TITLE

True Blue HMO Special Needs Plan

A Medicare-Medicaid Coordinated Plan Option

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Medicare-Medicaid Coordinated Plan Program Overview

• The Medicare-Medicaid Coordinated Plan (MMCP) is a fully

integrated Medicare Advantage Special Needs Plan for individuals eligible for both Medicare and full Medicaid

• Also known as the True Blue HMO Special Needs Plan (SNP)
• True Blue HMO SNP members receive the same benefits

available to them in Medicaid and Medicare, including prescription coverage

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True Blue HMO SNP

True Blue HMO SNP provides services for individuals enrolled in Medicare and full-benefit Idaho Medicaid. Individuals are eligible for True Blue HMO SNP if:

• Enrolled in Medicare and full Medicaid
• At least 21 years old
• Live in the MMCP service area
• Do not have end-stage renal disease

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2020 Idaho Medicaid Plus Service Area

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True Blue HMO SNP is a $0 premium plan with these additional benefits:

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Coordinated Care

We Put the Pieces Together

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Member Care Plan

• Member care plan is made available upon request to the enrollee’s identified

interdisciplinary team on the Blue Cross of Idaho provider portal, which includes: ▪ Primary Care Provider (PCP) ▪ Care Coordinator

• PCP is informed and may have ongoing communication with care coordinator.
• The care plan is a guide for everyone involved in the care of the member on how to

provide appropriate treatment to ensure optimal care outcomes.

• Any caregiver can find all the information needed to care for a member in the

member’s care plan. Members are encouraged to keep a copy of their care plan accessible.

• MMCP care plans are available upon request and PCPs can find them on the Blue Cross
• f Idaho provider portal.

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Care Plan Elements

• Health status
• Diagnosis
• Functional limitations
• Supports (natural and paid caregivers)
• Educational and vocational opportunities
• Goals
• Target dates
• Participant requested services
• Participant preferences

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Why Care Coordination

• Patients are educated
• Medication is monitored and adhered to
• Care settings are better transitioned
• Physicians stay informed and patients are more engaged, resulting in better

care outcomes

• Gaps in care are filled, patient volume increases and the cost of delivering

care can be quantified more accurately

• Preventive care is increased, leading to higher quality and more efficient,

coordinated care

• Healthcare costs are reduced, disease management is better and the

population is generally healthier

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Blue Cross Idaho Medicaid Plus

A Medicaid Coordinated Plan

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What is Idaho Medicaid Plus?

• Idaho Medicaid Plus is a plan for dual eligible beneficiaries that

coordinates most of their Medicaid benefits through a health plan.

• This program became mandatory November 2018 for Duals who

live in Twin Falls County and have not enrolled in the Idaho MMCP.

• On April 1, 2020, mandatory and passive enrollment was rolled
• ut in several new counties. Passive enrollment began in Adams,

Benewah, Clark, Gooding, Jerome, Latah, Shoshone, Valley and Washington counties. Participants in these counties may opt out

• f Blue Cross of Idaho and continue their benefits through the

state.

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• Boise
• Boundary
• Cassia
• Elmore
• Freemont
• Gem
• Jefferson
• Madison
• Minidoka
• Owyhee
• Payette
• Power

Mandatory Counties effective April 1, 2020:

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Blue Cross Idaho Medicaid Plus Timeline

January 1, 2020 February 1, 2020 March 1, 2020 April 1, 2020 IDHW enrollment letters mailed to members in new counties available April 1, 2020 Plans outreach to individuals, facilities and groups Welcome packet and identification cards are mailed to new members Go-live date in expansion counties

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MMCP vs. Idaho Medicaid Plus

MMCP

(True Blue HMO SNP)

Idaho Medicaid Plus

(Blue Cross of Idaho Medicaid Plus) Medicare Included Yes No Mandatory Enrollment No Yes Premium No No Participant Choice Yes Yes Available Today Yes Care Coordination Yes Yes Supplemental Benefits Yes No Select Counties

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Covered Benefits: MMCP vs. Idaho Medicaid Plus

MMCP (True Blue HMO SNP) Idaho Medicaid Plus (Blue Cross of Idaho Medicaid Plus)

MMCP covers all medically necessary and preventive services covered under Medicare Parts A, B and D, as well as additional services covered by Medicaid, including: Hospital, medical, prescription drugs, behavioral health (including community-based rehabilitation services), nursing home, aged and disabled (A&D) waiver, personal care services, targeted service coordination (TSC), as well as care coordination. *Developmental disability services, other than TSC, medical transportation and dental continue to be provided through Idaho Medicaid. Idaho Medicaid Plus covers all medically necessary Medicaid benefits, including:

• Hospital costs after Medicare payment
• Medical costs after Medicare payment
• Behavioral health, including community-based

rehabilitation services (CBRS)

• Nursing home after Medicare payment
• Aged and disabled (A&D) waiver
• Care coordination

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Key Points for Provider Community

Ensuring a Smooth Transition

• Health plan prompt pay requirements
• Providers may continue to bill on the same schedule
• Health plans are required to pay – at a minimum – the

Medicaid rate for the same service

• All Medicaid services the member is currently receiving

must be kept in place with existing providers for 90 days

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Contact us with Questions

Member Line Dual Special Needs Plan Member Line Idaho Medicaid Plus Phone: 888-495-2583 Phone: 800-289-7921 Waiver Providers Support Line Phone: 866-588-6174 Healthcare Operations All requests: authorization requests/UAI documents/notice

• f decisions/change requests/significant change requests

Care coordination/Medicaid prior authorization Phone: 800-682-9329 Fax: 208-472-5070 Email: MMCP-MQM@bcidaho.com Provider Enrollment Medicare-Medicaid Coordinated Plan (MMCP)/Idaho Medicaid Plus: HCBS, expanded mental health, ICF/long-term care, certified family homes statewide Phone: 986-224-3116 Fax: 208-331-7669 Email: providerancillaryspecialist@bcidaho.com Provider Training and Website Assistance MMCP/IMP Provider Relations Representatives Phone: toll free 866-432-4612, local 208-286-3678 Fax: 208-286-3561 Email: PRMedicareMedicaid@bcidaho.com Outreach Team Jacob Curtis, Dual Eligible Outreach Specialist Phone: 208-810-2731 Email: Jacob.Curtis@bcidaho.com Kristen Tracy, Dual Eligible Outreach Specialist Phone: 986-224-3045 Email: Kristen.Tracy@bcidaho.com

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