True Blue Special Needs Plan (HMO SNP) Medicare-Medicaid Coordinated Plan June 2020
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 Confidential and proprietary Blue Cross of Idaho 2
True Blue HMO Special Needs Plan DIVIDER SLIDE TITLE A Medicare-Medicaid Coordinated Plan Option
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 Confidential and proprietary Blue Cross of Idaho 4
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 Confidential and proprietary Blue Cross of Idaho 5
2020 Idaho Medicaid Plus Service Area Confidential and proprietary Blue Cross of Idaho 6
True Blue HMO SNP is a $0 premium plan with these additional benefits: Confidential and proprietary Blue Cross of Idaho 7
Coordinated Care We Put the Pieces Together Confidential and proprietary Blue Cross of Idaho 8
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 of Idaho provider portal. Confidential and proprietary Blue Cross of Idaho 9
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 Confidential and proprietary Blue Cross of Idaho 10
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 Confidential and proprietary Blue Cross of Idaho 11
Blue Cross Idaho Medicaid Plus A Medicaid Coordinated Plan Confidential and proprietary Blue Cross of Idaho 12
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 out 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 of Blue Cross of Idaho and continue their benefits through the state. Confidential and proprietary Blue Cross of Idaho 13
Mandatory Counties effective April 1, 2020: • • Boise Jefferson • • Boundary Madison • • Cassia Minidoka • • Elmore Owyhee • • Freemont Payette • • Gem Power Confidential and proprietary Blue Cross of Idaho 14
Blue Cross Idaho Medicaid Plus Timeline February 1, 2020 April 1, 2020 March 1, 2020 January 1, 2020 IDHW enrollment Plans outreach to Welcome packet Go-live date in letters mailed to individuals, facilities and identification expansion counties members in new and groups cards are mailed to counties available new members April 1, 2020 Confidential and proprietary Blue Cross of Idaho 15
MMCP vs. Idaho Medicaid Plus MMCP Idaho Medicaid Plus (True Blue HMO SNP) ( Blue Cross of Idaho Medicaid Plus ) Medicare Included Yes No Mandatory Enrollment No Yes Premium No No Participant Choice Yes Yes Available Today Yes Select Counties Care Coordination Yes Yes Supplemental Benefits Yes No Confidential and proprietary Blue Cross of Idaho 16
Covered Benefits: MMCP vs. Idaho Medicaid Plus MMCP Idaho Medicaid Plus (True Blue HMO SNP) (Blue Cross of Idaho Medicaid Plus) MMCP covers all medically necessary and preventive Idaho Medicaid Plus covers all medically necessary services covered under Medicare Parts A, B and D, as Medicaid benefits, including: well as additional services covered by Medicaid, • including: Hospital, medical, prescription drugs, Hospital costs after Medicare payment • behavioral health (including community-based Medical costs after Medicare payment • rehabilitation services), nursing home, aged and Behavioral health, including community-based disabled (A&D) waiver, personal care services, rehabilitation services (CBRS) • targeted service coordination (TSC), as well as care Nursing home after Medicare payment • coordination. Aged and disabled (A&D) waiver • Care coordination *Developmental disability services, other than TSC, medical transportation and dental continue to be provided through Idaho Medicaid. Confidential and proprietary Blue Cross of Idaho 17
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 Confidential and proprietary Blue Cross of Idaho 18
Contact us with Questions Member Line Dual Special Needs Plan Phone: 888-495-2583 Member Line Idaho Medicaid Plus Phone: 800-289-7921 Waiver Providers Support Line Phone: 866-588-6174 Healthcare Operations Phone: 800-682-9329 All requests: authorization requests/UAI documents/notice Fax: 208-472-5070 of decisions/change requests/significant change requests Email: MMCP-MQM@bcidaho.com Care coordination/Medicaid prior authorization Provider Enrollment Phone: 986-224-3116 Medicare-Medicaid Coordinated Plan (MMCP)/Idaho Fax: 208-331-7669 Medicaid Plus: Email: providerancillaryspecialist@bcidaho.com HCBS, expanded mental health, ICF/long-term care, certified family homes statewide 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 Confidential and proprietary Blue Cross of Idaho 19
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