Slide 1 - NAMI Minnesota

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					 Overview: Expansion of
Special Needs Basic Care

     NAMI Minnesota
      November 5, 2011


             Outline of Session
   Minnesota Health Care Managed Care Programs
   Special Needs Basic Care (SNBC)
   Coordination with Medicare and Medicare Part D
   New legislation about enrollment changes in
    Special Needs Basic Care
   SNBC Enrollment phase in and opt out process
   Rights of Enrollees
   Where to get assistance with enrollment
   Things to consider when enrolling in SNBC
   How to help people with enrollment decisions
   Stakeholder process and involvement
  Overview Minnesota’s Managed Care
           Public Programs
 Population           Eligibility         Managed              Enrollment
                                        Care Program
Families and     • Medical Assistance                          Mandatory
Children         • Minnesota Care
Non Disabled                                                   Mandatory
Adults without   • Minnesota Care
Seniors (65+)     Medical Assistance          MSC+             Mandatory
                                              MSHO             Voluntary
People with       Medical Assistance    SNBC (all people        Voluntary
Disabilities                            with disabilities in
                                        78 counties)
                                        PINs for people
                                        with SPMI/SED in
                                        Dakota county
What Do We Get From Health Plans?
   Health plans provide additional customer services, interpreter
    services, 24/7 nurse lines, navigation assistance, care management,
    transportation, and oversight not included in current FFS systems
   Since Medicare Part D is now delivered through managed care, to
    coordinate drug coverage we need to work with Medicare plans
   Working with health plans also participating in Medicare provides a
    mechanism for improving coordination between Medicare and
    Medicaid service delivery and financing
   Health plans help leverage network access for people who have
    difficulty accessing providers on their own (such as dental care)
   Health plans help direct/manage providers to encourage preventive
    care, best practices, care protocols, and work to measure improved
    health outcomes across populations
   Health plans conduct quality assurance and performance
    improvement programs, disease management programs, pay for
    performance programs and other incentives for improving and
    overseeing care
   Health plans have flexibility to pay providers and arrange care
    differently to address access issues where State cannot
   Administrative costs in MN health plan public programs are among
    the lowest in the US, and are reasonable (about 8%)
   All plans working with DHS are non profit
Minnesota Public Programs Contracted
 Managed Care Organizations (MCOs)
     Health Maintenance    County-Based Purchasing
     Organizations (HMO)        (CBP) Entities

    Blue Plus                Itasca Medical Care
    HealthPartners            (IMC)
    Medica                   PrimeWest Health
    Metropolitan Health       System (PW)
     Plan (MHP)               South Country
    UCare Minnesota           Health Alliance
      Enrollment Numbers
   Managed Care Enrollment Summary By Benefit
    October 2011
      MA Under
      SNBC………………………………..…..5,681
      PINS ………………….................. ..........391
      MSC+……………… ……………… …11,849
      MSHO………………………………..…36,762
      MinnesotaCare-MA……………….…124,239
     TOTAL MANAGED CARE                    583,122
      What is Special Needs BasicCare?
   SNBC is a managed care program designed with
    stakeholders especially for people with disabilities who
    have Medical Assistance (Medicaid).
   The goal of SNBC is to assure access to primary and
    preventive care for members
   SNBC can also assist in coordination of physical and
    mental health needs.
   Enrollment in SNBC is voluntary.
   SNBC started in 2008 and has about 6,000 enrollees in 78
   The State contracts with 5 health plans to provide SNBC.
   SNBC enrollees have access to a care coordinator, care
    guide or navigator to help them get physical health care,
    mental health services, and support services.
       Services for SNBC Members
   People enrolled in SNBC have access to all of the
    same basic care services provided under Medical
   All Medicaid mental health benefits including Mental
    Health Targeted Case Management are also
    included in SNBC.
   Up to 100 days of Medicare or Medicaid nursing
    facility coverage and home health aide and skilled
    RN visits are covered under SNBC by the health
   SNBC DOES NOT INCLUDE personal care, ICF-MR,
    home and community based services, private duty
    nursing and county case management for people
    with developmental disabilities
   These and other long term care services continue to
    be available through Medical Assistance fee-for-
    service for SNBC members.
                      Special Needs BasicCare (SNBC)
                        SNBC COVERED SERVICES
   Adult Mental Health Rehab Services: Crisis          Medical Supplies and Equipment
    Services, Assertive Community Treatment             Medical Transportation Services
    (ACT), Adult Rehabilitative Services (ARMHS),       Mental Health Services including: diagnostic
    Intensive Residential Treatment Services             assessment and testing, crisis assessment and
    (IRTS)                                               intervention, day treatment/partial
   Advanced Practice Nurse Services                     hospitalization, individual and family group
   Cancer Clinical Trials                               therapy, inpatient and outpatient treatment,
   Care Management Services - (Acute Medical)           neuropsycnologicai assessment and rehab,
    Chemical Dependency Treatment Services               medication management
   Child and Teen Checkups                             Nursing Home services (100 days for people
   Children’s Residential Mental Health Treatment       admitted from the community)
   Chiropractic Services                               OBRA Level 1 (NF)
   Clinic Services                                     Obstetrics and Gynecological Services
   Dental Services                                     Outpatient Hospital Services
   Disease Management                                  Physician Services
   Family Planning Services                            Podiatric Services
   Home Care Services - Specified:                     Prescription and Over-the-Counter Drugs Not
                                                         Otherwise Covered by Part B or D
         Home Health Aid (HHA), Skilled Nurse          Prosthetic and Orthotic Devices
         Visit (SNV), Home Care Therapies (PT, OT,
         RT, ST)                                        Public Health Services
   Hospice Services                                    Reconstructive Surgery
   Inpatient Hospital Services                         Regional Treatment Centers (under certain
   Interpreter Services                                 circumstances)
   Laboratory, Diagnostic and Radiological             Rehabilitation and Therapeutic Services
    Services                                                 (PT, OT, RT.ST)
   Medical Emergency, Post-Stabilization Care,         Transplants
    and Urgent Care Services                            Tuberculosis-Related Services
   Mental Health Targeted Case Management              Vaccines and Immunizations
                                                        Vision Care Services
             Special Needs BasicCare (SNBC)

                                          SERVICES WAIVER SERVICES
 Abortion Services, as specified
  by State and Federal law               Community Alternative for Disabled
                                          Individuals (CADI)
 Child Welfare Targeted Case
  Management                             Community Alternative Care (CAC)

 Circumcision for Newborns, as          Traumatic Brain injury (TBI-NF, TBI-
  specified by State law                  NB)
 Individual Education Plan (IEP)        Developmental Disabilities (DD)
  and Individual Family Service          Waiver Case Management
  Plan (IFSP) Services                   Long Term Care Coordination
 ICF-MR Services                         (LTCC)
 Long Term Nursing Home                 OBRA assessments, Level 1 and 2
  services (post 100 days)                (waivers)
 OBRA Level 2 assessments               Relocation Service Coordination
 Personal Care Assistance                (RSC)
  Services (PCA)
                                              SERVICES COVERED ELSEWHERE
 Private Duty Nursing (PDN)                     Group Residential Housing (GRH)
                                                 Medicare
 Vulnerable Adult - Developmental               SSI
  Disability (VADD) Targeted Case                SSDI
  Management                                     IV-E
                                                 Section 8 Housing
                                                 Food Stamps
                         Minnesota Department of Human
            How Does SNBC Work?
   There are no premiums or additional costs for enrolling
    in SNBC.
   People enroll by signing an enrollment form or having
    their guardians or authorized representatives sign it.
   Members can disenroll (or enroll) in any month by
    sending a written request to the State or the MCO
    (effective the 1st of the next month).
   SNBC health plans provide additional navigation
    assistance and care coordination to members to help
    them use the health care system.
   SNBC plans are required to assist members to receive
    primary and preventive care physician visits.
   SNBC health plans must also assist with coordination
    of Medicare benefits.
   Some SNBC plans offer an integrated Medicare plan
    that includes Part D drugs.
                   Key SNBC Contract
   Health Risk screening within 30 days of enrollment
   Medical home/Primary Care Clinic
   Facilitation of annual physician visits
   Broad availability and access to specialists,
    transportation and specialty DME suppliers
   Extended health related case management
   24/7 RN call lines
   Disability competent member services
   Provide information to enrollees about clinic
   Disease management programs specific to people with
   Health plans will cover most Medicaid co-pays for both
    duals and non duals.
   Communication protocols for working with counties
    and providers who are highly involved (eg residential,

    home health)
              Medicare and
         Special Needs Basic Care
   SNBC health plans either directly manage or
    coordinate with Medicare Parts A, B, D coverage for
    people who are eligible for both Medicare and Medical
    Assistance (often called “Dually Eligible”).
   Three of the SNBC plans also offer a Medicare Special
    Needs Plan (SNP) for people with disabilities that
    provides all Medicare services including Part D
    prescription drugs under one card.
   SNBC members can choose to enroll in these
    “integrated” Medicare and Medicaid SNP plans.
   For those who don’t enroll in a SNP Medicare remains
    fee-for-service including Part D drugs.
   Some parts of the State do not have SNP options.
SNBC and Medicare Part D Drugs
   Medicare Part D is now responsible for most drugs for people
    who are dually eligible for Medicare and Medicaid.
   Medicare eligible people must choose a Part D Plan.
   Enrollment in SNBC will not change a person’s enrollment in a
    Medicare Part D Drug Plan.
   SNBC plans must coordinate with Medicare Part D Plan
   However, if a Medicare eligible SNBC enrollee chooses to also
    enroll in their SNBC plan’s Medicare SNP, their Part D coverage
    will change to that SNP plan. This allows coordination of all
    Medicare and Medicaid prescription drugs under one health
   Dual eligibles are charged copays for Part D drugs
   Institutional enrollees are exempt from Part D co-pays
   Health Plans MCOs are NOT ALLOWED to waive Part D Medicare
    drug co-pays per federal Center for Medicaid and Medicare
    Services (CMS) rules.
          How is SNBC Going for Enrollees
   SNBC has low voluntary disenrollment rates (about 3%)
   High satisfaction (60% rate health plan a 9 or 10 on scale 1-10)
   89% report they are satisfied with their involvement in planning
    and care
   Low complaint and appeals rates
   Over 30% of current SNBC enrollees have a serious mental health
    condition with over 80% having some mental health diagnosis
   SNBC enrollees have more health and mental health need (about
    15-20% higher) than average fee-for-service enrollees (Risk
   Mental Health Targeted Case Management access rates in SNBC
    are also about 20% higher
   DHS is working with the Institute of Community Integration at the
    U of M on a large evaluation related to SNBC
   SNBC also is the platform for the Preferred Integrated Network
    (PIN) project, a partnership between Medica and Dakota County to
    integrate physical and mental health needs of enrollees
   Case studies illustrate how SNBC can be beneficial for enrollees
               SNBC Payments
   Medicaid payments to the health plans are “risk
    adjusted” based on the diagnoses and costs of each
    individual enrollee through the Chronic Disability
    Payment System
   Payments have been specially adjusted to include
    additional provisions for mental health services and
   This system will provide higher payments to health
    plans who enroll high cost enrollees, and lower
    payments for those who enroll more low cost
   Payments are designed to be budget neutral to
    current fee for service costs for enrollees
   Medicare also provides a separate risk adjusted
    payment for dual eligible enrollees for people enrolled
    in SNPs.
                  Enrollee Rights
   Enrollees of SNBC have access to the same rights to
    appeal Medicaid Assistance coverage issues as they
    do under fee for service.
   Members receive explanations of these appeal rights
    upon enrollment and DHS also sends additional
    information during the year to all members.
   Enrollees are encouraged to call the health plan to let
    them know of problems and can also make oral or
    written grievances/appeals to the health plan.
   Enrollees can also appeal directly to DHS through the
    State fair hearing process or appeal both to DHS and
    the health plan.
   For Medicare services, enrollees also have the right
    to appeal by contacting the health plan.
   Enrollees can also call the Ombudsman for State
    Managed Health Care Programs for assistance:
      1-800-657-3729 or 651-431-2660
    When SNBC Enrollees have a question or a
     problem with access, services or billing,
               they may contact:

   Health Plan Member Services.
   The County Advocate.
   The Ombudsman for State Managed Care Health
    Care Programs (651) 431-2660.
   Care Navigator, Care Guide or Care Coordinator
   DHS Appeals Office.
        Stakeholder Involvement
   DHS developed SNBC with the assistance of a broad
    group of stakeholders, including disability
    advocates, consumers, counties, providers and
    health plan representatives.
   This Statewide group will continue to meet to
    provide input to DHS in monitoring and oversight of
    SNBC. The group meets quarterly and meetings are
    open to the public.
      Contact Cindy Czech 651-431-2514 to be added to
       the mailing list.
   Each health plan participating in SNBC is required
    to have a similar local stakeholder’s group.
   This is an opportunity for consumers and health
    plans to work together to improve SNBC on an
    ongoing basis.
  What are the Special Needs BasicCare
          Health Plan Options?

MCO PLAN                   SNBC PROGRAM NAME
Medica                     AccessAbility Solution

                           Cornerstone Solutions
MHP   *
                           Prime Health Complete
PrimeWest Health   *
                           Ability Care
South Country Health   *
UCare                      UCare Connect

* Offers Medicare SNP                               21
      SNBC Expansion
Beginning Jan. 1, 2012, people with
disabilities under age 65 (including children)
who have Medical Assistance fee-for-service
coverage will be asked to enroll in an SNBC
health plan for their health care. Some
people may be excluded. Anyone can
choose not to enroll and “opt out” to stay in
fee-for-service. Those who do not opt out
will be enrolled.
This expansion of SNBC was mandated by
the 2011 Minnesota Legislature (256B.69,
subd. 28)                                    24
             SNBC Expansion Legislation
   New legislation requires that adults and children with disabilities
    receiving Medical Assistance (MA) be assigned to a Special
    Needs BasicCare (SNBC) health plan unless individuals choose
    to opt out of enrollment
      Beginning Jan. 1, 2012, people with disabilities who have MA
        must be asked to join a health plan participating in SNBC.
      People may choose to opt out of enrollment or to disenroll at
        any time and return to MA fee-for-service (FFS).
   Estimated 78,216 adults and 11,544 children with disabilities
    could be affected by the new law.
   Preliminary analysis indicates about 19,600 (25%) of these adults
    have a serious mental illness.
   Enrollment will be phased in between January and July 2012. The
    legislation projected that 50 percent would choose to opt out.
   SNBC is still considered a “voluntary” program under federal
    regulations due to the opt out provision.
   People enrolling under the new legislation for Medicaid would not
    be required to enroll in the Medicare SNP portion of SNBC but25
    could do so at any time.
     New SNBC Enrollment Process
   SNBC enrollment expansion will be phased in between January
    and July 1, 2012.
   All potential enrollees will receive letters informing them of the
    new enrollment process.
   The mailing will include information on SNBC, the health plan
    available in their county, their rights, the opt out process and
    how to contact the Disability Linkage Line for assistance.
   An opt out form will be included . People who want to opt out can
    return the form by the deadline and they will not be enrolled.
   People will NOT be enrolled before they are given a chance to opt
   If they do not return the form, they will be enrolled in one of the
    plan choices in their area by the State.
   People who have been enrolled can opt out at any time effective
    the next month.
   People who opted out may also choose to enroll at a later time.
SNBC Revised Implementation Schedule:

First Phase: January 1, 2012
Adults (Approx. 8700), not on HCBS waivers, in
counties currently served by Medica, SCHA and
PrimeWest where there is only one plan choice
(Counties with no choice of health plan – the person
is enrolled in whatever health plan serves that

The initial mailing notifying people of the managed
care program called Special Needs BasicCare
(SNBC) and the legislation enrolling them in a SNBC
unless they choose not to join SNBC is expected to
be sent the week of November 7th.
Second Phase: February 1, 2012
Adults (Approximately 6300), not on HCBS waivers, in
counties served by UCare where there is only one plan choice
(UCare is the only health plan choice). The initial mailing
notifying people of the managed care program called Special
Needs BasicCare (SNBC) and the legislation enrolling them in
a SNBC unless they choose not to join SNBC will be sent the
week of December 5.

Third Phase: March 1, 2012
 Enroll adults on HCBS waivers (CAC/CADI/TBI/DD) in all
counties (Approximately 20,628 adults) currently served by
SNBC MCOs. The initial mailing notifying people of the
managed care program called Special Needs BasicCare
(SNBC) and the legislation enrolling them in a SNBC unless
they choose not to join SNBC will be sent the week of January
Fourth Phase: April 1, 2012
Enroll all remaining adults (Approximately 41,000 adults not
on waivers) in counties with choice currently served by SNBC
MCOs. The initial mailing notifying people of the managed care
program called Special Needs BasicCare (SNBC) and the
legislation enrolling them in a SNBC unless they choose not to
join SNBC will be sent the week of February 1st.

Fifth Phase: July 1, 2012
Enroll all eligible children (approximately 11,000) statewide
plus adults (Approximately 1900) in the 9 counties currently
without SNBC MCO product. The initial mailing notifying
people of the managed care program called Special Needs
BasicCare (SNBC) and the legislation enrolling them in a
SNBC unless they choose not to join SNBC will be sent the
week of May 1sth.
                  Enrollment Exclusions
   Some people are excluded from enrollment in SNBC:
       People with other cost effective insurance or other HMO
        coverage (5,488)
       People with only Medicare A or only Medicare B
       People living in IMD/RTCs
       People receiving services through the Consumer Support Grant
       Other small groups such as people with ESRD, terminally ill
        individuals, torture victims, and American Indians in certain
        circumstances may be excluded.
       Monthly spenddowns: SNBC will no longer enroll new members
        with monthly income spenddowns to enroll.
       Current members with spenddowns may remain enrolled
       Those already enrolled may continue in SNBC if they later incur
        a spenddown but they agree to pay the spenddown to the State.
              Enrollment Information
   Phase-in enrollment mailings:
      Each enrollment phase in group will be sent a mailing 45
       days prior to their specific enrollment date with materials
       for enrolling in a plan or opting out.
      The mailing will specify a date by which they must notify
       DHS that they want to opt out.
   Future mailings
      People who have chosen to opt out would receive
       information annually from DHS about current plan choices
       and the opportunity to enroll.
      New Medical Assistance enrollees will be sent information
       on SNBC, current plan choices and the opportunity to opt
       out or enroll.
      Tracking of those who opt out will be maintained by DHS

   People are encouraged to call the Disability Linkage Line for
    assistance with enrollment if they have questions or need
    help with their options. (1-866-333-2466).
   DHS will do the enrollments, not the counties.
            Medicare Assistance
   People enrolling under the new legislation for Medicaid
    would not be required to enroll in the Medicare SNP
    portion of SNBC but could do so at any time.
   Disability Linkage Line: assists Medicare recipients of
    all ages with problems with their Medicare coverage
    and with selecting a Medicare Part D plan (SNBC
    include Medicare Parts A, B & D benefits).
      Disability Linkage Line: 1-800-333-2466

   The Linkage Line can also help with SNBC SNP
   Medicare: answers questions about Original Medicare
      1-800-633-4227
    Information from the Health Plan
   Shortly after enrollment enrollees should get information
    from the health plan including:
   Evidence of Coverage
      Explains what is covered and what is not covered by the
        health plan
      How to get the care needed or prescriptions filled
      What to do if unhappy with something related to getting
        covered services or prescriptions filled
      Members rights and responsibilities
   Health Plan Member Card
      Card includes member ID on the front
      Health Plan contact numbers are on the back (member
        services and 24-hour nurse line)
      Carry member cards at all times
   Provider Directory
      A list of the Health Plan’s network providers
   All health plan information must be reviewed and approved
    by the State.
        Things to think about
        when choosing a plan.
   Get information about the doctors available to
    serve you and the hospitals and other health care
    providers affiliated with the plan. If you want to
    keep the doctors you are with find out which
    health plans your provider is associated with. Are
    your specialists associated with the health plan?
   Determine whether the plan’s providers are in a
    location convenient to you and whether
    transportation is available for you.
   Determine if your prescription drugs are covered
    by the health plan.
   Find out about any additional benefits the health
    plan offers.
   There is a good guide on the SNBC training site
   (Go to MCO grid for comparison, and “Guide to
    Enrollment – on DHS website)                       34
          Primary Care Clinic

   Primary Care Clinic: the clinic you chose
    for your routine care. Most of your cares
    will be provided or approved by this clinic.
    The name of your clinic appears on your
    health plan card.
   Must select a primary care clinic or one
    will be selected for you.
   Some health plans allow you to choose a
    specialist as a primary care provider.
         Assistance with Implementation
   Providers/stakeholders can help individuals and assist with a
    smooth transition in the SNBC Expansion by:
      Identifying which clients/individuals are likely impacted by
       the SNBC Expansion
      Familiarize yourself and staff with the SNBC expansion
       implementation schedule, and the draft of the letter eligible
       people will be receiving in the mail from DHS.
      At appointments/contacts, ask the individual if he/she
       received a letter from DHS about their health care
       coverage, did the individual open it and read it, review it
       with him/her, tell him/her that it is important (don’t throw it
       away), where he/she can get more information and help
       (DLL, SNBC website, MCO member services, MCO
      Encourage individual to discuss this information with their
       support networks such as family/friends.
     Assistance with Implementation –

   Download the “Guide for Enrollment” and distribute to
   Assist in communication with DLL, if needed. DLL is happy to
    do three-way conversations:
   Follow up with him/her at future contacts to see if the person
    has the needed information for person to make decisions, and
    take actions/mail response, if needed.
   Help the individual transition (if changes in doctors, clinics,
    providers, to MCO/different MCO)

What if your prescription is not on
   your copy of the formulary
   Confirm the health plan does not cover the drug
       Call your care navigator/care guide
       Call member services
   If the prescription is not covered
       Ask your doctor if you can switch to another drug that is
        covered by the health plan
       You or your doctor can ask to make an exception to
        cover your drug
       If you recently joined the health plan you may be able to
        get a temporary supply of a drug you were taking when
        you joined the health plan. Work with member services
        or your care navigator on the transition.
          Transition Services
   The health plan is responsible for care when an
    enrollee is changing from fee-for-service or from
    one health plan to another. The plan may develop
    a transition plan special situations.
   Contact the plans member services when
    continuity of care is needed for this type of
    service, such as;
   Services previously authorized
   At risk pregnancy
   Chemical dependency treatment service
   Mental health services
   Prescription drugs
               SNBC Expansion
           Information for Providers
   Identify which and how many of your current and future
    clients will likely be impacted by the expansion of SNBC.
   Identify which MCOs currently and in 2012 will serve
    eligible individuals residing in your service area.
   Determine if your organizations contracts with the MCO/s to
    provide the services your organization is providing for your
    clients. Discuss with MCO topics, such as, strategy for
    “preparing for the expansion”, helping enrollees transition,
    and impact on referrals.
   If your agency is interested in joining the provider network
    of MCO – Identify your organizations strengths, costs and
    questions to discuss with MCO/s. Contact MCO for
    discussion/information about contracting with the MCO/s.
    DON’T contact MCO about specific individual client until
    after the client’s “Group” is enrolled – MCO will not have
    individual specific information until then.                 40
   Call the MCO first – most
    questions/problems can be resolved
    by contacting them directly.

   If problem is not resolved, call the
    DHS Provider HelpDesk 651- 431-
    2700 who will put you in touch with a
    contract manager.
     Stakeholder Expansion

 Regional Meetings
 Topic Driven Workgroups

 E-mail

 Stakeholder Meetings

 SNBC Web Site
                      DHS Managed Care
                        Staff Contacts
   Pam Parker, Manager,
   Sue Kvendru, Senior Programs in Managed Care Program Policy
   Deb Maruska, People with Disabilities Managed Care Program Policy
   Susan Kennedy, SNBC Coordinator
   Cindy Czech, Stakeholders Workgroup
   JoAnn Jones, Lead Worker Service Implementation
                                  Where to Access
                                  SNBC on the Web

   The SNBC color map:

   Managed Care Enrollment Figures:


   SNBC web site:

   Model Contract:
   CAC- Community Alternative Care Waiver
   CADI – Community Alternatives for Disabled Individuals Waiver
   CBP – County Based Purchasing
   CMS - Centers for Medicare and Medicaid Services
   DD – Developmental Disability Waiver
   Dual eligibles – Person eligible for both Medicare and Medicaid
   DHS – Department of Human Services
   EOC- Evidence of Coverage
   EW- Elderly Waiver Program
   FFS – Fee For Service
   HMO – Health Maintenance Organization
   MCO- Managed Care Organization
   MHCP- Minnesota Health Care Program
   MSC+- Minnesota Senior Care Plus
   MSHO - Minnesota Senior Health Option
   NF – Nursing Facility
   PMAP - Prepaid Medical Assistance Plan
   PINs- Preferred Integrated Network
   SNBC – Special Needs BasicCare
   SNP – Special Needs Plan
   TBI- Traumatic Brain Injury
   VADD - Vulnerable adult/developmental disability targeted case management services
Thank You!!
When Health Care
 Everyone Wins!
  we will make
 health care work
   for people.

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