The Integration of Acute and Long Term Care Services

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					   The Integration of Acute and Long Term
      Care Services: Status of Phase I
          and Decisions for Phase II

                             Presentation to
                            Stakeholders


Department of Medical Assistance Services      August 21, 2007
Cindi B. Jones, Chief Deputy Director
     Presentation Outline


Background for Development of the Blueprint


Community Model: PACE


Regional Model: Managed Care Organizations


Next Steps



                                              2
            Demographics Of Recipients In
             Virginia’s Medicaid Program

       The Elderly And Persons with Disabilities Represent 30 Percent
        of Medicaid Program Recipients

                            Adults          Aged

                               13%
                                       10%


                                           20%
                                                    Blind &    30%
                                                    Disabled
                             57%


                 Children

                                                                         3
Note: Unduplicated count of recipients in FY 2005
            Demographics Of Recipients In
             Virginia’s Medicaid Program
                                        (continued)



       Yet they account for 71 percent of program expenditures

                           Recipients                 Expenditures

                Aged         10%
                                                          26%   Aged
        Blind & Disabled     20%        30%
                Adults       13%
                                                71%       45% Blind & Disabled


              Children       57%
                                                          9%     Adults
                                                          21%   Children

                                                                                 4
Notes: FY 2005 recipient and expenditure data
          Demographics Of Recipients In
           Virginia’s Medicaid Program
                                      (continued)



     Meaning the cost of serving the elderly and disabled is
      substantially greater than the cost of care for children
          $12,000                          $11,595
                                 $10,831
          $10,000

           $8,000
                      $4,720
           $6,000

           $4,000
                                                                 $3,109
                                                      $1,725
           $2,000

               $0
                       All        Aged     Blind &    Children    Adults
                    Recipients             Disabled
Notes: FY 2005 recipient and expenditure data                              5
     The Blueprint for the Integration of
        Acute and Long Term Care
        2006 Virginia Acts of the General Assembly (Item 302, ZZ)



Completed December 2006, this plan
   explains how the various stakeholders are involved in the
    development and implementation of the new program models;

   describes the various steps for development and
    implementation of the program models;

   includes a review of other States’ models, funding, populations
    served, services provided, education of clients and providers,
    and location of programs; and

   describes the evaluation methods that will be used to ensure
    that the program provides access, quality, and consumer
    satisfaction.
                                                                      6
          Blueprint
            for the
        Integration of
  Acute and Long-Term Care
           Services

  Virginia Department of Medical Assistance Services
                  December 15, 2006
Found at: http://www.dmas.virginia.gov/altc-home.htm
    The Blueprint for the Integration of
       Acute and Long Term Care
                            (continued)



   DMAS held a series of three meetings on Acute and Long Term
    Care Integration Models and Issues (during Summer/Fall 2006):

    – First Meeting: Provided an overview of Medicaid funded
      acute and long term care services in Virginia and across the
      United States.

    – Second Meeting: Facilitated a meeting with stakeholders so
      they could provide input on the options for developing an
      integrated acute and long term care program in Virginia.

    – Third Meeting: Heard public comment on the integration of
      acute and long term care.


                                                                     8
               The Case for Integration

Current System: Fee-for-Service   New System: Capitated and
  and Fragmented                    Coordinated Care
 Primary and Acute Care
  Services                           Combines acute and long term
     –   Physician                    care services (except for certain
     –   Hospital                     waiver programs) under one
     –   Pharmacy                     capitated rate
     –   Labs
     –   Disease Management          Combines Medicare and Medicaid
   Long Term Care Services           funding
     – Nursing Facilities
     – Home and Community Based      ONE CALL—ALL CARE NEEDS
       Care Waiver programs (7)
     – Case Management
                                     Right Services at Right Time

                                                                          9
                  Integrated Model:
                 Populations Covered

All 234,945 Low-Income Seniors and Persons with Disabilities (ABD)

    Medicaid Only (non-duals)        Medicaid and Medicare
     86,732 clients                    (dual eligibles) 148,213
                                       clients

     – Don’t use long term care        – Don’t use long term care
       services (79,045 clients)         services (115,152 clients)

     – Use long term care              – Use long term care
       services (7,687 clients)          services (33,061 clients)



                                                                      10
      Presentation Outline


Background for Development of the Blueprint


Community Model: PACE


Regional Model: Managed Care Organizations


Next Steps



                                              11
            Two Models for Integration-
             Community Model: PACE

   Community Model: Program of All Inclusive Care for the
    Elderly or PACE. Combines Medicaid and Medicare funding to
    provide all medical, social, and long term care services through
    an adult day health care center.
     –   Limited to persons who are nursing facility eligible
     –   Voluntary enrollment
     –   Sites serve no more than 200 enrollees
     –   Site receives both a Medicaid and Medicare capitated rate and
         pays for all services

   Phase I: Six communities actively pursuing PACE—6 were
    awarded start up grants ($250,000 each). Implementation 2007-
    2008 (see Map on next slide).
     –   Hampton Roads (2)
     –   Richmond (1)
     –   Lynchburg (1)
     –   Far Southwest (2)                                               12
                  PACE IN THE COMMONWEALTH
                           OF VIRGINIA
       Map Key
   PACE Sentara
   PACE Mountain Empire
   PACE Centra
   PACE Riverside - Hampton
   PACE Riverside - Richmond
   PACE Appalachian                                                                                                                               Frederick
                                                                                                                                  Winchester
   RFA – PACE Northern Virginia                                                                                                                                                            Manassas Park
                                                                                                                                                              Clarke
                                                                                                                                                                       Loudoun               Falls Church

OPERATIONAL TIMELINE FOR PACE PROVIDERS                                                                                                          Warren                                    Arlington
                                                                                                                                      Shenandoah      Fauquier
                                                                                                                                                                                                Alexandria
PACE   Sentara                                           OCT 07                                                                                         Rappahannock                  Fairfax
                                                                                                                                                                                 Prince
                                                                                                                                                                                                   Fairfax City
                                                                                                                                                                                                      Manassas
PACE   Riverside - Hampton                               NOV 07                                                             Rockingham         Page                              William
                                                                                                                       Harrisonburg
PACE   Mountain Empire                                   FEB 08                                                                                              Culpeper
                                                                                                                                                                            Stafford
                                                                                                                                                      Madison
PACE   Appalachian                                       APR 08                                          Highland
                                                                                                                        Augusta          Greene                         Fredericksburg
                                                                                                                                                                                             King
                                                                                                                                                                                             George
PACE   Centra                                            JNE 08                                                      Staunton                                 Orange
                                                                                                                                                                   Spotsylvania                        Westmoreland
PACE   Riverside - Richmond                              JNE 08                                         Bath
                                                                                                                                            Albemarle
                                                                                                                       Waynesboro                                                               Essex
PACE   Northern Virginia                                 JAN 09                                          Lexington
                                                                                                                                       Charlottesville        Louisa              Caroline                        Northumberland

                                                                            Clifton Forge                                                         Fluvanna                                       King &      Richmond
                                                                                                               Buena Vista                                                                       Queen                             Accomack
                                                                                        Covington                                  Nelson                   Goochland       Hanover                                 Lancaster
                                                                                           Alleghany       Rockbridge                                                                             King        Middlesex
                                                                                                                                                                                 Henrico
                                                                                                                       Amherst                                                                    William
                                                                                                                                       Buckingham
                                                                                                   Botetourt                                            Powhatan     Richmond                   New
                                                                                                                                                Cumberland                                      Kent                    Matthews
                                                                                    Craig                            Lynchburg                                 Chesterfield                                          Northampton
                                                                                                                                                                                                        James Gloucester
                                                                                                                                 Appomattox                                                      Charles City
                                                                                           Roanoke         Bedford                                    Amelia
                                                                          Giles                                                                                    Col.Heights                     City
                                                                                       Salem                                               Prince
                                    Buchanan                                                     Roanoke City                                                                     Prince           York    Poquoso
                                                                                Montgomery            Bedford         Campbell             Edward                Petersburg      George Surry     Williamsburg
                                                                                                                                                    Nottoway                                               n
                              Dickenson                        Bland                                                                                           Dinwiddie Hopewell                         Hampton
                                                  Tazewell                                                                       Charlotte                                                     Isle of Newport News
                   Wise                                                  Radford                                                                                                               Wight
                                                                        Pulaski               Franklin                                         Lunenburg                                                    Norfolk
                                                                                                                                                                            Sussex
                                    Russell                                      Floyd                                                                                                        Portsmouth
                  Norton                                         Wythe
                                                    Smyth                                                   Pittsylvania                                  Brunswick                                              Virginia
                                                                                                                                                                                   Franklin                       Beach
            Lee                                                                                Henry                                                                                         Suffolk
                                    Washington                          Carroll                                                                                    Emporia
                      Scott                                                                                    Danville                                                      Southampton               Chesapeake
                                                                   Galax            Patrick                                Halifax          Mecklenburg
                                                           Grayson                            Martinsville                                                        Greensville
                                            Bristol
              PACE of SENTARA:
       Likely First PACE Site in Virginia

   Successful Pre-PACE program for 10 years

   Has served over 500 recipients since 1996

   Capacity to enroll 130 recipients with attendance up to 100 daily

   CMS response date for approval is September 25, 2007

   Targeted operational date is October 2007




                                                                        14
         PACE of Riverside at Hampton

   Hampton site is a community re-development project; housed in a
    building which has been vacant for 10 years

   RHS is highly regarded, extremely visible and dedicated to the
    population to be served

   Anticipate an average daily attendance of 90

   CMS has just completed their first 90-day clock review of provider
    application

   Targeted operational date is November 2007
                                                                         15
    PACE of Mountain Empire for Senior
        Citizens at Big Stone Gap

   One of two rural PACE sites in the Commonwealth; has been
    working on PACE for the past 10 years with feasibility study
    conducted in 1996
   Will make use of telemedicine at this site
   Serving one of the poorest regions of the U.S.
   Most conservative estimates place a sustainable program at 124
    recipients
   PACE provider application submitted to CMS on July 2, 2007;
    Currently under first 90-day clock review by CMS that will end on
    October 3, 2007
   Construction for new PACE site is slated to begin late 2007
   Targeted operational date February 2008
                                                                        16
PACE of Appalachian Agency for Senior
        Citizens at Cedar Bluff

   Second of two rural PACE sites in the Commonwealth

   Four counties over 1800 square miles, 676 persons per square mile,
    Per capita income $15,000

   Long history of working to improve the lives of the elderly

   Will utilize the Hub and Spoke service delivery model of care for
    PACE participants

   PACE provider application is currently under review by DMAS; will be
    sent to CMS Summer 2007.

   Targeted operational date is April 2008

                                                                        17
           PACE of Riverside at Richmond

   RHS will employ an aggressive targeted marketing strategy in
    Richmond
   Challenge in developing in a market with no current facilities,
    programs or services
   15 months following start-up of the Hampton site
   PACE eligibles in Richmond over 2,500
   Geographic considerations – 2 PACE centers within 5 years
   First center will be operating in Southside Richmond
   Targeted operational date June 2008


                                                                      18
           PACE of Centra at Lynchburg

   Began in 2000 from a grassroots citizen’s group concerned with
    health care for the elderly

   July 2006, Centra Health, local non-profit hospital system took over
     – Centra has a long-standing history of community stewardship
     – Centra Health is growing regionally with new affiliations with
        hospitals and health centers

   PACE site will be located in the center of the City of Lynchburg in an
    area that is part of the revitalization efforts of Lynchburg

   Targeted operational date June 2008

                                                                             19
    What’s Next with PACE: Phase II

   DMAS published a Request for Application (RFA) on July 23,
    2007 for the development of a PACE site for underserved areas
    of Northern Virginia.
         • This site will also be awarded a $250,000 start-up grant.
         • Letter of Intent and questions due August 23, 2007
         • Application deadline September 24, 2007
         • Implementation 2008-2009

   Future PACE sites will also be determined through RFAs in
    order to ensure open competition. No additional RFAs planned
    at this time.


                                                                       20
      Presentation Outline


Background for Development of the Blueprint


Community Model: PACE


Regional Model: Managed Care Organizations


Next Steps



                                              21
       Two Models for Integration –
               Regional

   Regional Model: Could range from a
    capitated payment system for Medicaid
    (potentially integrating Medicare
    funding) for acute care costs with care
    coordination for long term care services,
    to a fully capitated system for all acute
    and long term care services

                                                22
      DMAS Progress on the Expansion of
       Existing Managed Care Program

   The Medicaid managed care program, Medallion II, will go
    live in the Lynchburg region beginning October 1, 2007.
    Three managed care organizations will cover
    approximately 14,000 eligible enrollees.


   This expansion will provide Medallion II                                                                                         Winchester    Frederick

                                                                                                                                                           Clarke
                                                                                                                                                                 Loudoun
                                                                                                                                                                                 Manassas Park
                                                                                                                                                                                 Falls Church




    coverage in all areas of the State except
                                                                                                                                                  Warren                         Arlington
                                                                                                                                         Shenandoah    Fauquier                     Alexandria
                                                                                                                                                      Rappahannock             Fairfax Fairfax City
                                                                                                                                                                         Prince        Manassas
                                                                                                                                 Rockingham Page                         William
                                                                                                                             Harrisonburg
                                                                                                                                                           Culpeper
                                                                                                                                                                       Stafford


    for the deep southwest & portions
                                                                                                                  Highland                          Madison
                                                                                                                              Augusta       Greene                  FredericksburgKing
                                                                                                                                                           Orange                 George
                                                                                                                            Staunton
                                                                                                                                                                 Spotsylvania            Westmoreland
                                                                                                               Bath                          Albemarle
                                                                                                                               Waynesboro                                            Essex
                                                                                                                   Lexington               Charlottesville Louisa         Caroline                    Northumberland
                                                                                      Clifton Forge                                                                                           Richmond



    of our western border with
                                                                                                                          Buena                     Fluvanna                          King &
                                                                                                  Covington            Buena
                                                                                                                          Vista        Nelson                                         Queen                          Accomack
                                                                                                                                                           Goochland Hanover                            Lancaster
                                                                                                     Alleghany         Vista
                                                                                                                     Rockbridge                                                        King       Middlesex
                                                                                                                               Amherst                                   Henrico
                                                                                                                                          Buckingham                                    William
                                                                                                            Botetourt                                       Powhatan Richmond New
                                                                                                                                                      Cumberland                     Kent                  Matthews
                                                                                                  Craig                        Lynchburg                            Chesterfield            James Gloucester         Northampton
                                                                                                       Roanoke                      Appomattox                                       Charles City
                                                                                                                                                           Amelia


    West Virginia
                                                                                                                      Bedford                                          Col.Heights City
                                                                                      Giles          Salem                                       Prince
                                                   Buchanan                                                RoanokeCityCity
                                                                                                           RoanokeBedford Campbell                                                   Prince          York Poquoson
                                                                                                                                                 Edward               Petersburg
                                                                                              Montgomery                                                  Nottoway Dinwiddie       George Surry Williamsburg
                                                                                                                                                                             Hopewell                       Hampton
                                             Dickenson         Tazewell      Bland                                                                                                                Isle of Newport News
                                        Wise                                          Radford                                            Charlotte
                                                                                                           Franklin                                  Lunenburg                                    Wight      Norfolk
                                                                                    Pulaski                                                                                    Sussex
                                       Norton      Russell                                     Floyd                                                                                            Portsmouth
                                                                   Smyth      Wythe                                                                            Brunswick                                          Virginia
                                                                                                                       Pittsylvania
                                                                                                            Henry                                                                     Franklin Suffolk            Beach
                                 Lee                Washington                      Carroll                                                                            EmporiaSouthampton
                                        Scott                                                                                                                                                            Chesapeake
                                                                         GraysonGalax             Patrick Martinsville Danville Halifax
                                                                                                           Martinsville                           Mecklenburg
                                                                                                                                                                      Greensville
                                                           Bristol


                                                                                                                                                                                                                      23
       Implementation Regional Model:
                  Phase I

   Current System: Mandatory managed care for acute care
    needs only—49,000 low income seniors and individuals with
    disabilities (Aged, Blind, and Disabled) with no Medicare and
    with no long term care services.

   Phase I (September 1, 2007): Managed care organization
    (MCO) enrollees who become eligible for home and community-
    based service waiver programs will remain in their MCOs for
    acute and primary medical services. These individuals will
    continue to receive HCBC waiver services through the fee for
    service program.



                                                                    24
      Implementation: Regional Model
                 Phase I

   Implementation date is September 1, 2007; CMS has approved
    the 1915(b) waiver modification.

   In the first year, will impact about 500 Medicaid only clients
    who are receiving managed care first and now need long term
    care services.

   Phase I is statewide wherever there are MCOs.

   Populations excluded during Phase I (most of these populations
    are included in Phase II):
          • Will not include dual eligibles (Medicaid and Medicare)
          • Will not include nursing facility residents
          • Will not include Technology Assisted Waiver clients
          • Will not move current LTC waiver clients into managed
            care.                                                     25
       Implementation: Regional Model
              Phase I (continued)

   DMAS conducted several activities to ensure a smooth transition to
    Phase I:

     – Made changes to information system and to recipient and provider
       communications, amended MCO contracts, modified 1915(b)
       waiver, and promulgated regulations

     – Met with various stakeholder groups over past nine months

     – Met with and trained MCOs

     – Hiring two part-time transition coordinators to assist providers,
       recipients, and MCOs.

                                                                           26
    Implementation: Regional Model
               Phase II

   The roll out of Phase II will be on a scheduled and
    layered approach over time based on:
        • Geographic location (pilot first in two
          areas)
        • Populations Included
        • Funding sources (Medicaid and Medicare)
        • Services Included

   The focus will be what is feasible and will ensure a
    smooth transition for our recipients and providers.
                                                           27
Implementation: Regional Model
Phase II-Geographic Location

   On a geographic basis, the roll out will be one area at a time (every six
    months) until statewide

         • Tidewater                 August 8, 2008—initial wave
           13 cities and counties
         • Richmond                  January 2009—initial wave
           12 cities and counties
         • Northern                  August 2009
         • Surrounding counties      Winter 2010
         • Rural                     Summer 2010/Winter 2011

   Tidewater and Richmond were selected as the first pilot areas because
    of their strong health systems, competitive atmosphere, urban
    environment, and size of their Medicaid population.

                                                                                28
Implementation: Regional Model
 Phase II-Geographic Location
          Initial Wave
       TIDEWATER
                                    Richmond
073      Gloucester       036      Charles City
093     Isle Of Wight     041   Chesterfield County
095   James City County   049      Cumberland
199         York          075       Goochland
550      Chesapeake       085    Hanover County
650       Hampton         087    Henrico County
700    Newport News       127       New Kent
710       Norfolk         145       Powhatan
735      Poquoson         570    Colonial Heights
740      Portsmouth       670       Hopewell
800        Suffolk        730       Petersburg
810    Virginia Beach     760   Richmond, City of
830     Williamsburg                                  29
       Implementation: Regional Model
            Phase II-Populations

   At the end of Phase II, the goal is to have more than 200,000 low
    income seniors and persons with disabilities (known as the Aged, blind,
    and disabled) in some form of Medicaid managed care for their acute
    care needs only and/or long term care needs.

   The roll-out for populations in the geographic areas will include:
         • Medicaid only and Medicaid and Medicare (dual eligibles)-
             initial wave
         • Nursing Facility Clients (new admissions only)-initial wave
         • Home and Community Based Care Waiver Clients
               – Existing and new Elderly and Disabled with Consumer
                  Direction and AIDS waiver clients-initial wave
               – Later, existing and new Mental Retardation, Day Support,
                  Developmental Disabilities, Alzheimer's, Tech waiver
                  clients for acute care needs only (could be put in Phase I
                  option at any time)

                                                                               30
Implementation: Regional Model
     Phase II-Populations

   The initial waves in Tidewater and Richmond will provide
    integrated managed care for acute care and long term care
    services (when needed) to 36,710 new clients:

    – Medicaid and Medicare (dual eligibles): 30,398 clients
    – Nursing Facility Clients (new admissions only): 2,310
      clients (for a specific period of time)
    – Existing and new Elderly and Disabled with Consumer
      Direction and AIDS waiver clients: 4,002 clients




                                                                31
       Implementation: Regional Model
             Phase II-Funding

   To have truly integrated acute and long term care services, both
    the Medicaid and Medicare funding (through a Medicare
    Advantage Plan or a Special Needs Plan) need to be combined
    within the administration of one Managed Care Organization.

   However, due to the timing of federal requirements for Special
    Needs Plans (or SNPs), DMAS will need to start the initial wave
    with a Medicaid only integrated model for acute and long term
    care services.

   The Request for Proposals for the Integrated Managed Care
    Program will require that all participating health plans be
    classified as a Medicare Advantage and/or SNP or are
    working/applied for the classification.                            32
       Implementation: Regional Model
             Phase II-Services

   Medicaid managed acute and long term care services:
     – All current Medicaid state plan primary and acute care services,
       including mental health and transportation services
         • Excluded are the state plan option mental health services that are
            currently carved out

     – All Elderly and Disabled with Consumer Direction waiver services,
       including adult day health care, personal care aide (both agency and
       consumer-directed), personal emergency response systems and medication
       monitoring, and up to 720 hours per year of respite care (both agency and
       consumer-directed). Environmental modifications, assistive technology,
       transition services, and transition coordination will be added with Money
       Follows the Person in May 2008.

     – All HIV/AIDs waiver services, including personal care aide (both agency
       and consumer directed), private duty nursing, nutritional supplements,
       respite care (up to 720 hours per year), and case management. Transition
       services, personal emergency response systems and medication
       monitoring, assistive technology, and environmental modifications will be
       added with Money Follows the Person in May 2008.
                                                                                   33
       Implementation: Regional Model
             Phase II-Services

   Medicaid managed acute and long term care services (continued)
     – Nursing Facility Care (for a short period of time, such as 120-180
       days—to be discussed with nursing facility providers in the
       development of the RFP)
        • This allows the MCO an opportunity to move the client back
          home with community based care services, if appropriate.



     – Additional services
        • Care Coordination; intensive care management for long term
          care service clients
        • 24-hour/7 days a week access line
        • Disease management (if applicable)

                                                                            34
       Implementation: Regional Model
             Phase II-Services

   Home and Community Based Care Waiver Services Excluded
     – Mental Retardation, Day Support, Developmental Disabled
        • These waivers have waiting lists
     – Technology Dependent
        • This waiver is the most expensive
     – Alzheimer's Assisted Living Waiver
        • Numbers too small at this time

   Medicare Managed Care Services: Once the Medicare Advantage
    Plans or SNPS are in place, the Medicare/Medicaid clients will have
    coordinated Medicare services also. These plans may add enhanced
    services, such as dental care, vision, and hearing.


                                                                          35
      Implementation: Regional Model
         Phase II- Other Decisions

   Enrollment
    – Medicaid Managed Acute and Long Term Care: Enrollment
      will be mandatory with opt-out provisions (first 90 days,
      annual enrollment period, or if meet established good cause)
    – Medicare Managed Acute and Long Term Care (Special
      Needs Plans or Medicare Advantage Plans). Voluntary and
      based on Medicare rules.
    – In order to reduce disruption of care, DMAS will be
      developing ways to ensure that the Medicaid and the
      Medicare plans are the same provider.

   Federal Authority
    – 1915 (b) and (c) combination waiver will allow for mandatory
      enrollment

                                                                     36
      Implementation: Regional Model
         Phase II- Other Decisions

   Managed Care Organizations

    – Choose through Request for Proposal (RFP) process with a
      minimum of two plans for each region

    – Health plans must have Medicare Advantage or SNP or
      working toward it

    – Must have health plan accreditation—URAC/NCQA

    – Out of state plans can bid if licensed in Virginia and can fully
      demonstrate that they can meet the RFP requirements

                                                                         37
      Implementation: Regional Model
         Phase II-Capitation Rates

   Specific details regarding the populations and
    services that will be included are required to develop
    appropriate rate cells and service categories.

   Most of the historical fee-for-service (FFS) data
    required to develop capitation rates was gathered
    previously for the PACE program. The base data will
    be FFS data.

   Additional data will be needed for some services that
    are not currently included, such as case management
    services.
                                                             38
      Implementation: Regional Model
         Phase II-Capitation Rates

   Base FFS data will be trended forward to the contract
    period.

   Adjustments to the base FFS data will have to be
    developed regarding managed care savings and the
    effect of enrollment in Medicare Advantage plans.

   Risk adjustment methods should be explored to
    ensure that health plans receive capitation dollars
    that reflect the relative health status of the enrolled
    population. Actual implementation of this method is
    unlikely in the first one or two years of the program.

                                                              39
      Presentation Outline


Background for Development of the Blueprint


Community Model: PACE


Regional Model: Managed Care Organizations


Next Steps



                                              40
                    Regional Model:
                   Phase II Next Steps

   Will include stakeholder input throughout the development and
    implementation of Phase II

     – DMAS has made presentations and met with several groups
       separately throughout the past year

   Need to schedule a series of stakeholder meetings to provide input to
    the Request for Proposals
         • Nursing facilities/hospitals
         • Home Care Providers (pharmacy, DME, home health, personal
           care, rehabilitation)
         • Mental Health/Mental Retardation/Substance
           Abuse/Developmental Disabilities
         • Consumers and Advocates
         • Managed Care Organizations


                                                                            41
                  Regional Model:
                 Phase II Next Steps

   Timeframes available for stakeholder meetings

    – Wednesday, 9/5/07, from 10a.m.-noon—Hold for
      NFs/Hospitals
    – Thursday, 9/6/07, from 2 p.m.-4 p.m.
    – Monday, 9/10/07, from 10 a.m.-noon
    – Tuesday, 9/11/07, from 2 p.m.-4 p.m.
    – Monday, 9/17/07, from 10 a.m.-noon
    – Tuesday, 9/18/07, from 10 a.m.-noon
    – Wednesday, 9/26/07, from 2 p.m.-4 p.m.


                                                     42
                   Regional Model:
                  Phase II Next Steps

   Request for Proposal will be released in Fall 2007

   DMAS will submit 1915 (b) and (c) waivers to CMS

   The next presentation will discuss more specifics of DMAS’
    implementation plan




                                                                 43