|Jennie and friends|
The Dual Eligibles plan will be scaled back to a 3-year demonstration project to be implemented in selected regions of the state. Michigan and the CMS will formally conclude negotiations with a Memorandum of Understanding (MOU) that will be the basis for this implementation.
Neither the number nor location of regions has yet been decided. The state has recently approved a new regional configuration for Pre-Paid Inpatient Health Plans (PIHPs), reducing the number of PIHPs in the state from 18 to 10. A PIHP is the administrative entity over local Community Mental Health agencies. Within each selected region, no sub-populations or sets of services will be excluded from the plan.
According to the letter:
CMS will require three-way contracts between the federal government, the state and management entities selected to participate in the project.
- Management entities will include integrated care organizations (ICOs) and prepaid inpatient health plans (PIHPs).
- In the proposed plan, ICOs will cover physical health and long term care services, including but not limited to, institutional and community based long term services and supports and pharmacy.
- In the proposed plan, PIHPs will cover behavioral health and habilitative services, including developmental disabilities, mental illness, or substance abuse problems.
- Eligible individuals will be automatically enrolled into the integrated system, but can opt out prior to enrollment as well as after beginning to receive services.
- Michigan is continuing its process to include stakeholder input on an ongoing basis throughout the course of the demonstration.
- Subject to CMS approval, the program will begin providing coverage in January of 2014.