Tuesday, January 15, 2013

Latest Revisions to the Michigan Dual Eligibles Plan

Jennie and friends
The Michigan Association of Community Mental Health Boards (MACMHB) and the Michigan Association of Hospital Plans (MAHP) issued a joint letter to members on changes to the state plan to integrate the care of people eligible for both Medicare and Medicaid. In negotiations with the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees and regulates Medicare and Medicaid, a preliminary agreement has been worked out with the state. 

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.
Here is the map of these new regions. The Integrated Care Organizations will cover the same regions as the PIHPs. (The CMH Partnership of Southeast Michigan will remain intact and continue to include Washtenaw, Livingston, Monroe, and Lenawee Counties). "Once selected, each region and contracted entities, (ICO/PIHPs) will be maintained for a total of three years to accommodate evaluation requirements."

In addition:

  • 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.
Other details in the letter and documents on the Michigan Integrated Care Web site include schedules for Integrated Care Organizations to apply for contracts. Here is more information and background on the Dual Eligibles Plan. Stay tuned for further developments.

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