Lessons Learned: Implementation of CCC+ in the Tidewater Area. Impact on individuals with Developmental Disabilities

Transcription

1 Lessons Learned: Implementation of CCC+ in the Tidewater Area Impact on individuals with Developmental Disabilities

2 Ways to Reduce Anxiety. Before individuals receive their letter from DMAS regarding their assigned MCO, consider the following: Send a letter to those individuals who may possibly be impacted by CCC-P and inform them to contact their CM or clinician about their assigned MCO once notified. (handout) Post CCC-P information flyers, ideally at payment windows. (handout) Provide a link to CCC-P information on your agency web-site: CCC Plus - Medicaid Colonial Behavioral Health

3 CM/Support Coordinator Role Complete training on CCC-P (DMAS, MCOs) Meet with MCOs to establish your communication plan. Track MCO assignments for persons on your case load. Work with your Fiscal staff to obtain the information. Know the MCO benefit plans and help individuals with selecting the best MCO to meet all of their needs. Plan for the MCO Care Coordinator to be a member of the person-centered planning team.

4 Collaboration with the MCO Care Coordination Establish contact with each individual s MCO Care Coordinator. Engage with them to ensure the needs of their covered members are met. Participate in the individual s MCO initial assessment if possible. Share assessment information with the MCO Coordinator. Inform the MCO Care Coordinator about upcoming monthly, quarterly and annual meeting dates for Waiver individuals. Regardless of the implementation of CCC-P, all CM/Support Coordinator duties / responsibilities as prescribed by DBHDS Performance Contract and Office of Licensing; DMAS regulations; and DOJ requirements remain in tact. The MCO Coordinator does not complete these requirements for the Waiver individuals.

5 Troubleshooting Transportation issues Only medical transport for Waiver individuals is impacted at this time, not their transportation to/from Waiver programs. Calling Maximus on behalf of individual CMs/Supported Coordinators must use the prescribed statement/format when contacting Maximus---share information with parents/guardians also. (handout) Critical incident reporting yes, CHRIS and MCO critical incident reporting must occur.

6 Troubleshooting Transfers When transferring CM/Support Coordinator duties, inform the receiving CSB of the individual s MCO and the Care Coordinator contact information. MCOs assignments are based on the individual s address, not their CSB locality. This can be confusing if an individual lives in one CSB area, but their CM/Support Coordinator is provided by another CSB. Inform MCOs if they incorrectly contact you as the CSB CM provider for an individual.

7 Maximus Process for Managing Authorized Callers Caller Calling on Behalf of the Member: ESR must ask the Caller what is their relationship to the Member and then ask the Caller to allow the ESR to speak to the Member to obtain permission to speak to the Caller o Caller must verify the Member s Medicaid ID# Member s Name Address SS# or DOB Phone number (add into Maxeb) This process is applicable each time a Caller calls on behalf of a Member Parent Calling on Behalf of a Child(s) Under Age 18 and Is Not Listed as the Child Representative in the System: The Parent must verify the following: o Medicaid ID# or Case ID# o Child s name o Address o SS# or DOB o Phone number (add into Maxeb) Maximus should enter the Parent s Name and Contact information in the system for future reference

8 Caller that is Calling for a Member that is Non-Verbal the ESR should ask the Caller what is their relationship to Member Caller must verify the following: o Member s Medicaid ID# o Member s Name o Address o SS# or DOB o Phone number (add into Maxeb) This process is applicable each time a Caller calls on behalf of a Member Caller is the Family Substitute for a Member that is not capable of responding or giving information Caller must verify their relationship to the Member: o Member s Medicaid ID# o Member s Name o Address o SS# or DOB o Phone number (add into Maxeb) This process is applicable each time a Caller calls on behalf of a Member

9 June 7, 2017 Dear Sir or Madam: Colonial Behavioral Health SERVING JAMES CITY COUNTY, CITY OF POQUOSON, CITY OF WILLIAMSBURG AND YORK COUNTY Please be informed, on August 1, 2017 your Medicaid insurance plan may be changing. If so, starting on this date you will be enrolled in a new Medicaid program called CCC Plus, which stands for the Commonwealth Coordinated Care Plus Program. At this time your current health insurance coverage will stop and your new insurance program will begin. If you are impacted by the CCC Plus implementation, Medicaid will be sending you a letter sometime around June 18, 2017 to let you know more about this new program. Please let your CBH Case Manager or Clinician know when you get this letter. There are six insurance companies that will be providing coverage under this new Medicaid program. You will be able to choose the insurance company that best meets your needs. Those companies are: Aetna Anthem Magellan Optima United Healthcare Virginia Premier Your CBH Case Manager or Clinician will help you with this change in your insurance program if needed. They will help you find out which of the insurance companies covers the doctors that you see and provides the services and supports that you need, so you can decide which insurance program is best for you. After you sign up with your new insurance company, you will get a new insurance card in the mail. Please have this with you for all of your CBH appointments, as well as any other medical appointments that you may have. Please talk to your CBH Case Manager or Clinician about any questions that you may have about this new Medicaid program. Thank you Merrimac Trail, Williamsburg, Virginia Voice (757) TDD (757) Fax (757)