Centers for Medicare & Medicaid

Services & Idaho Department of

Health and Welfare Demonstration
to Integrate Care for Dual Eligible
Individuals
Idaho Medicare-Medicaid
Coordinated Plan (MMCP)
Stakeholder Update
June 5, 2013
Webinar Topics
Plan Benefit Package
RFP versus Contract
Timeline
Implementation- phased in approach
MOU
Readiness Review

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Plan Benefit Package (PBP)
The PBP is a list of Medicare and Medicaid
benefits Health Plans will offer in the
Demonstration
All Medicare and Medicaid benefits, unless
otherwise carved out as in the case of
Developmental Disabilities services, are required
CMS required Health Plans to submit a PBP by
June 3, 2013
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Plan Benefit Package (PBP)
Two Health Plans have submitted PBPs for the
Demonstration
CMS provided a template to IDHW to provide
PBP guidance to Health Plans for services that
may have Medicaid benefit limitations greater
than Medicare benefit limitations
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Plan Benefit Package (PBP)
IDHW posted guidance on Medicaid benefits and
answers to PBP-related questions at:
www.MedicaidLTCManagedCare.dhw.idaho.gov
PBP includes benefit limitations, cost sharing
information, prior authorization requirements, and
other notes. Health Plans must be at least as Enrollee-
friendly as Medicaid.
Benefit limitations example: 12 hours/day limitation for
adult day health.
Cost sharing information example: possible $3.65
copayments for specified services
Prior authorization requirements, if applicable
Other notes to clarify the nature of a benefit

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RFP vs. Contract
IDHW requested an exemption to the
competitive bid process - request approved by
the Department of Purchasing
This means we move directly to contract
negotiations
Process will involve release of the contract to the
interested health plans for review and bid, along
with a questionnaire
Plans will submit their bid and their responses
to the questionnaire for evaluation by IDHW

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Timeline for Phased-In Enrollment
Approach
Enrollment in the Demonstration will be phased in by IDHWs three
geographical service areas (Southwest, East and North).

Opt-in enrollment in the Southwest geographic area begins on March 1,
2014.
All Enrollees in the Southwest geographic area who have not opted-in or
out before April 1, 2014 will be passively enrolled on that date.
Opt-in enrollment in the East geographic area begins on May 1, 2014.
All Enrollees in the East geographic area who have not opted-in or out
before June 1, 2014 will be passively enrolled on that date.
Opt-in enrollment in the North geographic area begins on July, 1, 2014.
All Enrollees in the North geographic area who have not opted-in or out
before August, 1, 2014 will be passively enrolled on that date.
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Tasks and Timeline for April 1, 2014
Implementation
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Key Timeline Step Target Dates
Plans submitted integrated Plan Benefit Packages to CMS June 3, 2013
Plans submit supplemental formulary files, including the
Additional Demonstration Drug (ADD) file, in HPMS
June 7, 2013
MOU Signed July, 2013
State releases contract and questionnaire for Medicaid
only services to interested organizations for review & bid
July, 2013
Plans selected by State August, 2013
Readiness Reviews Aug. Nov. 2013
State submits 1915(c) amendments October, 2013
State submits 1915(b) waiver application October, 2013
Contract shared with plans and the State
November 15,
2013
Tasks and Timeline for April 1, 2014
Implementation cont.
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Key Timeline Step Target Dates
Health Home SPA submitted if needed December 1, 2013
Coordinated Benchmark SPA December 1, 2013
State and Health Plan Sign contract December, 2013
60-day beneficiary notice sent in Area One (State) January, 2014
Plan Marketing begins February 1, 2014
Opt-in service coverage begins in Area One March 1, 2014
30-day beneficiary notice sent in Area One (State) March 1, 2014
Passive Enrollment takes effect in Area One April 1, 2014
Passive Enrollment takes effect in Area Two June 1, 2014
Passive Enrollment takes effect in Area Three August 1, 2014
Questions?
Email
LTCmanagedcare@dhw.idaho.gov
Website
http://www.MedicaidLTCManagedCare.d
hw.idaho.gov

Duals Demonstration Feedback
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