Community Supported Living Arrangement and Integrated Care Program Medicare and Medicaid Eligible and Medicaid-Only Eligibles

Regulation Authority:

RIGL 40-8 Title XIX of the Social Security Act

Purpose and Reason:

This proposed rule-making supports the mission of the Integrated Care Program to transform the delivery system through purchasing person-centered, comprehensive, coordinated, quality health care and support services that promote and enhance the ability of Medicaid-only and Medicaid/Medicare eligible (MME) recipients to maintain a high quality of life and live independently in the community. Care management is a critical component of this strategy. The adoption of this proposed rule will build upon, improve and integrate with current Care Management programs to better meet the needs of the target population. Care should be less fragmented and more person-centered; care managers should strive to better communicate across settings and providers; and members should have greater involvement in their care management. The Affordable Care Act provides the states an opportunity to improve the coordination of services for consumers through managed care and primary care case management arrangements. Beginning July l, 2013, EOHHS will enroll all Medicaid members, including Medicare and Medicaid eligibles (MMEs) into a managed care organization (MCO) or a primary care case management program (PCCM). These members will receive a notice from EOHHS explaining the changes and informing them of their ability to choose between an MCO or PCCM through which all of their Medicaid covered services, including long-term services and supports (LTSS), will be coordinated and reimbursed. LTSS includes nursing home care as well as home and community-based supports that allow members to live independently in the community. Medicare services will continue to be administered by the Medicare program in calendar year 2013. Members will be asked to choose one of these options within thirty days of receiving their notice. Members who do not make a choice will be auto-enrolled into one of these two programs, however, they will have the ability to switch between programs.