Additional info on the Dual Eligible Demonstration

I wanted to send out another post on the Dual Eligible Demonstration, since there seems to be some confusion around it.  Specifically, I want to share what we think consumers, providers and families should know.

Several of our Dual Eligible consumers have received letters from our local Regional Care Collaborative Organization (RCCO, commonly pronounced ree-koh).  Here is a useful definition of what a RCCO is from the Colorado.gov website:

The RCCO connects Medicaid clients to Medicaid providers and also helps Medicaid clients find community and social services in their area.  The RCCO helps providers to communicate with Medicaid clients and with each other, so Medicaid clients receive coordinated care.  A RCCO will also help Medicaid clients get the right care when they are returning home from the hospital or a nursing facility, by providing the support needed for a quick recovery.  A RCCO helps with other care transitions too, like moving from children's health services to adult health services, or moving from a hospital to nursing care.

There are seven different RCCOs for the State of Colorado, and like Community Centered Boards (CCBs) each serves a geographical area.  The RCCO for our geographical area (region 6) is called the Colorado Community Health Alliance (CCHA).  The letters that some of our Dual Eligible consumers have received are actually from CCHA.  These letters are being sent to inform the consumer that she or he will be passively enrolled in the Dual Eligible Demonstration project unless they contact CCHA to opt out of the program.  That means that if the consumer takes no action then she or he will be enrolled in the program.  This is a technique that is being used to ensure that a large number of individuals participate in the Demonstration.

Overall, we think that the Dual Eligible Demonstration is a positive thing, in that it will help streamline care for individuals being served by both Medicaid and Medicare.  However, we encourage each consumer or guardian that receives this letter to contact CCHA and confirm that their primary care physician is indeed participating in the Demonstration project.  We have heard from another agency that a consumer was enrolled in the program and later found out that their primary care physician was not participating.  We have been assured by the State that individuals should not be receiving these letters unless their primary care physician is participating, but we still urge individuals or their guardians to find out for sure before enrolling.

If you have any further questions about the program, click here to access the Colorado.gov website page about it, which explains the project in much greater detail.

Dual-Elligible Demonstration Stakeholder Update

This week there was stakeholder meeting for Colorado's "Demonstration to Integrate Care for Dual Eligible Individuals."  Essentially, this project aims to steam-line care and billing for individuals who receive both Medicaid and Medicare.  Since many individuals with intellectual and/or developmental disabilities (I/DD) are dual eligible, this is an important project for Innovations to follow.  Click here to read the complete proposal that the State of Colorado Department of Healthcare Policy and Financing (HCPF) submitted to the Centers for Medicare and Medicaid (CMS).

At this point, HCPF is negotiating with CMS to ensure that Colorado benefits from any savings from this program.  Once a deal is reached, and a Memorandum of Understanding is finalized, the State will move forward with implementation of the program.  HCPF expects that the first enrollees of the program will begin receiving Demonstration services as of June 1st, 2013.  There is an Advisory Group for this project that meets regularly.  Click here for the minutes of that group's latest meeting.

Enrollment in this Demonstration is done passively, where an individual who is Dual Eligible will receive a letter asking them if they want to opt out of the demonstration.  If the individual chooses not to opt out or does nothing, then they will be enrolled in the demonstration.  At this point, we think that the Demonstration will benefit individuals, as it will help their physicians coordinate care.  Initially, we were concerned about provider enrollment, but HCPF has made provider enrollment a priority, and have ensured that an individual will not lose their primary care physician by participating in this demonstration.  We will continue to follow the implementation of this project and will post more details as they become available.

The Innovations Advocacy Council

I want to use one of the first posts on this blog to give credit to the Innovations Advocacy Council, who identified the need for Innovations to share information more directly with its stakeholders, and inspired the creation of this blog. 

The Innovations Advocacy Council was founded this past year to give members of the Innovations network an opportunity to provide ideas and feedback to the Innovations Management team.  The Mission of the Innovations Advocacy Council is to “support and empower individuals with developmental disabilities to maintain full and independent lives. The Innovations Advocacy Council will work toward strengthening bonds in the community and its interaction with individuals with developmental disabilities, as well as advocating for individuals with disabilities within Innovations and governing agencies.”  The Advocacy Council consists of a diverse cross-section of people who are connected with our services here at Innovations.  Specifically, it is comprised of individuals receiving services from Innovations, family members and guardians of people receiving services, contract providers for Innovations, and employees of Innovations.   We continue to be grateful for the opportunity to get feedback from a group of people that cares deeply about the individuals we serve. 

If you have any agenda items for the Advocacy Council, or if you wish to learn more about the Council, please contact Lou Ella Price at lprice@imaginecolorado.org.

Joint Budget Committee Hearing for CDHS

The new year got off to a fast start with the Colorado Joint Budget Committee (JBC) hearing for the Colorado Department of Human Services (CDHS) on Wednesday, January 2nd.  The JBC heard from CDHS Executive Director Reggie Bicha, who answered questions from the JBC and outlined the Department's short-term and long-term goals.  Some highlights from the presentation:

• A new office was created in CDHS last June called the Office of Early Childhood.  This office will consolidate and streamline programs for young children.
• CDHS is requesting $1.78M in appropriation for Early Intervention funding due to growth in the number of children in Colorado who need such services.
• CHDS is anticipating steady growth in individuals diagnosed with Intellectual/ Developmental Disability (I/DD) (due to increases in technology and health care)
• CDHS would like to see definition of I/DD changed in rule to match Colorado state law.
• The new Office of Community Living, established by Gov. Hickenlooper, will address long term strategies, including drawing down the waitlist for services, simplifying the waivers, and improving the system for accessing services..
• Mr. Bicha acknowledged the problem that parents of children with severe disabilities need to “give up” their children to get services.
• A transition plan is being developed to transition kids to adult waiver at age 18.
• CDHS does not want to eliminate CHRP or just thrust kids into the DD system due to unintended negative impacts, and will transition kids on a person-by-person basis.
• The JBC budget proposal provides services for 809 additional individuals, including 573 enrollments for children on the CES waiting list.
• CDHS is committed to transitioning people to the “most integrated setting,” and will work to transition people from the Regional Centers to community placements when possible.  
• CDHS will continue to use Regional Centers for short-term stabilization.
• Mr. Bicha agrees with Gov. Hickenlooper's recommendation of a 1.5% provider rate increase for the next fiscal year.  When pressed by Rep. Levy, he stated that CDHS will not be asking for any further rate increase for next fiscal year.

Click here for the agenda for the CDHS hearing and the written responses from CDHS to questions from the JBC.  Click here for an audio recording of the hearing.