New Mexico Human Services Department1

The New Mexico Medicaid

Managed Care Program

Medical Assistance

Division

December 2018

Overview of Centennial Care

Centennial Care updates effective January 1, 2019

Centennial Care Open Enrollment Period

Questions

Introduction of Managed Care Organizations (MCOs) that will be providing services as of January 1, 2019

MCO Value-Added Services

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A Comprehensive Service Delivery System◦ Managed Care Organizations are responsible for integrating

care to address all health needs of the member through robust care coordination

Personal Responsibility◦ Engage recipients in their personal health decisions through

incentives and disincentives

Payment Reform◦ Use innovative payment methodologies to reward quality care

and improve health outcomes instead of just the quantity of care

Administrative Simplification◦ Combine all Medicaid waivers (except the Developmental

Disabilities and Medically Fragile waivers) into a single, comprehensive Section 1115 waiver

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Develop

Comprehensive

Delivery System

Emphasize

Payment

Reform

Simplify

Program

Administration

Encourage

Personal

Responsibility

Involve members in their own health

Educate beneficiaries to be savvy consumers

Promote integrated care

Care coordination for at-risk members

Pay providers for value and outcomes

Right care, right time, right setting

Streamline and modernize the

program

Purchase quality care

Bend the cost curve over time

Program updates will be effective 1/1/19

Basic program structure is the same as when Centennial Care began in 2014

Change in MCOs that will provide services and some new program initiatives

The three MCOs selected by HSD to provide services effective January 1, 2019 are:• Blue Cross/Blue Shield of New Mexico

• Presbyterian Health Plan

• Western Sky Community Care

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The Community Benefit provides home and community-based services so members who meet a nursing facility level of care (NF LOC) can stay in their homes and communities instead of moving to a nursing home.

◦ Increase annual limit for Community Benefit Respite for people with long term care needs from 100 to 300 hours

◦ Nutritional Counseling added to Agency-Based Community Benefit (ABCB)

◦ Start-up goods, up to $2,000 for new Self-Directed Community Benefit (SDCB) members that may include a computer, printer or fax machine

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Annual limits on certain SDCB services for new members entering SDCB on or after 1/1/19 (existing SDCB members are grandfathered)◦ Related Goods $2,000

◦ Specialized Therapies $2,000

◦ Non-Medical Transportation $1,000

SDCB Non-Medical Transportation Billing◦ Currently, providers can bill for transportation by time, trip,

mileage, or carrier pass (bus pass or taxi)

◦ Billing for time and trip will no longer be allowed for new or renewed SDCB plans after 1/1/19

◦ Only mileage and bus/taxi pass will be allowed

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Home-visiting pilot program in up to four designated counties, including Bernalillo, that focuses on pre-natal, post-partum and early childhood development◦ Working in collaboration with CYFD

◦ Two delivery models identified:

Nurse Family Partnership and

Parents as Teachers

◦ Different sets of services depending on type of visit: Prenatal visits

Post-partum visits

Infant/child visits

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New supportive housing services beginning 7/1/19 for members with Serious Mental Illness (SMI) to assist with acquiring, retaining and maintaining stable housing

Eligible members will access the program through a network of providers associated with the Linkages Supportive Housing Program

The program utilizes certified peer support workers for service delivery

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Extend Screening, Brief Intervention, and Referral to Treatment (SBIRT) services through primary care, community health centers and urgent care facilities

Provide SUD treatment for adults in accredited residential treatment centers

Expand inpatient SUD services (Institutes for Mental Disease)

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Copayment Most Centennial Care Members

Non-preferred prescription drugs(Psychotropic drugs and family planning drugs/supplies are exempt)

$8/prescriptionAll FPLs and COEs, certain

exemptions will apply

Non-emergency ER visits (hospital determines if emergent)

$8/visitAll FPLs and COEs, certain

exemptions will apply

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The following populations will be exempt from copayments:•Native American members;

•Individuals in a Fee for Service Category of Eligibility (COE)

•Individuals on the DD waiver;

•Individuals in an Institutional Care COE

•Individuals with a Household (HH) income of 0% FPL; and

•People receiving hospice care.

Begins March 1, 2019

Sunsetting existing co-pays for Children’s Health Insurance Program (CHIP) eligible members & Working Disabled Individuals

$10 Monthly Premium for Other Adult (Expansion) and Transitional Medical Assistance (TMA) adults in Centennial Care

Monthly premiums in subsequent years can be up to $20 at state’s option

Member Rewards program will have option to apply earned credits toward premium payments

If premium is not received by the monthly due date, there will be a grace period before services are suspended

For new members in the these two categories, premium payment must be received before services will begin

Native American members are exempt from premiums

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Phase out 3 month retroactive (retro) eligibility for non-pregnant Centennial Care members

2019: allow one month of retro coverage

2020: eliminate retro coverage

Some Centennial Care members can continue to receive retro coverage when requested:

◦ Individuals eligible for Institutional Care (IC) categories of eligibility

◦ Pregnant women

◦ Children under age 19

◦ Native Americans in Fee For Service Medicaid

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Family Planning Eligibility◦ Change to cover men and women through age 50

◦ Will no longer cover individuals with other full health insurance

◦ Individuals under age 65 who only have Medicare coverage can continue to receive Family Planning coverage

Nursing Facility Level of Care (NFLOC) Assessments◦ Community Benefit members who meet certain criteria and

who are always expected to meet NFLOC will not be required to have an annual NFLOC assessment

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Services provided through Managed Care Organizations (MCOs)

MCOs are insurance companies that contract with providers and healthcare facilities to provide services to their members

MCO enrollment is for a 12-month period

Each year, members can choose to change MCOs before the end of their 12-month enrollment

This year there is a special enrollment period for January 1, 2019.

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Current Centennial Care MCOs:◦ Effective September 1, 2018, all United Healthcare

members were transitioned to Presbyterian Health Plan

◦ Current MCOs will provide services though December 31, 2018

Starting January 1, 2019, there will be changes to the MCOs that provide Centennial Care services

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The three MCOs selected by HSD to provide services effective January 1, 2019 are:

• Blue Cross/Blue Shield of New Mexico

• Presbyterian Health Plan

• Western Sky Community Care

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Open Enrollment

• October 1, 2018 – November 30, 2018

During these 2 months, Centennial Care enrollees were able to choose the MCO to provide their Medicaid services

Enrollment selections made during open enrollment will be effective on January 1, 2019

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Any individual enrolled with Blue Cross or Presbyterian who did not choose a new MCO was re-enrolled with his/her current MCO

All other Centennial Care enrollees who did not choose an MCO was auto-assigned to a MCO

MCO choices and assignments will be

effective on January 1, 2019

All Centennial Care enrollees who chose or wereassigned to a MCO during open enrollment will have 3 months (starting January 1, 2019) to change their MCO

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An open enrollment notice was sent to all members at the end of September

The Enrollment Notice was sent by HSD in a turquoise envelope

The turquoise envelope listed the MCOs that will be available to provide Centennial Care services starting January 1, 2019◦ Included instructions on how and when to choose a

MCO

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Starting January 1, 2019, MCO changes can be made:◦ On-line:

www.Yes.state.nm.us

◦ By Phone:

1-888-997-2583

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All Centennial Care MCOs offer the same Medicaid benefits for each approved Medicaid category of eligibility

MCOs also offer Value-Added services (VAS)

Value-added services are benefits above and beyond what the MCO is required to provide

Benefits vary from one MCO to the next and may also be available for specific categories of eligibility

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MCO Choices can be made:◦ On-line:

www.Yes.state.nm.us

◦ By Phone:

1-888-997-2583

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Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Administered by

2019 Value Added

Services

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• Dental Varnish (PCP Office) - Available to children from

newborn to three years of age on Medicaid.

– There is a limit of six applications of the varnish per child.

– A prior authorization is not required to access this service.

• Eyeglasses for Members in the Medicaid Expansion

Population - Available to members 21 years and older

who have diabetes or high blood pressure.

– BCBSNM will reimburse members up to $150 a year for a vision test and

one pair of corrective eyeglasses (frames and lenses).

– The VAS is limited to an annual spending amount of $100,000.

– Access to this VAS requires prior authorization.

• Native American Traditional Healing and Wellness -

Available to Native American members.

– A member is allowed one $250 grant per calendar year.

– The member is required to return a signed verification form.

– Limited to an annual spending amount of $25,000 for members in the

Medicaid Expansion population.

Physical Health Value Added Services

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• Home Meal Delivery for Members Transitioning from a Nursing Facility into the

Community

– Meals will be provided upon discharge for up to seven days following the member's transition to ensure the member

has enough food to sustain them until food can be obtained.

– The VAS is limited to an annual spending amount of $30,000.

– This VAS will be provided on a case-by-case basis and will be considered when the transition of care plan is

completed.

• Remote Monitoring Program - Available to members with chronic conditions.

– This VAS is available to members with chronic conditions, such as congestive heart failure, diabetes, or chronic

obstructive pulmonary disease (COPD).

– This VAS is limited to serving 100 members.

– To qualify for this VAS, members must participate in the Paramedicine Program.

• Extended Lodging for Homeless Members - Available to members who are homeless,

but require extensive medical treatment post-hospital discharge.

– The VAS is limited to a two week stay during the transition.

– Access to this VAS requires an assessment of need.

Physical Health Value Added Services,continued

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To qualify for all maternity Value Added Services,

expecting mothers need to enroll in the BCBSNM Special

Beginnings.

• Baby Moby Wrap for Pregnant Members*

– The VAS is limited to one Moby wrap per delivery.

• Full Medicaid Benefits for Pregnant Members - Available

to Medicaid members covered under COE 301 or 035.

– Prior authorization is only required if the particular service should require one.

• Infant Car Seats**

– This VAS is limited to one seat per delivery.

Maternity Value Added Services

* Must have attended the post-partum appointment with an Obstetrics (OB) provider 21-56 days after delivery.

** Must complete prenatal requirements.

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To qualify for all maternity Value Added Services,

expecting mothers need to enroll in the BCBSNM Special

Beginnings.

• Portable Infant Cribs**

– This VAS is limited to one crib per delivery.

– Limited to an annual spending amount of $25,000 for members in the

Medicaid Expansion population.

• Prenatal Education (In-Person and On-Line)

– To access in-person prenatal classes, members must enroll and participate in

the BCBSNM Special Beginnings Program.

– To access the on-line program, members must enroll and participate in the

BCBSNM Special Beginnings Program and Safe Sleep Program.

Maternity Value Added Services,continued

**To qualify for the portable infant crib, the member must complete the prenatal requirements and enroll in the Safe Sleep

Program.

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• Electroconvulsive Therapy (ECT)

– ECT is offered when it is the preferred treatment for certain psychiatric conditions.

– This VAS is available to all members, except members in the Medicaid Expansion population.

– A prior authorization is required to access this VAS.

• Transitional Living for Chemically Dependent/Psychiatrically Impaired Adults and

Children - Available to members enrolled in an outpatient substance abuse center or in active

treatment for psychiatric issues.

– This is considered a short-term emergency placement and is limited to 18 days.

– This VAS is available to all members, except members in the Medicaid Expansion population.

– The VAS is limited to an annual spending amount of $125,000.

– A prior authorization is required to access this VAS.

• Wellness Centers - Available to Medicaid adults, children, adolescents and families with

behavioral health needs.

– The VAS is limited to an annual spending amount of $270,000.

– A prior authorization is not required to access this VAS.

Behavioral Health Value Added Services

Value-Added Services

Presbyterian Centennial Care Value-Added Services

• Full benefits for Pregnancy Services Only members

Members have full medical and behavioral health benefits. This includes prescription drug coverage, transportation services and routine dental services

• Baby Benefits programA program that helps mothers stay healthy during pregnancy. Moms can earn up to $150 in gift card rewards for going to prenatal and postpartum visits

Presbyterian Centennial Care Value-Added Services

• PhysicalsYearly adult routine physicals and

children’s school sports physicals

• Dental varnishSimple protective dental treatments

by trained primary care staff for

children.

Presbyterian Centennial Care Value-Added Services

• Traditional Medicine benefitWe can help you with $300 per

calendar year (Jan 1 to Dec 31) -

available to Native American

members

• MedisafeA medicine reminder app for your

smartphone that tracks your

prescription drugs and reminds you

when it’s time for a refill

Presbyterian Centennial Care Value-Added Services

• Tabtime VibeA pill case that beeps and vibrates to

remind you when it’s time to take your

medicine

• Wellness ClassesWellness classes for adults with a

diagnosis of diabetes or members

age 5-64 diagnosed with asthma

9/21/2018

A Centennial Care Choice

Value-Added Services

9/21/2018

Value Added Services

Value Added Services Description

Boys & Girls Club Membership A $30 credit towards the membership fee to the local Boys and Girls Club.

This is for children age 6-18 years old.

Care Grants Care Grants are for requests to help members receive special items. The requests

can be made by Western Sky Community Care (WSCC) staff, providers, or

caregivers. The items may include bike helmets, athletic shoes, music instruments, or

classroom art supplies for a child. This VAS is limited to $50 per household.

Caregiver ‘Thanks to You’ Package One “Thanks to You” package for caregivers. Items may include: A waterproof

keepsake bag, a caregiver journal, an important phone numbers magnet and

caregiver educational material. Members are those who receive LTSS and Home and

Community Based Services (HCBS), and living or moving into a caregiver’s home.

Dental Varnish Application of dental varnish by trained primary care physician (PCP) staff during a

regular Early and Periodic Screening, Diagnostic and Treatment (EPSDT) visit for

children age 6 months to 3 years.

GED Preparation & Testing Provide official General Education Diploma (GED) testing practice materials upon

request and/or provide financial assistance for completion of the GED test.

Native American Traditional Healing

Benefit

Reimbursement for ceremonial or spiritual healing that may improve behavioral health

and/or physical health. Members are allowed up to $250 per member per calendar

year. This VAS is limited to an annual spending of $150,000.

9/21/2018

Value Added Services

Value Added Services Description

Post Discharge Meals Eligible members will have access to 10 healthy, home-delivered meals. This will be

initiated at the time of discharge planning, following an acute inpatient hospital stay or

transition out of a nursing facility to community based setting. Limitations and

restrictions may apply.

Practice Dental Visits The practice visit provides an opportunity for individuals with Intellectual and/or

Developmental Disabilities (I/DD) who are fearful of dental visits to go to a simulated

dental exam only in accepting provider offices.

Practice Gynecology Visits The practice visit provides an opportunity for individuals with Intellectual and/or

Developmental Disabilities (I/DD) who are fearful of gynecology visits to go to a

simulated gynecological exam only in accepting provider offices.

Wellness & Emotional Support The MyStrength.com online program gives Members information overcome

depression and anxiety. This online program includes simple tools, weekly exercises,

mood trackers and daily inspirational quotes and videos. The program may be used

independently or with other services.

Thank you!

An electronic version of this presentation can be downloaded at:

http://www.hsd.state.nm.us/centennial-care-2-0.aspx

or may be requested via e-mail at:

CCInfo@state.nm.us

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