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State Medicaid Integration Tracker StateArkansasState UpdatesBalancing Incentive ProgramThe Centers for Medicare & Medicaid Services (CMS) announced (3/ 15/ 2013) thatArkansas w ill receive an estim ated 61.2 m illion in enhanced Med icaid fund s (2%enhanced FMAP rate). (Source: Balancing Incentive Program Aw ard Letter)BIP Application (11/ 27/ 2012); BIP Aw ard Letter (3/ 15/ 2013)Health HomesCMS approved planning request. (Source: Integrated Care Resource Center)Section 1915(k) Community First Choice Option (CFCO)The state plans to submit a §1915(k) State Plan Amendment to CMS to implement CFCOon July 1, 2013. (Source: CFCO 6th Meeting Minutes (5/30/2013)) The program wouldprovide additional resources and a mechanism to address Arkansas’ waiting list of over2,000 people with developmental disabilities seeking services under the existing AlternativeCommunity Services Waiver, offering long-awaited services to those who need them. Thestate estimates it could serve 20,294 clients under CFCO. (Source: Community First ChoiceOption Development and Implementation Council Presentation (11/20/2012))State Website on CFCODevelopment & Implementation Council Meeting DocumentsCaliforniaCurrently Operating Medicaid Managed LTSS ProgramUnd er Med icaid §1915(a) authority, SCAN Connections at Home provid es longterm services and supports (LTSS) to Medicare-Med icaid enrollees of age 65 andold er at capitated rate. Services includ e nursing facility and H CBS w aiver -likeservices, includ ing hom em aker, hom e d elivered m eals, personal care,transportation escort, custod ial care, in -hom e respite, and ad ult d ay. The programoperates in lim ited geographic area and enrollm ent is voluntary. (Source: CMS andTruven H ealth Analytics, The Grow th of Managed Long-Term Services andSupports (MLTSS) Program s: A 2012 Upd ate, July 2012)State Website on SCAN Connections at H om eState D emonstration to Integrate Care for D ual Eligible IndividualsCoordinated Care Initiative (CCI): California subm itted a revised d em onstrationproposal to CMS on May 31, 2012. On June 27, 2012, the governor approved a bill(SB 1008) to revise the existing law to require the Departm ent of H ealth CareServices to establish d emonstration sites in up to eight counties not sooner thanMarch 1, 2013. (Source: Cald uals.org, July 3, 2012) Accord ing to thed em onstration proposal, target population includes all full benefit Med icareMed icaid enrollees w ho are age 21 or over in eight counties w ith specifiedexceptions. Full benefit d ually-eligible beneficiaries are those Med icarebeneficiaries w ith Parts A, B, and D coverage and full Medi-Cal coverage. Med i-Calcovers Med icare prem ium s, co-insurance, copaym ents, and d ed uctibles, as w ell asservices that Med icare does not cover (prim arily long-term services and supports).Beneficiaries w ith d evelopm ental disabilities w ho are receiving services from theDepartm ent of Developm ental Services and regional centers are carved out fromthe d em onstration, w hile som e people w ith developm ental disabilities receivingservices through the state’s in -hom e supportive services (IH SS) and com munitybased ad ult services (CBAS) w ill be includ ed in the d em onstration. Those enrolledin §1915(c) H CBS w aiver program s are also exclud ed from the dem onstra tion.State Medicaid Integration Tracker June 20137

State Medicaid Integration Tracker StateCaliforniaState UpdatesCovered benefits includ e Med icare (Parts A, B and D) and Med icaid coveredservices. The d em onstration w ill use a capitated paym ent m od el. (Source:Dem onstration Proposal; N ASDDDS Managed Care Tracking Report) Stateofficials proposed (05/ 25/ 2012) a ch ange in the im plem entation d ate, from March2013 to June 2013. (Source: w w w .californiahealthline.org, May 30, 2012)Dem onstration ProposalState Website on Coord inated Care InitiativeTim elineCoord inated Care Initiative Fact Sheets on CalDuals.orgCMS announced on March 27, 2013 that California w ould be the fifth state to enterinto a Mem orand um of Und erstanding (MOU) to integrate care for d ually -eligiblebeneficiaries as a com ponent of California’s Coord inate Care Initiative (CCI).Accord ing to the state’s w ebsite, the project w ill be called the Cal MediConnectfrom now on. Through Cal Med iConnect, eligible beneficiaries w ill have theopportunity to com bine all their Medicare and Med i-Cal benefits into one healthplan — and receive m ore coord inated and accountable care. Enrollm ent w asinitially expected to begin no sooner than October 1, 2013. On May 6, 2013,how ever, the Departm ent of H ealth Care Services (DH CS) announced that CalMed iConnect w ould begin no earlier than January 2014. (Source: CalDuals,accessed 5/ 13/ 2013)Mem orand um of Und erstand ingSection 1915(k) Community First Choice (CFC) OptionCalifornia submitted CFCO SPA #11-034 in December 2011 and received approval fromCMS in August 2012. California is the first state to receive approval from CMS(9/ 4/ 2012) to enact the Com m unity First Choice Option, w hich w ill provid e thestate an estim ated 573 m illion in ad ditional federal fund s d uring the first tw oyears of im plem entation. Com m unity First Choice w ill enhance Med i-Cal’s abilityto provid e com m unity-based personal attend ant services and support to seniorsand persons w ith disabilities to certain enrollees w ho otherw ise w ould needinstitutional care. California im m ed iately w ill begin claiming the Com m unity FirstChoice fed eral funding, w hich is retroactive for m ost In -H om e Supportive Services(IH SS) program services provid ed since December 1, 2011. (Source: Press Release,9/ 4/ 2012) In May 2013, the state subm itted its second CFCO SPA (CFCO SPA #13007), currently pending with CMS. (Source: State Website on CFCO)Section 1915(i) State Plan Amendment1. Approved State Plan Amend m entCalifornia submitted an application to im plem ent a §1915(i) H om e and Com m unityBased Services State Plan Option (SPA# 09-023A) in 2009 and received approvalfrom CMS on April 25, 2013. The state’s SPA is the first in the nation approved byCMS und er §1915(i) specifically for persons w ith d evelopm ental d isabilities. TheSPA approval allow s the state to access fed eral fund ing for services, such asresid ential supports, d ay program s and respite, provid ed to ind ivid uals w ho d onot m eet the institutional level of care eligibility criteria of the current MedicaidH CBS Waiver. (Source: Press Release, May 1, 2013)2. Pending State Plan Amend m entsCalifornia Departm ent of H ealth Care Services (DH CS) submitted tw o ad ditionalState Med icaid Integration Tracker June 20138

State Medicaid Integration Tracker StateCaliforniaState Updates§1915(i) State Plan Am end m ents in 2011. The first one (SPA# 11-041) proposed totarget d evelopm entally d isabled individ uals w ith a need for habilitation services.This SPA w ould extend Med i-Cal coverage for existing sp ecialized health and otherhom e and com m unity-based services provid ed to Med i-Cal-eligible persons w ithd evelopm ental d isabilities. Med i-Cal-eligible persons w ith d evelopm entald isabilities w ho d o not m eet the criteria for institutional long -term care servicesw ill be covered und er this State Plan option. Services covered und er the SPAw ould includ e com m unity living arrangem ent services, respite care, and d ayservices. The state anticipates serving 42,000 in the first year. The second §1915(i)(SPA# 11-040) proposed to target infants and todd lers w ith d evelopm ental d elaysand w ould provid e a 1-day session w ith fam ilies to prepare the child ren for sch oolor other appropriate facilities (currently fund ed w ith state-only fund s). Californiaanticipates serving 3,800 in the first year. (Source: California Departm ent of H ealthCare Services Website)Health HomesCMS approved planning request. (Source: Integrated Care Resource Center)ColoradoState D emonstration to Integrate Care for D ual Eligible IndividualsColorad o’s d em onstration w ill includ e the state’s entire d ually -eligible population,includ ing those w ith I/ DD, w ith enhanced coord ination betw een acute and long term care. (Source: N ASDDDS Managed Care Tracking Report) The demonstrationis statew id e w ith m anaged fee-for-service as the paym ent m od el. Covered benefitsinclud e Med icare Parts A, B, and D, Medicaid State Plan, Behavioral H ealthServices available und er an existing §1915(b) Medicaid w aiver, and H om e andCom m unity-Based Services available und er §1915(c) Med icaid w aivers.Im plem entation d ate w as not specified . (Source: Dem onstration Proposal)State Website on Duals Dem onstrationSection 1915 (i) State Plan AmendmentColorad o subm itted a State Plan Am end m ent to im plem ent §1915(i) State PlanOption in 2008 and received approval from CMS in 2009. To qualify for State PlanH CBS Services provid ed und er the option, a physician m ust d ocum ent that theind ivid ual’s health is at risk w ithout appropriate supports d ue to a chroniccond ition and/ or progressive d isease as d ocum ented by a physician requiressignificant assistance w ith transferring m obility or supervision and assistance w ithat least one of the follow ing Activities of Daily Living bathing d ressing eating ortoileting. (Source: State Plan Am end m ent)Accountable Care Collaborative (ACC)A bipartisan bill, w hich establishes a program to pilot-test Med icaid fee-for-servicealternatives and Regional Care Collaborative Organizations (RCCO), w as signedinto law by Governor John H ickenlooper (6/ 4/ 2012). (Source: Mod ernH ealthcare.com ; Mod ernPhysician.com ) Accord ing to the state w ebsite, Med icaid clients in theAccountable Care Collaborative (ACC) w ill receive the regular Med icaid benefitpackage, and w ill also belong to a “Regional Care Collaborative Organization”(RCCO). The Regional Care Collaborative Organization (click here for stateresource) connects Med icaid clients to Medicaid provid ers by helping Med icaidclients find com m unity and social services in their area and provid ers comm unicatew ith Med icaid clients and w ith each other. A RCCO w ill also help Med icaidclients get the right care w hen they are returning hom e from the hospital or aState Medicaid Integration Tracker June 20139

State Medicaid Integration Tracker StateColoradoState Updatesnursing facility, by provid ing the support needed for a quick recovery. A RCCOhelps w ith other care transitions too, like m oving from child ren’s health services toad ult health services, or m oving from a hospital to nursing care. All clients enrolledin the ACC also have to choose Prim ary Care Medical Provid er (PCMP). PrimaryCare Medical Provider (click here for state resource) is a Med icaid client's m ainhealth care provid er. A PCMP is a Med icaid client's “m ed ical hom e,” w here he orshe w ill get m ost of their health care. When a Med icaid client need s specialistcare, the PCMP w ill help him or her find the right specialist.Accountable Care Collaborative State WebsiteAccountable Care Collaborative Fact SheetSelected by the Center's for Med icare and Med icaid Services' (CMS') InnovationCenter to participate in the Com prehensive Primary Care (CPC) Initiative, the statew ill im plem ent this new prim ary care initiative through the existing ACC Program .The CPC Initiative is focused on strengthening prim ary care and fosteringcollaboration betw een health care system s. (Source: Colorad o Departm ent ofH ealth Care Policy and Financing)Section 1915(k) Community First Choice OptionThe state is currently consid ering pursuing the option. In 2012, Colorad o's LongTerm Services and Supports (LTSS) Strategic Planning Report id entified consum erd irection/ Com m unity First Choice as an im portant initiative w ithin the strategy ofLTSS. In accord ance w ith the fed eral final rule on the option, Com m unity FirstChoice Council has been form ed . (Source: Colorad o Com m unity First ChoiceCouncil w ebsite)ConnecticutState D emonstration to Integrate Care for D ual Eligible IndividualsConnecticut’s financial alignm ent d em onstration proposes to serve d ually -eligible(MMEs) age 18 to 64, and age 65 and old er. The populations served w ill includ eind ivid uals w ith Serious m ental illness (SMI), and ind ivid uals w ith Intellectual andDevelopm ental Disabilities, w ith increased coord ination focused on acute healthcare. (Source: N ASDDDS Managed Care Tracking Report) Covered benefits includ eMed icaid State Plan services (includ ing §1915(i)), Med icaid w aiver services,Med icare Parts A, B and D, and adjunct services and supports, such as IntensiveCare Managem ent, chronic disease self-m anagem ent ed ucation, nutritioncounseling, falls prevention, m ed ication m anagem ent services, and potentially also,peer support and recovery assistance. The d em onstration w ill utilize a managedfee-for-service paym ent m od el. Participation of MMEs in the Ad ministrativeServices Organization (ASO) m od el w ill begin statew id e effective January 1, 2013.Participation of MMEs in H ealth N eighborhood s (H N ) m od el w ill be launched on apilot basis in lim ited service areas starting April 1, 2013. The Departm ent thenplans to use the know ledge gained in this pilot period to expand the initiative toserve ad d itional MMEs, and also potentially to expand the m od el to serve single eligible Medicaid individuals (MEs) and convert risk -adjusted ad vanced paym entsto H N s (APM II) to a H ealth H om es coverage option. (Source: Dem onstrationProposal)Balancing Incentive ProgramThe Centers for Medicare & Medicaid Services (CMS) announced (12/ 7/ 2012) thatConnecticut w ill receive an estim ated 72.8 m illion in enhanced Med icaid fund s(2% enhancem ent of the state’s FMAP rate). (Source: CMS Balancing IncentiveProgram w ebsite)State Med icaid Integration Tracker June 201310

State Medicaid Integration Tracker StateConnecticutState UpdatesCMS Aw ard Announcem ent (12/ 7/ 2012)BIP Application (10/ 31/ 2012)Section 1915(i) State Plan AmendmentConnecticut’s §1915(i) State Plan Am end m ent to CMS w as submitted in 2011 andthe option w ent effective in 2012. It is one of funding sources for ConnecticutH om e Care Program . Since February 2012, ind ivid uals w ith incom es up to 150% ofthe federal poverty level (FPL) have been able to get Med icaid -covered non-hom ehealth care com m unity-based services und er this option. (Source: OLR ResearchReport: Connecticut H om e Care Program , February 2013) The state has id entifiedeld erly and d isabled ind ivid uals, includ ing old er ad ults financially, but notfunctionally eligible for the state’s H CBS eld er w aiver as the target populations.Services covered by the option w ould includ e ad ult d ay health, care managem ent,hom em aker, personal care assistant, respite, assisted living, assistive technology,chore services, com panion, environm ental accessibility ad aptations, hom ed elivered m eals, m ental health counseling, personal em ergency response system s,and transportation. (Source: State Plan Am end m ent)Connecticut restructures the state’s relationships w ith Medicaid managed careplansStarting January 1, 2012, Connecticut began d irectly reim bursing health careprovid ers, w hile a non -profit organization, Comm unity H ealth N etw ork ofConnecticut, Inc., provides care coord ination and custom er service for all of thestate’s Med icaid and Child ren’s H ealth Insurance Program beneficiaries, plusm em bers of a state-funded health program s for low -incom e ad ults — about 600,000people in all. All services w ill be coord inated by the Departm ent of Social Services’single, statew id e ad m inistrative services organization (ASO). (Source: Stateline;Com m unity H ealth N etw ork of Connecticut, Inc.)Press ReleaseRequest for Proposals (April 2011)H B06518. An Act Establishing An Ad m inistrative Services OrganizationD elaw areCurrently Operating Medicaid Managed LTSS Program & State Initiatives toIntegrate Care for D ual Eligible IndividualsAm endm ent to Diam ond State H ealth Plan (DSH P) §1115 Medicaid m anaged cared em onstration w aiver (approved 3/ 22/ 2012) ad ded D iamond State Health PlanPlus (D SHP Plus) in order to integrate Long Term Care Med icaid and other fullbenefit d ually eligible into the DSH P. DSH P Plus began on April 1, 2012. Servicesprovid ed in capitated rate includ e prim ary, acute, and behavioral services, andLTSS. Prescription d rugs are carved out of both DSH P and DSH P Plus. Targetpopulation includ es old er persons, persons w ith physical d isabilities, persons w ithH IV/ AIDS, persons using Money Follow s the Person services, w orkers w ithd isabilities using Buy-in, Med icare-Med icaid enrollees, and all SSI-eligible child renand ad ults except persons in ICF/ MRs and persons in DD/ MR §1915(c) w aiver.The Am end m ent also consolidates Eld erly/ Disabled , Acquired Brain Injury, andAssisted Living §1915(i) w aivers into one Eld erly and Disabled w aiver program .Eld erly and Disabled w aiver program and AIDS/ H IV w aiver w ill be incorporatedinto the long-term care m anaged care program . (Source: Med icaid .gov; DSH P FactSheet)Waiver Am end ment Request Letter to CMSCurrent Approval Docum entDiam ond State H ealth Plan w ebsiteState Medicaid Integration Tracker June 201311

State Medicaid Integration Tracker StateD elaw areState UpdatesFinal rule of the Departm ent of H ealth and Social Services, Division of Med icaidand Medical Assistance, am end s and ad opts regulations regard ing the Diam ondState H ealth Plan (DSH P) §1115 Med icaid m anaged care d em onstration w aiver.The rule expand s the DSH P to includ e Long-Term Care Med icaid and other fullbenefit d ual eligible beneficiaries und er the nam e Diam ond State H ealth Plan Plus.The rule is effective June 10, 2012. For m ore inform ation, please click here. (Source:BN A Register, 6/ 12/ 2012)Section 1915(i) State Plan AmendmentThe state plans to im plem ent the option in FY 2013. (Source: Kaiser Comm ission onMed icaid and the Uninsured , April 2013)D istrict ofColumbiaSection 1915(i) State Plan AmendmentAccord ing to a DC official, the District is looking to d evelop and im plem ent the§1915(i) State Plan option in the Afford able Care Act for its Day Treatmentprogram , and is currently engaged in conversations w ith CMS technical assistancecontractor to d eterm ine how the District can best use the §1915(i) option in its effortto bring Day Treatm ent service d elivery into compliance. Target population w illinclud e old er ad ults, ad ults w ith physical disabilities ad ults w ith m ental illness,and ad ults w ith intellectual and d evelopm ental disabilities. (Source: NASUAD)Health HomesCMS approved planning request. (Source: Integrated Care Resource Center)FloridaCurrently Operating Medicaid Managed LTSS ProgramFlorida Long-term Care Community D iversion Program operating und er §1915(a)and §1915(c) Medicaid authorities serves Med icare-Med icaid d ual eligibles of age65 and old er in 46 of 67 counties in the State. The state is currently processingapplications for the rem aining counties. Enrollm ent is voluntary w ith opt in.(Source: CMS and Truven H ealth Analytics, The Grow th of Managed Long-TermServices and Supports (MLTSS) Program s: A 2012 Upd ate, July 2012)State Website on Long-term Care Com m unity Diversion ProgramApproved WaiverProjected Medicaid Managed LTSS Program & State Initiatives to Integrate Carefor D ual Eligible IndividualsThe Florid a Agency for H ealth Care Ad m inistration (AH CA) recently (2/ 1/ 2013)received approval of its application for a §1915(b)(c) com bination w aiver from CMSto im plem ent the long-term care com ponent of the State Med icaid Managed Care(SMMC) Program . These sim ultaneous (b) & (c) w aivers are effective beginningJuly 1, 2013, through June 30, 2016. The Agency had subm itted (8/ 1/ 2011) initial§1915(b) w aiver application and a concurrent initial §1915(c) w aiver application tothe CMS to im plem ent the Florida Long Term Care Managed Care program asm and ated by the 2011 Florid a Legislature (H ouse Bill 7107). The legislaturerequired the agency to create a statew id e long-term care m anaged care program forMed icaid recipients w ho are (a) 65 years of age or old er, or age 18 or old er andeligi

(Source: Calduals.org, July 3, 2012) According to the proposal, target population includes all full benefit Medicare-nefit dually-eligible beneficiaries are those Medicare -Cal coverage. Medi Cal -insurance, copayments, and deductibles, as well as (primarily long-ter