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State Demo on Dual Eligible Integrated Care
January 11, 2011

The Center for Medicare and Medicaid Innovation (CMMI) issued a request for proposals for state demonstrations that integrate care for dual eligible individuals. Information about the grant and submission requirements is available at http://innovations.cms.gov/opportunities/opportunities.shtml.

The Office of Mental Health and Substance Abuse Services (OMHSAS) distributed a stakeholder letter from the Office of Long Term Living requesting (OLTL) input to help the Departments of Aging and Public Welfare (DPW) with an application for a planning grant. Up to 15 states will be funded up to $1 million each to plan for integration of care for dual eligibles. Applications are due February 1 with start dates in April for those selected. The 12 – 18 month planning period requires development and presentation to CMMI of a demonstration model for integrating care. The proposal must include methods for evaluating the benefit and the impact of the demonstration. CMMI will then evaluate the proposed model and determine whether to fund implementation. If awarded the planning grant, Aging and DPW would plan for integration of all physical health, behavioral health, and long-term supports and services for dual eligibles. Also, if awarded the planning grant, Pennsylvania may not be awarded funding for implementation of a demonstration project.

Aging and DPW request input from stakeholders on suggestions for the strategic planning process and models for integrated care by January 14 to RA-IntegratedCareComments@state.pa.us. Address responses to questions to Kevin Hancock, director, Bureau of Community Development, OLTL. Questions are as follows:

  1. What is the name, e-mail address, and organization of the person completing this survey?
  2. Would you or your organization be willing to actively participate in regularly scheduled planning meetings to design a demonstration for integrating care for dual eligibles? In person? Or by phone?
  3. What approaches to integrating care for dual eligibles would you recommend Pennsylvania explore? And, why? Please include specific information about each approach.
  4. Do you have any particular concerns about specific services or populations with regard to integrating Medicare and Medicaid services? If so, please explain which services or populations and what your concerns are?
  5. Would you prefer to see a demonstration that is voluntary or mandatory?
  6. What other recommendations do you have about the proposal?
  7. If willing, individuals or organizations are asked to submit a letter of support for the Departments’ application for a planning grant to the above email address.

PCPA has long struggled with issues of access to behavioral health services for dual eligible individuals. PCPA is also working on a strategic goal related to integration of behavioral and physical health. Efforts at integration are needed, but the association is mindful of the need for maintenance of the carve-out for behavioral health services to ensure that funds remain available for these services. If individuals with intellectual disabilities are included in the demonstration project, there are concerns about returning to waiver services if funding for the project ended. PCPA members that serve dual eligibles are encouraged to review the CMMI proposal and submit responses to the above questions, even though time is very short. PCPA would appreciate a copy of any comments submitted. Please share them with Betty Simmonds at PCPA.

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