September 5, 2013

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Neighborhood –Who we are
Rhody Health Options Overview
State update information
Payment for Services
Case Management
Wrap up and Next Steps
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• Founded by RI’s Community Health Centers to expand access to care and improve health for at-risk populations
• Incorporated as an HMO in December 1993; began serving members in Spring 1994
• EOHHS partner for proactive Medicaid managed care
• Support Medicaid programs only
• 92,000 members currently
• Serve 67 percent of all RI Medicaid managed care participants
• Non-profit; offices in Providence
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• Large network; nearly every doctor/provider in RI
• More than 900 Primary Care Practitioners
– 42% of Neighborhood’s members receive their primary care at one of the 21 Community Health Centers in the state
• More than 2700 Specialists and robust ancillary and
DME networks
• More than 480 Behavioral Health Providers
• All hospitals in the state
• Nearly every pharmacy in the state
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• Rated “Excellent” by NCQA since 2001
• Ranked as one of Top 10 Medicaid Health Plans in America by
NCQA since rankings began in 2004 -
(#5 in 2012)
• 5 th Fastest Growing Private Company in RI -
Providence Business News (2011)
• Sample of Community Service Awards
– Healthy Moms, Healthy Babies Coalition
– Latino Public Radio
– Reach Out and Read Rhode Island
– The African Alliance of Rhode Island
– PARI Independent Living Center
– Rhode Island Foster Parent Association
97% of Neighborhood members would recommend us to family or friends
(2012 CAHPS Survey)
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Adults eligible for
Medicaid/Medicare
- Medicaid benefits
(Nov 2013)
Children with special health care needs
(2003)
Parents in
RIte Care
(1998)
Children in foster care
(2000)
Medicaid-only eligible adults with disabilities
(2008)
Adults in HealthSource RI –
Both Individual (up to
250%) and Small Business
(Jan 2014)
Children in
RIte Care
(1994)
Adults in
Medicaid
Expansion
(Jan 2014)
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– It is designed to transform the delivery of services to elderly and disabled Medicaid only members and Medicaid Medicare
Eligible members (duals) to maintain a high quality of life and live independently in the community.
– The goal of the program is to integrate the two government programs to eliminate the fragmentation and inefficiencies that exist today and improve the quality of care for members.
– In June 2013 EOHHS selected Neighborhood to be its managed care organization to implement this program.
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• Phase I
– Implementation of Medicaid Long Term Care benefits to managed care beginning November 2013.
– These members will be known as Rhody Health
Options members.
• Phase II
– Adds the integration of the Medicare benefit
– The full integration, is currently scheduled for implementation in early 2015.
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Timeline
• Awards announced August 2013
• Readiness Review July – Sept 2013
• Consumer letters Sept 1, 2013 - Feb 1, 2014 will be sent
– EOHHS will be phasing in RHO membership in 4 waves
– Approximately 6400 members per wave
– Complete Enrollment Schedule available on EOHHS website
– Members will be given the choice to opt out of the program
– We are currently working with EOHHS to identify all members in Wave 1 to insure smooth transition.
• Effective Enrollment Nov 1, 2013 - April 1, 2014 Dates
• Presentations & Trainings - July 2013 and ongoing Trainings by
EOHHS
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Schedule a Presentation on the Integrated Care Initiative
• The State will begin to set up community presentations on these two new programs: Rhody Health Options and Connect Care
Choice Community Partners. If you would like to schedule a presentation for your agency or organization, please contact
Alison Buckser at abuckser@ohhs.ri.gov
• Check the state website www.eohhs.ri.gov (under “Integrated
Care”)
• Email your questions at: integratedcare@ohhs.ri.gov
• There will be an Enrollment Help Line starting on Sept 1, 2013.
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Medical Management
Utilization/Medical Review
Nursing Home Transition Care Team
Care Management
Care Managers
Social Workers
Community Outreach Workers
Housing Specialists
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Neighborhood Case Managers can assist with:
• LTSS Waiver application assistance
• Develop and monitor individualized Plan of Care
• Collaborate to assess for safe discharge plan to the community when appropriate
• Participate in discharge planning meetings with members and caregivers
• Facilitate community services to ensure safe transition plan
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• Provide access for case managers to meet member and review medical record, including MDS
• Provide supportive clinical information for those receiving skilled services
• Collaboration in identification of those with potential discharge plan
• Collaboration in ensuring a safe transition to the community when applicable
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• Rhody Health Option members will be billed to
Neighborhood Health Plan of RI
• Connect Care Members will be billed to the state (as it is done today).
• Claims typically process within 7-14 days
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Neighborhood will require a claim submission for payment
• Claim submission can be completed via electronic faxes regular mail or electronically via a clearinghouse
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• Michelle Lupoli, Director of Medical Management, 459-6035
• Kathy Ullrich, Manager of Care Management, Duals 427-6526
• Meghan Ruane, Director of Operations, 459-6606
• Pat Huschle, Director of Provider Engagement and
Contracting,459-6012
• Maureen Brousseau, Manager of Ancillary Network,459-6033
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