This week, our In Focus section reviews Alabama’s Integrated Care Network (ICN) program, based on a concept paper released by the Alabama Medicaid Agency in March 2018. The ICN program will establish a new Medicaid long-term care program focusing on a person-centered approach to care delivery using the Primary Care Case Management (PCCM) Entity delivery model, with implementation expected on October 1, 2018.
Alabama’s current long-term services and supports (LTSS) system covers approximately 23,000 qualified elderly and disabled adults. The ICN program, in an effort to fix the fragmentation in the LTSS delivery system and to create a more fiscally sustainable system, will introduce managed care components, including a strong emphasis on case management, outreach, and an effort to increase home and community-based services (HCBS) utilization over institutional care. The PCCM model was chosen after the state deemed that a full-risk, capitated model would be more costly compared to the current Medicaid program.
The Alabama Medicaid Agency will continue to process claims and pay for all Medicaid-covered services on a fee-for-service (FFS) basis, with the exception of HCBS case management services for the Elderly and Disabled and ACT waivers. The agency will also be responsible for maintaining the Medicaid fee-for-service provider network as well as operation of a call center, provision of satisfaction surveys, and a grievance and appeals system.
The ICN will be responsible for education, outreach, and case management services. It will be the primary source of contact for Medicaid LTSS. The ICN will educate eligible beneficiaries about nursing facility and HCBS waiver options and coordinate with hospitals on educational resources related to community options.
ICN clinical staff will coordinate all services for members to support overall health, not just long-term care needs. The ICN will contract with the statewide network of local Area Agencies on Aging (AAAs) to deliver HCBS waiver case management services for the first two years of the program. The ICN will reimburse the AAAs at a minimum rate equal to the prevailing Medicaid fee-for-service payment schedule. It will be held accountable for increasing the percentage of members in HCBS settings. The ICN will also be required to have coordinating agreements with nursing facilities to share information, recommend medical interventions to avoid hospital admissions and emergency room visits, and suggest quality improvements in the care-planning process.
Additionally, the ICN will be responsible for data management, quality improvement, and other administrative functions.
The following individuals will be eligible to participate in the ICN program:
- Medicaid beneficiaries receiving care within a nursing facility
- Medicaid beneficiaries receiving care through select HCBS waiver programs
- Elderly and Disabled Waiver – targeting individuals who are frail or physically disabled
- Alabama Community Transition (ACT) Waiver – targeting individuals currently residing in institutional long-term care who seek to transition to an HCBS setting
Dual eligibles who qualify based on the above criteria will be included in the program. Approximately 85 percent of the ICN enrollment is expected to be duals.
The following populations will be excluded from the ICN program and continue to be administered on a fee-for-service basis by the state:
- State of Alabama Independent Living (SAIL) waiver participants
- Technology Assisted (TA) waiver participants
- Participants in either of the two waivers serving individuals with intellectual and developmental disabilities (I/DD)
- Individuals in Alabama’s Program for All Inclusive Care for the Elderly (PACE)
- Individuals living in an intermediate care facility
- Individuals receiving Medicaid-funded hospice room and board in a nursing facility or
Medicaid-funded hospice in the community
Each ICN’s performance will be evaluated by the ICN Quality Assurance Committee (QAC) based on the following quality measures:
- Long-Term Care
- Service Delivery and Effectiveness
- Person-Centered Planning and Coordination
- Choice and Control
- Community Inclusion
- Holistic Health and Functioning
- System Performance and Accountability
The ICN RFP is expected to be released in April 2018. Awards are expected in June 2018 with implementation set to begin by October 1, 2018, pending CMS approval of the 1915(b) waiver application and 1915(c) waiver amendments to be submitted mid-2018.
|RFP Released||April 2018|
|Anticipated Award||June 2018|
|Anticipated Enrollment||August 2018|
|Anticipated Go-Live||October 1, 2018|