Centennial Care 2.0

Human Services Department (HSD) has selected the following MCOs to provide services to persons eligible for New Mexico Medicaid through a Centers for Medicare and Medicaid (CMS) 1115 Demonstration Wavier. Centers for Medicare and Medicaid (CMS)

The 12/6/17 New Mexico Centennial Care 2.0 Federal submission to Human Services Department (HSD) and to Centers for Medicare and Medicaid (CMS) and Human Services Department (HSD)

What does LTSS mean to you?

Centennial Care 2.0 has the Long-Term Services and Supports (LTSS) built into the wavier to provide Home and Community based services. The following is from the CMS LTSS website:

Long term services and supports graphic

The two main models for providing LTSS are home- and community-based care and facility-based care. The table below compares the main differences between the two models. It is important to note that, often, the care available to a patient under each model is quite similar. What is different is how the care is delivered and where the patient lives.

Home- and Community-Based Care Facility-Based Care
What LTSS services can be provided? Medical and personal services to help with daily living tasks Medical and personal services to help with daily living tasks
Where does the patient live? In their own home, or with a family member In a facility designed to provide LTSS to patients who live there
Where are the services provided? By caregivers who visit the home, or by going out to visit providers in the community Many services are provided by onsite caregivers who work at the facility
Who are the paid or reimbursable caregivers? Family members can sometimes be certified as live-in or visiting caregivers, depending on the state's requirements. Other care can be provided by medical providers in the community Caregivers are the professional medical staff who work at or visit the facility

Under either model, the services available are determined by the funding or reimbursement options that your program has access to. For example, if state programs, such as Medicaid, play a large role in your program's funding, allowable services will be influenced by your state's definition of allowable services. Learn more about LTSS financing.

Centennial Care 2.0 Demonstration Waiver 1115 is a Home-and Community-Based Services (HCBS)

HCBS address the needs of people with functional limitations who need help with daily living activities. HCBS keep elderly and disabled people in their homes and in their home communities.

Retrieved from: https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/LTSS-TA-Center/info/ltss-models.html

How to access Centennial Care 2.0

The person selects their MCO when they enroll (or complete the annual recertification). Then the MCO assigns a Care Coordinator. The Care Coordinator does a phone assessment which assigns Level 1, Level 2 or Level 3 to the Member. The assigned level relates to service and support needs.

When a person has Level 2 or Level 3 this means they need more services and may be eligible for Agency Based Community Benefit (ABCB) or after receiving ABCB for 120 days they can access Self-Directed Community Benefit (SDCB). Self-Directed Choices (SDC) provides Support Broker services and supports to members on Self-Directed Community Based services and supports.

Self-Directed Choices serves you as a Support Broker?

Self-Directed Choices contracts with Blue Cross/Blue Shield NM and Western Sky to provide Self-Directed Community Benefit (SDCB) services as your Support Broker.

Self-Directed Choices provides Person-Centered Planning and Monitoring by

  • Contacting you within 5 days of receiving your selection form
  • Scheduling your Enrollment Meeting within thirty (30) calendar days to Educate you on SDCB services
  • Coordinating with You and the Care Coordinator to submit your Care Plan budget (30) calendar days before start date
  • Providing Assistance and Guidance as you move your services and supports from Agency Based to SDCB services and supports
  • Monthly Telephonic Contact
  • Quarterly In-Person Visit
  • Assist you with Monitoring Spending Reports
  • Annual Working Plan Shell opened within 90 calendar days from the expiration of the current plan
  • Annual SDCB Care Plan submitted within 30 calendar days of expiration of the current SDCB Care Plan

Managed Care Organizations (MCOs) who provide Centennial Care services to their members:

Blue Cross / Blue Shield of New Mexico

Presbyterian Health Plan

Western Sky

United Healthcare

Molina Healthcare

Link to Human Services Department (HSD) RFP for Centennial Care 2.0

Questions

  • What are the available New Mexico Medicaid Waivers and how will they enhance my life?
  • What does it mean for individuals/families to be an official employer of record?
  • How to dream about the individual's future

Contact us to discuss these and other questions. For more information call Self-Directed Choices at 1 (877) 464-1252 or (505) 508-1663 or email Sandy@sdchoices.com.