In early April, DHCS shared for stakeholder comment a comprehensive strategy for the Coordinated Care Initiative (CCI) focused on improving the quality of care and care coordination in Cal MediConnect for beneficiaries, ensuring that beneficiary satisfaction remains high and increases, and generating sustainability for the program.
In total, DHCS received letters and comments that represented the views of more than 40 stakeholder groups. This robust stakeholder engagement is critical to the success of the CCI, and DHCS appreciates everyone who participated in the comment process.
Today, DHCS is sharing an update on its policy decisions, as well as additional materials for stakeholder comment.
In response to stakeholder feedback, DHCS is not moving forward with annual passive enrollment. In lieu of passive enrollment, stakeholders requested DHCS pursue enrollment strategies that support voluntary “opt-in” enrollment. Building on the work already underway by DHCS and the Cal MediConnect plans, DHCS will continue to move forward with a voluntary “opt-in” enrollment effort. These strategies will include streamlined enrollment and mandatory MLTSS plan enrollment. DHCS will continue to monitor participation in the program. Should voluntary enrollment not prove to be a viable option for sustainable enrollment in the program, passive enrollment remains an option in future years.
DHCS will move forward and implement the streamlined enrollment proposal. Streamlined enrollment will provide a simpler method for beneficiaries to enroll in the Cal MediConnect product associated with their MLTSS plan. This builds on lessons learned around beneficiary outreach, including that the best way to educate beneficiaries is through one-on-one conversations that can answer their specific questions about their providers and how to make a smooth transition. DHCS believes that sufficient beneficiary safeguards will be in place and that beneficiaries’ enrollment experience will be improved. DHCS will closely monitor this process to ensure beneficiary protections are working and plans are operating appropriately.
Streamlined enrollment would begin in July 2016 and prior to the start of streamlined enrollment, DHCS will work with the plans to ensure the process is smooth and beneficiary protections are in place. As part of streamlined enrollment, both HCO and the plan would reach out to the beneficiary to confirm the choice. The HCO call script is available here for stakeholder comment.
The “opt-in” strategy will also include ongoing mandatory enrollment of MLTSS-eligible beneficiaries into MLTSS health plans. Cal MediConnect-eligible beneficiaries will receive the new Cal MediConnect and MLTSS Resource and Guide Book, which is in the final stages of beneficiary user testing and will be ready for use by July or August of 2016. Beneficiaries who became newly eligible for MLTSS or Cal MediConnect since passive enrollment in their county ended will be mandatorily enrolled in a Medi-Cal managed care health plan no sooner than August 2016. Those who become eligible moving forward will be enrolled on a monthly basis.
DHCS will also explore other voluntary “opt-in” strategies in partnership with the Centers for Medicare & Medicaid Services (CMS), health plans, and other stakeholders. At the same time, DHCS will use detailed analysis of beneficiaries who have opted out of the program to more effectively focus provider education and outreach activities, in partnership with the health plans and other partners conducting intensive provider education. This work will be informed by – and be built on – our existing provider outreach and education efforts and materials, including the CCI Physician Toolkit. DHCS will also be share this data with Cal MediConnect health plans to help them in their education and outreach efforts.
DHCS also proposed several activities focused on strengthening LTSS referrals and improving care coordination – both of which are at the heart of the CCI. Stakeholders were overwhelmingly supportive of these proposals, and DHCS is moving forward on all of them.
This includes standardizing the Health Risk Assessment (HRA) referral questions for MSSP, IHSS, and CBAS to reflect the best practices developed over the early years of the program and expanding data collection and reporting on ICT and ICP completions, and CBAS, MSSP, and IHSS referrals.
Draft standardized HRA referral questions are available here for stakeholder comment. We look forward to receiving stakeholder input by Friday, May 20th, and will share final questions shortly thereafter. Draft revised data measures will be shared for stakeholder comment later this month.
DHCS will also be moving forward with convening a series of meetings, beginning in summer 2016, with Cal MediConnect plans to share best practices and ensure all plans are performing to the highest standard. DHCS looks forward to working with the plans – and when appropriate other stakeholders – on these meetings.
DHCS will also extend the continuity of care period for Medicare services from 6 months to 12 months to match the Medi-Cal continuity of care period, and modify requirements to just one visit with a specialist within the past 12 months, as is the case with primary care physicians. DHCS is in the process of updating its Duals-Plan Letter and will update stakeholders when the policy change is effective.
Finally, DHCS is moving forward with exploring ways to make it easier for beneficiaries to stay enrolled in Cal MediConnect for more than 30 days while the health plan helps the beneficiary reestablish their Medi-Cal eligibility. DHCS will update stakeholders on this work as it moves forward.
Thank you for your continued support of the CCI.
Find copies of the comments submitted posted below, identified by the submitting entities:
- AgeWell Senior Services
- Alzheimer’s Family Services Center
- Anthem Blue Cross
- California Association of Health Facilities
- California Association of Health Plans
- Central Health Plan of California
- Community Health Group
- Congress of California Seniors
- Council on Aging – Orange County
- Health Plan of San Mateo
- Health Net
- Justice in Aging: Long | Short
- L.A. Care
- Local Health Plans of California
- MOMS Orange County
- Orange County Adult Day Services Coalition
- Orange County Social Services Agency
- State Independent Living Council
- The SCAN Foundation