In 2016, the Department of Health Care Services (DHCS) announced it would be pursuing a comprehensive strategy to strengthen the Coordinated Care Initiative and Cal MediConnect (CMC). One of the key areas DHCS focused on was improving referrals to Long-Term Services and Supports (LTSS). The effort included creating standardized LTSS referral questions for all CMC and Managed Long Term Services and Supports (MLTSS) plans to use in their Health Risk Assessments (HRAs). To accomplish this, DHCS convened a workgroup of 20 participants from a variety of stakeholder groups, including: advocates, LTSS providers, health plans, medical groups, and state agencies.
DHCS is proud to announce the release of the Cal MediConnect HRA Workgroup: Summary of Recommendations. This report is the final product of that workgroup and provides a set of standardized LTSS referral questions and guidance for plans on how to use them to identify members who may qualify for and benefit from LTSS.
The workgroup met five times over four months for discussion, collaboration, and multiple rounds of review. They assembled a comprehensive set of risk factors that may indicate a need for LTSS services. To address the spectrum of challenges a beneficiary may face, the workgroup identified four different categories: social determinants, functional capacity, medical conditions, and behavioral health conditions. Next, they identified questions from the DHCS proposed LTSS referral questions that addressed those risk factors. To account for the remaining risk factors or aspects of risk factors that were not accounted for in existing questions, the workgroup crafted new questions. To improve accessibility for all beneficiaries, the questions were adjusted to meet health literacy and cultural competency requirements.
The final report is being shared with stakeholders. DHCS is currently revising HRA guidance plan letters for CMC plans ( DPL 15-005), MLTSS plans (APL 14-010) and plans serving Seniors and People with Disabilities (PL 14-005). The Dual Plan Letter and All Plan Letters will be circulated for public comment before being finalized for plans.
As Cal MediConnect moves forward in 2017, the state and DHCS are committed to strengthening access to LTSS for dual-eligible beneficiaries. DHCS looks forward to these recommendations being used by Cal MediConnect plans to continue to provide coordinated care to their members.