This week, DHCS released the revised HRA plan letters for stakeholder comment. Any questions or comments can be sent to DHCS_PMMB@dhcs.ca.gov until April 7, 2017.
1) Medi-Cal All Plan Letter (APL) titled “Care Coordination Requirements for Managed Long-Term Services and Supports”(APL 17-00A)
2) Medi-Cal APL titled “Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities” and the accompanying attachment “Long-Term Services and Supports Referral Questions.” (APL 17-00B)
3) Cal MediConnect Duals Plan Letter (DPL) titled “Health Risk Assessment and Risk Stratification Requirements for Cal MediConnect” and the accompanying attachment “Health Risk Assessment and Risk Stratification Requirements for Cal MediConnect.” (DPL 17-00C)
The proposed questions are included in the “attachment” documents.
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.
In February, DHCS released the “Cal MediConnect HRA Workgroup: Summary of Recommendations.” This report 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 plan letters take the workgroup recommendations and translate them into formal guidance for the Cal MediConnect and Medi-Cal managed care plans.
Please note that the DPL and APL numbers (17-00A, 17-00B and 17-00C) are only temporary for ease of reference until final numbers are assigned upon release of the finalized plan letters.
Click here for more information about the HRA LTSS workgroup and its process.