The Department of Health Care Services (DHCS) has released a revised framework for transitioning the Multipurpose Senior Services Program (MSSP) to managed care, reflecting stakeholder feedback received during the public comment period in the fall of 2017.
As proposed in the Governor’s January 2017 budget, the MSSP transition into managed care has been delayed to no sooner than January 1, 2020. This reflects the lengthened demonstration period for the Coordinated Care Initiative (CCI) and will give managed care plans, MSSP sites, stakeholders, and beneficiaries sufficient time to work together to plan for a smooth transition.
The framework outlines the steps and process moving forward in transitioning MSSP to a managed care benefit in the CCI counties, including plan-readiness reviews, consumer protections, and a stakeholder engagement process. DHCS released both redline (accessible) and clean (accessible) versions of the framework, showing the specific changes made in response to stakeholder feedback.
Here are some of the revisions and clarifications made to the framework in response to stakeholder feedback:
- Readiness assessments and transition plans will now be reviewed simultaneously to ensure sufficient time for both local stakeholder engagement and for health plans to prepare for the transition.
- DHCS and the California Department of Aging (CDA) will develop 60 and 30-day notices to educate current MSSP participants about the transition and how it will impact them.
- MSSP waiver enrollment caps in CCI counties will end with the transition, allowing the plans to enroll any eligible member in the new managed care benefit, as long as medically necessary. Consistent with current MSSP eligibility criteria, the new benefit will only be available to beneficiaries aged 65 years or older who meet the level of care criteria.
- The Cal MediConnect and Medi-Cal plans (not local Agencies on Aging) will partner with the MSSP sites to develop local transition plans. CMC and MCPs will then be responsible for compiling and submitting the final plan to DHCS.
- DHCS and CDA will remain active participants throughout the transition process to provide guidance and technical assistance.
- Continuity of care will be automatic, an important consumer protection that will provide MSSP services for up to 12 months.
In response to the request for more detail regarding the model of care, DHCS and the CDA are convening a workgroup with MSSP sites and health plans to create a model of care proposal. This proposal will be released for public stakeholder comment in the spring of 2018.