MSSP Transition Model of Care Workgroup Releases Second Recommendations for Public Comment

Under the Coordinated Care Initiative (CCI), the Multipurpose Senior Services Programs (MSSP) will transition from a federal 1915(c) Home and Community-Based Services (HCBS) waiver to a fully integrated Medi-Cal managed care benefit in the CCI counties no sooner than January 1, 2020. In preparation for this transition, the Department of Health Care Services (DHCS) and the California Department of Aging (CDA) have convened a Model of Care Workgroup composed of MSSP sites and managed care plans.

This Workgroup is tasked with developing recommendations for a model of care for the new Home and Community-Based Services Care Planning and Management (HCBS CPM) benefit that will take the place of the MSSP program in CCI Counties. The workgroup has met 20 times since January 2018 and will continue to meet and work through outlined areas of the program. The first set of recommendations have been completed.

DHCS and CDA are seeking public comment on this second set of Model of Care recommendations, which are available here . The public comment period will be open from now until close of business on Friday, February 8 to

Model of Care Workgroup Recommendations
The second set of recommendations from the Model of Care Workgroup includes a detailed process to determine appropriate use of purchased services at MSSP sites. These include:

  • Assessment and Development of the Care Plan: The Workgroup recommends that providers determine a service or item as necessary to prevent elevation to a higher level of care.
  • Emergency Care Plan: The Workgroup recommends that the provider create an Emergency Care Plan in the event that the specified services or items will be purchased.
  • Informal and Formal Resources: Before purchasing items or services, the provider should determine if the service can be provided by the beneficiary’s support network, Medi-Cal, and/or a local organization.

CCI was designed to improve coordination and integration of care for dual beneficiaries (people who are enrolled in both Medicare and Medicaid). A significant component of CCI is to enhance coordination for long term services and supports (LTSS) benefits such as the Multipurpose Senior Services Program (MSSP). MSSP sites provide social and health care management for seniors who are 65 years of age or older who qualify to reside in a nursing home but wish to remain in the community. MSSP sites provide services such as housing assistance, meal services, transportation, and chore and personal care assistance.

  1. Edward Schor

    In Recommendations 1 & 2 there is no mention of the role of the patient and/or family in creation of the care plans. Not only is family engagement important to assure adoption and implement of care plans, but the shared determination of content and priorities is likely to improve adherence and enhance outcomes.

    Recommendation 3 is prudent, but may place expectations on providers for which they are ill-equipped to meet without additional resources, i.e., time, staff, training and reimbursement.

  2. All care planning and the resulting Care Plans must be person-centered. The Administration for Community Living and the Centers for Medicare & Medicaid Services just announced the launch of the National Center on Advancing Person-Centered Practices and Systems (NCAPPS). States can apply for a technical assistance grant to help it transition all its programs that provide any portion of the spectrum of long term services and supports (LTSS) to the person-centered model of service delivery. We strongly encrourage our state to apply for one of those grants. Independent Living Centers (CILs/ILCs), as defined by the federal Rehabilitation Act within the Workforce Innovation and Opportunity Act (WIOA) and in the California Welfare and Institutions Code, are essential partners in the LTSS system and must be included in any redesigned LTSS delivery system, The system needs to have sufficient funding committed to provide the LTSS that are defined in each individual care plan. It does no good to have a care plan that has no funding to implement. However, most ILC’s are not financially big enough to be direct Medi-Cal providers. We need to be able to subcontract with larger Medi-Cal providers to provide LTSS for individuals, and be paid by those organizations for the services, which in turn that large organization will bill to Medi-Cal. This financial model is in place with the newest Medi-Cal Home and Community Based waiver and easily replicated on a bigger scale for an entire LTSS system.

  3. Good morning, My name is Lee Cutler and our company is Bay Area Vital-link. Established in 1981,we have been servicing our communiyies with Medical Alert systems, Medication dispensors and monitoring, Fall Ptreventation presentations, Over the years we have assisted all our local Fall Preventation Task Force providing guidience on how to set and operate the task force. We assited the finance of the Sit And Be Fit video.

    We service Mill Peninsula Care program, (CalDuals)

  4. Sally Chaney

    Will this program be offered in more counties than currently involved? I am having great difficulty with my Doctor’s office & their lack of understanding how to TAR-Treatment Authorization Request my secondary insurance – Partnership-MediCal. I am requesting a TAR for the FreeStyle Libre 14 Day System, Reader & Sensors for Diabetes. The first part of the TAR is the requirement I must submit a Authorization Request to MediCare (my primary ins.). MediCare will deny request. I must then appeal. The appeal will be denied. This however will satisfy my secondary insurance, Partnership’s TAR and allow them to pay for my diabetes monitor and sensors. I have been requesting this as of Nov. 2018. As of today, Jan. 8, 2019 I still do not have the first step taken by my physician’s office. … Having people who understand how MediCare (primary) & MediCal (secondary) work together would be very welcome event for me. I need this help now. I am in Solano County where there is no CaDuals program.

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