The Cal MediConnect (CMC) program has been extended until Dec. 31, 2022. On April 24, 2019, the Centers for Medicare & Medicaid Services (CMS) announced that it approved the three-year extension request by the California Department of Health Care Services (DHCS); the program, to provide coordinated services for beneficiaries eligible for both Medicare and Medicaid, originally was scheduled to end effective December 31, 2019.
The extension allows more time to focus on quality improvement and evaluation of the program while maintaining continuity for dual-eligible individuals enrolled in the Coordinated Care Initiative (CCI), which includes CMC. The additional time will support market stability, improve savings, and address selection bias issues at disenrollment, with the ultimate goal of improving outcomes for beneficiaries.
The change will be coupled with program updates intended to improve financial sustainability, quality of care, beneficiary experience, and outcomes for Cal MediConnect (CMC) enrollees.
The extension will be made formal in a forthcoming amendment to the three-way contracts between CMS, DHCS, and CMC plans, which will also contain additional details on the program updates.
Greater Emphasis on Measurable Performance
- To strengthen the financial incentive for CMC plans to focus on quality improvements and the beneficiary experience, the amount withheld to be used as quality incentive payments for CMC plans (known as a quality withhold) for CMC plans will increase from 3% to 4%, starting in 2020. This change supports DHCS and CMS’ goals of continued improvements in CMC beneficiary outcomes.
- The quality withhold measures are described further on the MMCO website. Measures are related to the rate of annual flu vaccination, controlling high blood pressure, documentation of care goals, and interactions of the care team. More information is also available on the CMC Performance Dashboard.
Enrollment Continuity Incentive
- To further incentivize enrollment retention of CMC enrollees, including higher cost and higher need beneficiaries, CMS will implement a retrospective financial penalty in the Medicare portion of the capitation rate for CMC plans with high disenrollment rates using the existing Medicare Part C measure entitled, “Members Choosing to Leave Plan.” The measure is already calculated for CMC plans, and CMS has several years of CMC-specific data.
- The penalty does not include members who were involuntarily disenrolled due to loss of Medi-Cal eligibility.
Increasing Shared Savings
- During the extension period, CMS and DHCS will establish a one-sided profit sharing “experience rebate” that allows them to share in recoupments if CMC plans have gains above a certain threshold.
- This maintains incentives for CMC plans to experiment with innovative ways of providing care that may result in cost savings, while allowing CMS and DHCS to share in those savings.
Additionally, CMS and DHCS are moving forward with other program improvements based on a recent stakeholder engagement process and in partnership with the CMC plans. CMS and DHCS look forward to continuing to work collaboratively with stakeholders to improve the delivery and experience of care for dual-eligible Californians in Cal MediConnect.
Does this mean FFP for IHSS care will continue at 56%
I’m confused! Will I still be able to stay on Medicare in the CalDuals plan (the “old plan”) when I chose not to enroll in Cal MediConnect plan. I saw the words “financial penalty” and got scared!!
Good Afternoon,
Will the Cal MediConnect (CMC) program extension be for all 7 Counties through 12-31-2022 ?
1- Los Angeles
2- Orange
3- Riverside
4- San Bernardino
5- San Diego
6- San Mateo
7- Santa Clara
Thank for this clarification.
Best Regards, Susan LaPadula, CMBA, ICMRS
Good Evening~
Will the Cal MediConnect (CMC) Health Plans remain the same in all 7 CCI Counties through
December 31, 2022?
CMC Health Plans: Los Angeles County:
1- Anthem Blue Cross CMC 2- Blue Shield of CA Promise Health Plan
3- Health Net CMC /Centene 4- LA Care CMC 5- Molina Duals Options
Orange County: 1- CalOptima One Care Connect
Riverside County: 1- IEHP DualChoice 2- Molina Dual Options
San Bernardino County: 1-IEHP DualChoice 2-Molina Dual Options
San Diego County: 1- Blue Shield of CA Promise Health Plan
2-CommuniCare Advantage 3-Health Net CMC/Centene 4-Molina Dual Options
San Mateo County: 1-Health Plan of San Mateo
Santa Clara County: 1-Anthem Blue Cross CMC
2-Santa Clara Family Health Plan
Thank you for this clarification.
Best Regards,
Susan LaPadula, CMBA, ICMRS
Cal Optima does not provide its contracted hospitals electronic Remittances for dual eligible claims where Medicare fee for service deductibles and co-pays were billed to Cal Optima and zero payment was due as a result of payment ceiling cut-backs. As a result, the hospitals whose zero paid claims were processed by Cal Optima are often unable to provide the documentation (835 electronic RA response) required by Medicare to be reimbursed for the unpaid crossover deductible and coinsurance claims. Medicare requires a proof of billing and Medicaid claims processing. Absent of a returned transaction showing a zero pay dual eligible amount for each claim the Hospital cannot prove the dual eligible (crossover) claim has been properly adjudicated.
What does this mean to those of us who opted out of CalDuals HMO’s and stay in the “old plan.” (medi/medi)??
Enrollment Continuity Incentive
To further incentivize enrollment retention of CMC enrollees, including higher cost and higher need beneficiaries, CMS will implement a retrospective financial penalty in the Medicare portion of the capitation rate for CMC plans with high disenrollment rates using the existing Medicare Part C measure entitled, “Members Choosing to Leave Plan.” The measure is already calculated for CMC plans, and CMS has several years of CMC-specific data.
The penalty does not include members who were involuntarily disenrolled due to loss of Medi-Cal eligibility.
(What does that mean to me)???