During the second work group meeting, participants will dive into discussions and questions related to California’s proposed demonstration to integrate care for dual eligible beneficiaries.
A meeting summary will be posted soon. During the meeting, suggestions for communication strategies and FAQs were requested. Please comment below or send suggested frequently asked questions to info@CalDuals.org.
Meeting Materials:
I inquired during the June 13 meeting as to if or how private community case managers (such as myself)would be included as providers or will be invited to assist in the caldual demonstration?I was asked to send you the name of the network group of case managers I belong to in the Placer/Sacramento area but since we are not a designated county for the caldual demonstration currently I’m not sure our network would be helpful at this time but I would like to make sure that case managers such as ours in the other counties will be included so that when this demonstration grows and gets to our county we will not be excluded.
I am a gerontologist and work with doctor offices in aiding them as a case manager (at no charge to them) to assist them in assessing what care and resources their patients need and getting those resources implemented for them if that means financial assistance to pay for care, or implementing medical and non-medical in-home health services to placement and referral to RCFE’s, transportation etc.
Please let me know if we will be considered providers in this provider outreach part of the CalDual demonstration and what we need to do to be included if we as private community professionals will be included.
Thank you.
I am just wondering why everyone only talking about Physicians?
The Dual Demnstration project to be successfull all Medi-Cal proider categories should be included in these discussions.
For example Non Emergency Medical Transportation (NEMT) is #1 bridge to access to care. More then 70% Duial Eligibles are utilizing NEMT to get access to Physicians, Clinics, Hospitals etc. We have already a bad experience with mandatory tranfer of SPDs to managed care. Many SPDs have lost their transportation completely or had to switch to other NEMT providers approved by a new established brokerage system.
In Southern California Health Plans do not contract with existing NEMT FFS providers. Health plans have extended exclusive contracts with such brokers as Logisticare, LLC, American Logistics etc. Almost all existing NEMT FFS providers
have refused transportation services to mandatory transfered SPDs.
It is a huge mess. There is a huge fear among Dual Eligibles regarding transfer to menaged care. They are afraid of losing their transportation completely or losing their NEMT provider with which they have a strong relationship for years. Many Dual Eligibles will opt out of Demonstration project just to retain NEMT services, if Department of Managed Care will not insist that Health Plans be required to contract with existing FFS NEMT providers.
Marat Sheynkman,
Executive Director
California Medical Transportation Association