The following draft documents are part of the requirements that the Centers for Medicare & Medicaid Services (CMS) and the California Department of Health Care Services (DHCS) will use to assess health plan readiness to implement the duals demonstration. CMS and the State are developing a Health Plan Readiness Plan. This Readiness Plan will incorporate these standards to assess whether the participating health plans are compliant and able to deliver high quality, coordinated care. The readiness review process will begin after the Memorandum of Understanding (MOU) is completed between CMS and California, marking federal approval of California’s proposal. The MOU is expected to be complete in December.
- Draft Long-term Services and Supports Readiness Standards (Nov. 26, 2012)
- Draft Long-term Services and Supports Readiness Standards This document reflects significant stakeholder input received on the version released in August. It describes the specific requirements that will be incorporated into the Health Plan Readiness Tool. The LTSS standards have undergone revision and structural changes based on the stakeholder input, including reformatting from a table to paragraph format. These standards also will be required of health plans for the non-demonstration population receiving managed LTSS. Please note that the care coordination elements were removed and included in the care coordination standards document.
- Draft Care Coordination Standards (Nov. 26, 2012) This document proposes key care coordination standards which include the initial assessment process, the Health Risk Assessment, Individual Care Plans, ongoing care coordination, qualifications for care coordinators, and the role of Interdisciplinary Care Teams.
- Please email comments using the templates below by Monday Dec. 10th to info@calduals.org
The right of dual eligibles to opt out of the program should be prominently noted in all documents, not just in the FAQs.
The right of dual eligibles to opt out of the program should be prominently noted in all documents, not just in the FAQs.
LTSS Standards draft 5 item 2. Are NF/SNFs required to assess residents for ability to live in community and, if able, to develop a plan and/or arrange for that, OR just provide an “opportunity” to transition if resident requests that option.
LTSS Standards draft 5 item 2. Are NF/SNFs required to assess residents for ability to live in community and, if able, to develop a plan and/or arrange for that, OR just provide an “opportunity” to transition if resident requests that option.
When doing readiness review I would like the consumer interviews to weigh more heavily than the data recieved from hospital or health plan and that goes with reasesstment too.
When you do the reasesstment or review that all ADA standards are applied and written in code for all disabilities.
When doing readiness review I would like the consumer interviews to weigh more heavily than the data recieved from hospital or health plan and that goes with reasesstment too.
When you do the reasesstment or review that all ADA standards are applied and written in code for all disabilities.
I have many concerns but the two most concerning are as follows.
First, I am concerned for the people that are on the waiting lists for LTSS Waivers (IHO etc.) It is not fair,and is against the Olmstead decision for our most vulnerable citizens to be denied community services that they would ultimately receive if it were not for CCI.
Second, I am concerned about due process and aid paid pending if someone is suspected but NOT proven to be committing fraud. As it is now we get aid paid pending without penalty but it appears that will no longer be the case according to these protocols. This MAJOR change will be devastating for many people and life threatening for some.
I have many concerns but the two most concerning are as follows.
First, I am concerned for the people that are on the waiting lists for LTSS Waivers (IHO etc.) It is not fair,and is against the Olmstead decision for our most vulnerable citizens to be denied community services that they would ultimately receive if it were not for CCI.
Second, I am concerned about due process and aid paid pending if someone is suspected but NOT proven to be committing fraud. As it is now we get aid paid pending without penalty but it appears that will no longer be the case according to these protocols. This MAJOR change will be devastating for many people and life threatening for some.
I am submiting these comments on behalf of The Personal Assistance Services Council of Los Angeles County:
1. It’s recommended the Legislature of the State of California enact legislation to accomplish the following goals to prevent discontinuity of care.
a. Seniors and People with Disabilities who are put into managed-care, be they be part of the SPD transition or the Dual Demonstration Pilots, must have a right to receive continuous approved medications, treatments, surgeries, durable medical equipment etc. If the plan chooses to deny these services ongoing, they must be required to send out written notice that is specific to that medication, treatment, procedure or supplies etc. that is refused stating why; with a large print statement on that notice that Informs the Senior or Persons with Disability of their right to appeal, Aid Paid Pending that appeal and the phone number to call in order to arrange that appeal.
b. If that appeal is decided in the patient’s favor by an Administrative Law Judge, the Director of the Health Plan or the Department of Health Care Services shall not have the right to overturn that appeal, or such appeal rights are meaningless.
c. In order to have adequate failsafe and backup necessary to prevent this discontinuity of care in any managed care transition for seniors or persons with disabilities, patients must be permitted to return to their fee for service providers if all necessary records and authorizations are not in place.
In addition, to insure consumer participation,
requesting the Legislature of the State of California enact legislation to accomplish the following goal:
a. All Counties transitioning Seniors and Persons with Disabilities into managed-care plans include at least 5% or more current IHSS Consumers as members of any policy level board or workgroup.
I am submiting these comments on behalf of The Personal Assistance Services Council of Los Angeles County:
1. It’s recommended the Legislature of the State of California enact legislation to accomplish the following goals to prevent discontinuity of care.
a. Seniors and People with Disabilities who are put into managed-care, be they be part of the SPD transition or the Dual Demonstration Pilots, must have a right to receive continuous approved medications, treatments, surgeries, durable medical equipment etc. If the plan chooses to deny these services ongoing, they must be required to send out written notice that is specific to that medication, treatment, procedure or supplies etc. that is refused stating why; with a large print statement on that notice that Informs the Senior or Persons with Disability of their right to appeal, Aid Paid Pending that appeal and the phone number to call in order to arrange that appeal.
b. If that appeal is decided in the patient’s favor by an Administrative Law Judge, the Director of the Health Plan or the Department of Health Care Services shall not have the right to overturn that appeal, or such appeal rights are meaningless.
c. In order to have adequate failsafe and backup necessary to prevent this discontinuity of care in any managed care transition for seniors or persons with disabilities, patients must be permitted to return to their fee for service providers if all necessary records and authorizations are not in place.
In addition, to insure consumer participation,
requesting the Legislature of the State of California enact legislation to accomplish the following goal:
a. All Counties transitioning Seniors and Persons with Disabilities into managed-care plans include at least 5% or more current IHSS Consumers as members of any policy level board or workgroup.
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