CCI enrollment is now planned to start in September 2013.
Governor Jerry Brown released his proposed budget for Fiscal Year 2013-14 that included an update to the timeline for implementing the Coordinated Care Initiative (CCI) and the duals demonstration.
Pending federal approval, the duals demonstration would give beneficiaries the opportunity to combine their Medi-Cal and Medicare benefits into one health plan and receive more coordinated and accountable care than available in today’s fragmented health care delivery system.
Two areas of the budget related to CCI:
- Timeline. The proposed budget calls for implementing both parts of the CCI, the duals demonstration and transition to managed care for Long Term Supports and Services, in September 2013.
- This means that the first notices that any beneficiaries would receive about these transitions would come no earlier than June 2013.
- Enrollment Phase-in. There are eight counties in the CCI: Alameda, Los Angeles, San Bernardino, San Diego, San Mateo, Santa Clara, Orange and Riverside. According to the budget announcement:
- In Los Angeles County, enrollment will phase in over 18 months.
- In San Mateo, enrollment will occur all at once in September 2013.
- For all other counties, enrollment will phase-in over 12 months.
I am very concerned that this “Dual” program will have a catastrophic impact on patients, doctors and therapists in California and elsewhere. In many situations that I have observed over the past 12 years, pledging your regular Medicare to an HMO Medicare Advantage plan winds up being a disaster for the patinet. The main reason is that every single intervention that a patinet needs requires a preauthorization (while under an HMO) that can take weeks or even longer to complete. In many cases, the service is not authorized because the HMO wants to save money. That’s the bottom line here: The state of California wants to save money with this program and they won’t. The HMOS are just going to get richer. Here’s the good news: this “Dual” program is voluntary and individuals can opt out of it. However, the enrollment process is passive in nature. That is, the passive enrollment process that the state of California is using is extremely disconcerting because many of these patients may fail to respond to the letter notiifying them of this program. When they fail to respond, they will automatically be placed into a Medicare HMO plan. Do your homework on this one Medi/Medi patients and watch out for a letter from the state of CA sometime this year.
I am very concerned that this “Dual” program will have a catastrophic impact on patients, doctors and therapists in California and elsewhere. In many situations that I have observed over the past 12 years, pledging your regular Medicare to an HMO Medicare Advantage plan winds up being a disaster for the patinet. The main reason is that every single intervention that a patinet needs requires a preauthorization (while under an HMO) that can take weeks or even longer to complete. In many cases, the service is not authorized because the HMO wants to save money. That’s the bottom line here: The state of California wants to save money with this program and they won’t. The HMOS are just going to get richer. Here’s the good news: this “Dual” program is voluntary and individuals can opt out of it. However, the enrollment process is passive in nature. That is, the passive enrollment process that the state of California is using is extremely disconcerting because many of these patients may fail to respond to the letter notiifying them of this program. When they fail to respond, they will automatically be placed into a Medicare HMO plan. Do your homework on this one Medi/Medi patients and watch out for a letter from the state of CA sometime this year.
Another problem not addressed is how money will be paid to medical providers when they are located in counties that aren’t included in the coverage areas. The person signing up for the Dual program may reside in Santa Clara but is sent to San Francisco to see a specialist at one of the hospitals there. How will billing be handled for treatment out of network be handled for these people? I don’t think the concern is that the HMO won’t allow or cover the treatment, it’s Medicare guidelines that we all need to be worried about. HMOs can only cover what Medicare allows, and IF Medicare does not cover a service, lab, test, treatment, therapy then your HMO and supplementary insurance most likely will not cover it unless you pay a higher premium for extra coverage, as you do when you choose a Part D plan for medication coverage. You must also be careful if you are already covered by a retirement plan to NOT SWITCH to one of these government plans before you totally understand what you are switching to and how it will affect your costs because once you leave your retirement medical insurance plan you most likely will never be allowed to go back to it and will be stuck with Medicare choices from then on, and Medicaid if your finances require that level of assistance. You really have to know what you are doing, and you should get advice from a local Senior Resource center, Area on Aging Agency or State Health Insurance Program who will help you compare programs available to you do decide what options are best at no cost for the consultation.
Another problem not addressed is how money will be paid to medical providers when they are located in counties that aren’t included in the coverage areas. The person signing up for the Dual program may reside in Santa Clara but is sent to San Francisco to see a specialist at one of the hospitals there. How will billing be handled for treatment out of network be handled for these people? I don’t think the concern is that the HMO won’t allow or cover the treatment, it’s Medicare guidelines that we all need to be worried about. HMOs can only cover what Medicare allows, and IF Medicare does not cover a service, lab, test, treatment, therapy then your HMO and supplementary insurance most likely will not cover it unless you pay a higher premium for extra coverage, as you do when you choose a Part D plan for medication coverage. You must also be careful if you are already covered by a retirement plan to NOT SWITCH to one of these government plans before you totally understand what you are switching to and how it will affect your costs because once you leave your retirement medical insurance plan you most likely will never be allowed to go back to it and will be stuck with Medicare choices from then on, and Medicaid if your finances require that level of assistance. You really have to know what you are doing, and you should get advice from a local Senior Resource center, Area on Aging Agency or State Health Insurance Program who will help you compare programs available to you do decide what options are best at no cost for the consultation.
“I don’t think the concern is that the HMO won’t allow or cover the treatment, it’s Medicare guidelines that we all need to be worried about.”
HMOs will delay approving a medically needed service for as long as they possibly can and we know why. If a pateint is in a Skilled Nursing Facility and has an HMO Medicare Advantage Plan, their medical treatmnet will suffer. This whole program is going to be a catastrophy for providers and patients alike.
“I don’t think the concern is that the HMO won’t allow or cover the treatment, it’s Medicare guidelines that we all need to be worried about.”
HMOs will delay approving a medically needed service for as long as they possibly can and we know why. If a pateint is in a Skilled Nursing Facility and has an HMO Medicare Advantage Plan, their medical treatmnet will suffer. This whole program is going to be a catastrophy for providers and patients alike.
Another issue involves Day Treatment Programs which are essential for the stability of many clients. Medicale HMO’s will not authorize them, will not pay providers. This can cause decompensation for some. I’m told the alternative is to “OPT-OUT” of only Medicale and keep the Traditional Medicare so at least 80% of the charges are covered.
NEW YORK CITY with family in California
Another issue involves Day Treatment Programs which are essential for the stability of many clients. Medicale HMO’s will not authorize them, will not pay providers. This can cause decompensation for some. I’m told the alternative is to “OPT-OUT” of only Medicale and keep the Traditional Medicare so at least 80% of the charges are covered.
NEW YORK CITY with family in California
Doris,
You are correct. The dual poupulation has the option to opt out, but they must respond to a letter that will be sent to them schedule now for sometime in late June 2013.
Doris,
You are correct. The dual poupulation has the option to opt out, but they must respond to a letter that will be sent to them schedule now for sometime in late June 2013.