Today, the Department of Health Care Service (DHCS) is announcing a Medicare Advantage policy proposal to reflect the continued respect for beneficiary choice, promote enrollment into Cal MediConnect, and advance the goals of coordinated care as set forth in the Coordinated Care Initiative (CCI).
DHCS has outlined its complete proposal on Medicare Advantage/Duals Special Needs Plans policy for 2015 here.
DHCS will discuss the proposal on an upcoming stakeholder call.
Please confirm that no Regional center clients will be passively enrolled.
tI am very concerned
People with developmental disabilities who are receiving services through a 1915(c) waiver, regional center, or state developmental center, are not eligible for Cal MediConnect and are excluded from auto-enrollment (sometimes referred to as “passive enrollment”) into Cal MediConnect. This means that the State will not send notices about Cal MediConnect to people receiving these services and will not auto-enroll this population into Cal MediConnect plans. Individuals with development disabilities who are not receiving services through a 1915(c) waiver, regional center, or state developmental center are eligible for Cal MediConnect and will be subject to passive enrollment.
Please confirm that no Regional center clients will be passively enrolled.
tI am very concerned
People with developmental disabilities who are receiving services through a 1915(c) waiver, regional center, or state developmental center, are not eligible for Cal MediConnect and are excluded from auto-enrollment (sometimes referred to as “passive enrollment”) into Cal MediConnect. This means that the State will not send notices about Cal MediConnect to people receiving these services and will not auto-enroll this population into Cal MediConnect plans. Individuals with development disabilities who are not receiving services through a 1915(c) waiver, regional center, or state developmental center are eligible for Cal MediConnect and will be subject to passive enrollment.
Explain to me how patients in SNFs are not exempt from passive enrollment? How can you expect someone with dementia or psychosis to understand (or CARE ABOUT) the letters they will receive? This is unethical.
DHCS agrees that those residing in SNFs are a vulnerable population. The goal of Cal MediConnect is to better serve these people by coordinating their Medicare and Medi-Cal services. Understanding the important role of the SNF in care coordination, DHCS released a continuity of care dual plan letter (DPL) that allows for people to stay in their current nursing home when they enroll in Cal MediConnect. The guidance states, “A beneficiary who is a long-term resident of a nursing facility (NF) prior to enrollment will not be required to change NFs during the duration of the Duals Demonstration Project if the facility is licensed by the California Department of Public Health (CDPH), meets acceptable quality standards, and the facility and MMP agree to Medi-Cal rates in accordance with the three-way contract.”
Here is the full text of the DPL:
http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/DPL2013/DPL13-005.pdf
Explain to me how patients in SNFs are not exempt from passive enrollment? How can you expect someone with dementia or psychosis to understand (or CARE ABOUT) the letters they will receive? This is unethical.
DHCS agrees that those residing in SNFs are a vulnerable population. The goal of Cal MediConnect is to better serve these people by coordinating their Medicare and Medi-Cal services. Understanding the important role of the SNF in care coordination, DHCS released a continuity of care dual plan letter (DPL) that allows for people to stay in their current nursing home when they enroll in Cal MediConnect. The guidance states, “A beneficiary who is a long-term resident of a nursing facility (NF) prior to enrollment will not be required to change NFs during the duration of the Duals Demonstration Project if the facility is licensed by the California Department of Public Health (CDPH), meets acceptable quality standards, and the facility and MMP agree to Medi-Cal rates in accordance with the three-way contract.”
Here is the full text of the DPL:
http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/DPL2013/DPL13-005.pdf
“DHCS agrees that those residing in SNFs are a vulnerable population. The goal of Cal MediConnect is to better serve these people by coordinating their Medicare and Medi-Cal services.”
This will never, ever happen. Don’t you realize that when one has an HMO on their Medicare they will need a pre-authorization for every single service that is performed on them. That means that their will be significant delays in treatment because HMOs only care about their bottom line. HMOs are masters at stonewalling services. Regular Medicare is the best insurance their is!!!!! The only ones benefitting from this will be the HMOs. People will not only get poor quality services because of this demonstration, there will be many who die because of it as well. I will never vote for another democrat as long as I live.
“DHCS agrees that those residing in SNFs are a vulnerable population. The goal of Cal MediConnect is to better serve these people by coordinating their Medicare and Medi-Cal services.”
This will never, ever happen. Don’t you realize that when one has an HMO on their Medicare they will need a pre-authorization for every single service that is performed on them. That means that their will be significant delays in treatment because HMOs only care about their bottom line. HMOs are masters at stonewalling services. Regular Medicare is the best insurance their is!!!!! The only ones benefitting from this will be the HMOs. People will not only get poor quality services because of this demonstration, there will be many who die because of it as well. I will never vote for another democrat as long as I live.
“A beneficiary who is a long-term resident of a nursing facility (NF) prior to enrollment will not be required to change NFs during the duration of the Duals Demonstration Project if the facility is licensed by the California Department of Public Health (CDPH), meets acceptable quality standards, and the facility and MMP agree to Medi-Cal rates in accordance with the three-way contract.”
My concern is not that SNF residents will have to leave their facility; the issues is that many will be passively enrolled because they suffer from psychosis, dementia and other related mental illnesses and will either toss the letter or not be able to complete it. Also, where the heck do these letters go? Family members may throw them away or not even understand the issues. I already have patients who are receiving letters and their birthday isn’t until November. This doesn’t make any sense as Medi-Medis are being enrolled based on their DOB. Passive enrollment is unethical.
“A beneficiary who is a long-term resident of a nursing facility (NF) prior to enrollment will not be required to change NFs during the duration of the Duals Demonstration Project if the facility is licensed by the California Department of Public Health (CDPH), meets acceptable quality standards, and the facility and MMP agree to Medi-Cal rates in accordance with the three-way contract.”
My concern is not that SNF residents will have to leave their facility; the issues is that many will be passively enrolled because they suffer from psychosis, dementia and other related mental illnesses and will either toss the letter or not be able to complete it. Also, where the heck do these letters go? Family members may throw them away or not even understand the issues. I already have patients who are receiving letters and their birthday isn’t until November. This doesn’t make any sense as Medi-Medis are being enrolled based on their DOB. Passive enrollment is unethical.
I have clients who have signed up on cal mediconnect and want to get into another dual medicare program. I submitted the applications with the appropriate forms and for some reason cal mediconnect is disenrolling my client from the medicare plan and reenrolling into the calmediconnect program at random. Is anyone else having this issue?
Please have them call Health Care Options to confirm that their decisions have been processed in the system and are accurate. HCO’s number is 1-844-580-7272.
Health Care Options is unable to assist on over 80% of inquiries in my SNF due to no Representative information. They then defer back to the Medi-Cal worker who then assures us there is a Representative showing in the system. The Medi-Cal worker then defers us back to Health Care Options who states there is no Representative showing on the “QD” screen of online Meds system. Now, there are different agencies entering different information and the bottom line is Health Care Options will not speak with us or family members because the LEADER program is not correctly crossing over to online MEDS. The patient/nursing home/family member is now stuck trying to get the two agencies to talk to each other, which they will not. This is a disaster of epic “passive enrollment” proportions.
I have clients who have signed up on cal mediconnect and want to get into another dual medicare program. I submitted the applications with the appropriate forms and for some reason cal mediconnect is disenrolling my client from the medicare plan and reenrolling into the calmediconnect program at random. Is anyone else having this issue?
Please have them call Health Care Options to confirm that their decisions have been processed in the system and are accurate. HCO’s number is 1-844-580-7272.
Health Care Options is unable to assist on over 80% of inquiries in my SNF due to no Representative information. They then defer back to the Medi-Cal worker who then assures us there is a Representative showing in the system. The Medi-Cal worker then defers us back to Health Care Options who states there is no Representative showing on the “QD” screen of online Meds system. Now, there are different agencies entering different information and the bottom line is Health Care Options will not speak with us or family members because the LEADER program is not correctly crossing over to online MEDS. The patient/nursing home/family member is now stuck trying to get the two agencies to talk to each other, which they will not. This is a disaster of epic “passive enrollment” proportions.
If a member in Cal Medi Connect plans signed up for any MA plans, will they be dis-enrolled in Cal Medi Connect?
If a person selects an MA plan, they will be disenrolled from CalMediConnect. The person will still be enrolled in the Medi-Cal managed care plan for their Medi-Cal benefits.
All individuals must contact Health Care Options to change their enrollment in any health plan.
If a member in Cal Medi Connect plans signed up for any MA plans, will they be dis-enrolled in Cal Medi Connect?
If a person selects an MA plan, they will be disenrolled from CalMediConnect. The person will still be enrolled in the Medi-Cal managed care plan for their Medi-Cal benefits.
All individuals must contact Health Care Options to change their enrollment in any health plan.
When will the state MIPPA policy for DSNPs be finalized as CMS has a July 1 deadline?
DHCS is in the final stages of finishing the DSNP policy. The language is pending approval of State Budget that is currently with the Governor.
When will the state MIPPA policy for DSNPs be finalized as CMS has a July 1 deadline?
DHCS is in the final stages of finishing the DSNP policy. The language is pending approval of State Budget that is currently with the Governor.
I think it is important for the public to know what really happens with regards to having an HMO on their Medicare. I just spoke with an admin at an assisted living facility in Hollywood. She reported to me that she is in the process of having to opt out 25-30 of her Medicare/LACARE patients because LACARE is not providing adequate services and is not paying their doctors. This is a typical occurrence. So sad for these patients.
I think it is important for the public to know what really happens with regards to having an HMO on their Medicare. I just spoke with an admin at an assisted living facility in Hollywood. She reported to me that she is in the process of having to opt out 25-30 of her Medicare/LACARE patients because LACARE is not providing adequate services and is not paying their doctors. This is a typical occurrence. So sad for these patients.