Under the Coordinated Care Initiative (CCI), MSSP will transition from a federal 1915(c) HCBS waiver to a fully integrated Medi-Cal managed care benefit in the CCI counties no sooner than January 1, 2020. In preparation for this transition, the Department of Health Care Services (DHCS) and the California Department of Aging (CDA) have convened a Model of Care Workgroup composed of Multipurpose Senior Services Program (MSSP) sites and managed care plans.
This Workgroup is tasked with developing recommendations for a model of care for the new Home and Community-Based Services Care Planning and Management (HCBS CPM) benefit that will take the place of the MSSP program in CCI Counties. The workgroup has met 13 times since January 2018 and will continue to meet and work through outlined areas of the program. The first set of recommendations have been completed.
DHCS and CDA are seeking public comment on this first set of Model of Care recommendations, which are available here. The public comment period will be open for the month of September, with comments being due by close of business on Monday, October 1 to info@calduals.org.
Model of Care Workgroup Recommendations
The first set of recommendations from the Model of Care Workgroup include:
- Eligible Members: The Workgroup recommends gradually expanding eligibility for the HCBS CPM benefit to beneficiaries age 62 years and older, while maintaining the same level of care criteria.
- Data Sharing: The Workgroup developed a series of recommendations on how plans and providers could work towards improved data sharing, including bidirectional data sharing, real-time data access, and eventually fully integrated care plans and member data.
- Joint Care Planning: The Workgroup developed a joint care planning process for plans and HCBS CPM providers to coordinate care for both members in Cal MediConnect and in Medi-Cal managed care.
Background
CCI was designed to improve coordination and integration of care for dual beneficiaries (people who are enrolled in both Medicare and Medicaid). A significant component of CCI is to enhance coordination for long term services and supports (LTSS) benefits such as the Multipurpose Senior Services Program (MSSP). MSSP sites provide social and health care management for seniors who are 65 years of age or older who qualify to reside in a nursing home but wish to remain in the community. MSSP sites provide services such as housing assistance, meal services, transportation, and chore and personal care assistance.
I am a Case Manager for Age Well Senior Services located in Laguna Hills. we make them aware of resources in the community and set them up with e.g. transportation and Meals on Wheels. When we have seniors who area risk for a SNF we make a referral to MSSP.When an applicant is admitted into the MSSP program we discharge the client for our Case Management program. The wait list to get into the MSSP program is usually 6 months which is a long time for seniors who need more care management than we can provide. Many of their needs require the assistance of a social worker who can advocate for them,
I find that these seniors need help with heir housing needs. Many of them are on Section 8 and for a variety of reasons they have to move. It is too overwhelming for these people who are usually living on their own with little family involvement. They need a Social Worker who can help them find another place to live and to move to the apartment. Another need is having a social worker advocating for affordable dental health that is close to where they live. These seniors are too frail to travel long distances to get to a dentist.
Basically I am suggesting to have a social work program that is more involved in the senior’s quality of life