In January 2019, the Department of Health Care Services (DHCS) requested stakeholder feedback on cost-neutral initiatives and activities to help improve the Cal MediConnect Program (CMC). In total, DHCS received 23 sets of comments representing 43 organizations and individuals. Click here for a complete summary of stakeholder input.
Based on stakeholder input, the following summary outlines the improvements that DHCS intends to make or has already implemented:
- Improving Care Coordination: Many comments addressed various aspects of care coordination in Cal MediConnect, including health risk assessments, individualized care plans, care coordination protocols, and ensuring that care coordination is targeted appropriately based on member needs.
- Targeted Care Coordination Efforts: DHCS will consider this feedback as it continues its best practices work to improve plan efforts around care coordination. Last year, the department focused on broad coordination efforts with long-term services and supports (LTSS), and this year is drilling down on referrals and coordination with Multipurpose Senior Services Programs (MSSP), the provision of Care Plan Option (CPO) services, as well as integrating and coordinating physical and behavioral health
- Identifying Lessons Learned: DHCS will also conduct an internal assessment of available information related to CMC care coordination, mostly based on the public evaluation efforts and best practices work, and how that can help inform improvements to CMC and Medi-Cal more broadly.
- Connecting Members to Benefits: Stakeholders highlighted efforts to ensure members are appropriately referred to LTSS services, as well as access to durable medical equipment (DME), transportation services, and proper linguistic support. DHCS is focusing on these areas by:
- Transportation: Updating the transportation Dual Plan Letter (DPL) to ensure that members are informed of their right to transportation without exhausting available public transportation.
- Interpretation: Continuing to increase regulatory oversight of interpretation services in Medi-Cal plans as a part of timely access metrics, and looking to lessons learned from this effort for potential improvements in CMC.
- DME: Creating a DHCS and Cal MediConnect plan workgroup to review the challenges around accessing DME and to establish feasible solutions to identified barriers.
- Data Sharing and Reporting: Stakeholders flagged areas to improve data sharing across Cal MediConnect plans, providers, and counties, as well as requests to expand and improve the CMC performance dashboard.
- LTSS Data: DHCS added LTSS utilization data to the December dashboard and has now expanded to include referrals to specific LTSS services. In addition, DHCS will add data on CPO services to future dashboards.
- Metrics will be added as clean and useful data become available. However, DHCS will not add new metrics or reporting at this point in time.
- Streamline Reporting: DHCS will also work with the Centers for Medicare and Medicaid Services (CMS) and the CMC plans to review plan reporting to identify ways to streamline this process and to find and eliminate redundancies.
- LTSS Data: DHCS added LTSS utilization data to the December dashboard and has now expanded to include referrals to specific LTSS services. In addition, DHCS will add data on CPO services to future dashboards.
- Enrollment: DHCS received some comments regarding how to both encourage new enrollment in CMC and how to help maintain stable enrollment in the program.
- New-to-Medicare Duals: DHCS remains committed to a voluntary enrollment strategy for CMC, but is looking into some technical barriers that plans have flagged around encouraging new-to-Medicare dual eligibles to consider CMC.
- Other Issues: Stakeholders also raised a diversity of other issues, including some outside the scope of this work as they pertain to rates. However, DHCS is considering and working on some of these ideas – for example, cross-posting to provider manuals on CalDuals.
Click here to access a recording of the March 21st CCI Stakeholder Webinar. The webinar includes a discussion on this feedback as well as the March 2019 CMC Performance Dashboard.
Managed Care Crossover Claims
There is difficulty throughout California and especially with Cal Optima in receiving electronic paid claims detail for managed care Medi-Cal crossover claims adjudicated. Hospitals need the claims detail to match with Medicare R/A’s to claim unpaid deductibles and coinsurance as bad debts on the Medicare Cost Report. It would be very helpful to require standard claims encounter data for crossover claims. The health care industry needs a uniform process to account for these claims in order to avoid under-reporting bad debts relating to Medicaid cutbacks.
I did not see any feedback on the lack of consistency with state developed reporting variables such as the number of CMC members contacted/engaged. Many plans are informing downstream entities that a welcome letter counts, some just any visit with a PCP, whereas I had understood that the DHCS was really interested in learning how many CMC members were actually engaged with personal conversation with a Care coordinator or case manager. DHCS publishes dashboards for this measure when the measure is not being applied with a uniform definition across plans that are reporting.