Coordinated Care Initiative (CCI) / Cal MediConnect
Updated: JANUARY 29, 2018
Cal MediConnect Health Plans -- Point of Contact Lists
For Advocates and Stakeholders | For MLTSS Providers
Cal MediConnect Enrollment Data
As of JUNE 1, 2017
Recent Cal Duals Coordinated Care Initiative Updates
JAN 2018 PDF :: Word | DEC 2017 PDF :: Word
Integration of Medicare and Medicaid in California: Provider Perspectives of Cal MediConnect
JAN 2018 | University of Caifornia, San Francisco and Berkeley | Research Brief
In 2014, California became one of 13 states to implement a financial and administrative alignment demonstration called the Coordinated Care Initiative (CCI).
In California, existing Medicare and Medi-Cal (California’s Medicaid program) managed care health plans in seven counties created new products called “Cal MediConnect” (CMC). In demonstration counties, beneficiaries eligible for both Medicare and Medi-Cal, sometimes called “duals,” were passively enrolled into CMC plans, with an option to opt out. Those who were enrolled received all Medicare and Medi-Cal benefits, including both medical services and managed long-term services and supports (LTSS) through a single capitated CMC health plan. CMC plans were also required to provide care coordination services and coordinate behavioral health care.
By September 2017, more than 116,000 dual beneficiaries were enrolled in CMC plans. To deliver these services, CMC plans developed corresponding provider networks, including primary care providers (PCPs), provider groups, Federally qualified health centers (FQHCs), hospitals, and long-term care (LTC) providers. Researchers from University of California conducted an evaluation of the impact of the CMC program on beneficiaries and health systems.
Data collected for this research brief built on Phase I results and included 19 additional interviews with provider stakeholders including physician providers, provider groups, CMC plan directors of provider networks, FQHCs, hospitals, management services organizations (MSOs), and LTC providers. MORE
CCI Stakeholder Call Set for December 14
HOST: Department of Health Care Services (DHCS)
10:00 AM – 11:00 AM (Pacific) |
FEE: None | REGISTER
Cal MediConnect Enrollment:
Why Are Dual-Eligible Consumers in Los Angeles County Opting Out?
SEPT 27, 2017 | UCLA Center for Health Policy Research
Three in five of the poorest, sickest residents in Los Angeles County have rejected a managed health care program meant to improve their access to health services, according to a policy brief by the UCLA Center for Health Policy Research. As a result, the county’s opt-out rate for the program is the highest in California, pushing overall enrollment far lower than expected. READ FULL POLICY BRIEF
CCI Update - New CalDuals Website
MAY 2, 2017 | Health Care Delivery Systems, CA Department of Health Care Services
The Department of Health Care Services (DHCS) is pleased to announce an updated and improved program website for the Coordinated Care Initiative (CCI), www.CalDuals.org.
As part of the comprehensive strategy announced in 2016, DHCS has been making program improvements to the CCI and Cal MediConnect. One of the areas of improvement includes updating the program website, www.CalDuals.org. In October, we formed a workgroup to solicit stakeholder feedback to help guide these changes and make the best end-product possible.
This revamped website has a more user-friendly design and navigation, particularly catering to beneficiaries. Thank you to the California Collaborative for Long Term Services and Supports and to the CalDuals website workgroup members for their help on this project.
The updated site will continue to be an important source of educational resources about the CCI, highlight outreach events on our public calendar, and be a mechanism for stakeholder feedback. Notable changes include: a simplified sitemap with fewer pages; an archive section for policy and founding documents; and distinct landing pages for specific audiences with tailored menus.
Please visit our new www.CalDuals.org and familiarize yourself with the new features. We hope these changes will improve your ability to serve California's dual eligible population. Any questions or feedback about the website can be sent to firstname.lastname@example.org.
Save the Date
To hear more about the new website and other program updates, join our May stakeholder call on May 18 at 10:00 am. To register for the call, CLICK HERE.
Findings from Cal MediConnect Evaluations Summarized for CAADS Members
MAR 27, 2017 | Justice in Aging | Amber Christ, Senior Staff Attorney
RTI has released two reports this month that offer an evaluation of California's duals demonstration – Cal MediConnect – as well as other demos across the country. RTI will also release its full California-specific evaluation in the next few months.
CAADS members may view a brief summary of each report with regard to California-specific findings on the Members Only page. Special thanks to Amber Christ, Senior Staff Attorney with Justice in Aging, for preparing the summary.
1. Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans Under the Financial Alignment Initiative | Full Report, MAR 2017
2. Beneficiary Experience: Early Findings from Focus Groups with Enrollees Participating in the Financial Alignment Initiative | Full Report, MAR 2017
Dismantling the CCI Opposed by Statewide Organizations Representing Counties
MAR 3, 2017 | Letter to Assembly Budget Subcommittee #1 Chair
Eight statewide organizations representing counties have submitted a letter to Joaquin Arambula, Chair, Assembly Budget Subcommittee #1, describing the impact of the return of the IHSS program to the counties, including a devastating cost shift to counties of $623 million in 2017-18 alone. READ LETTER
The 2017-18 Budget: The Coordinated Care Initiative—A Critical Juncture
FEB 27, 2017 | Legislative Analyst's Office | View Full Report
Medi-Cal and Medicare Jointly Provide Health Care and Long-Term Services and Supports (LTSS) to Many Seniors and Persons With Disabilities (SPDs). About 2.1 million SPDs are enrolled in Medi-Cal, the state-federal program providing health care and LTSS to low-income persons. LTSS include, among other supports and services, institutional care in skilled nursing facilities and home- and community-based services (HCBS) such as those provided by the In-Home Supportive Services (IHSS) program. About two-thirds of SPDs are also eligible for Medicare, the federal program that provides health care services to qualifying persons over age 65 and certain persons with disabilities. The SPDs who are eligible for both Medi-Cal and Medicare are known as “dual eligibles” and receive services paid by both programs.
Coordinated Care Initiative (CCI) Implemented to Improve Coordination of Health Care and LTSS for SPDs and Reduce Overall Costs. The CCI is a joint state-federal demonstration project that was implemented beginning in 2012-13, and designed to improve the coordination of health care and LTSS and reduce the overall costs of providing care for SPDs. The CCI made a variety of changes in the seven “demonstration counties” where it was implemented, including: (1) integrating Medi-Cal and Medicare benefits for dual eligibles opting for managed care through a program known as Cal MediConnect, (2) mandatorily enrolling dual eligibles in managed care for their Medi-Cal benefits, (3) integrating LTSS under Medi-Cal managed care, (4) introducing state-level collective bargaining for IHSS providers, and (5) creating a universal assessment tool for all HCBS LTSS. On a statewide basis, the CCI replaced counties’ historical 35 percent share of nonfederal costs of the IHSS program with a maintenance of effort (IHSS MOE) that required counties to maintain their 2011-12 IHSS expenditure levels, with the addition of an annual growth factor of 3.5 percent and the costs of locally negotiated IHSS wage increases. Included in CCI-related legislation is a “poison pill” provision that automatically discontinues all components of the CCI if the administration determines that the CCI does not generate net General Fund savings.
CCI Discontinued Following Administration’s Determination That CCI Does Not Generate Net General Fund Savings. With the release of the Governor’s 2017-18 budget, the administration estimated that the CCI generates net General Fund costs of $278 million in 2016-17 and $42 million in 2017-18. The major factor causing the CCI to generate net General Fund costs rather than savings in the administration’s determination was the IHSS MOE. In accordance with state law, this determination automatically ends the program.
However, the Administration Proposes Continuing Certain Major CCI Components. Despite the automatic termination of the CCI, the Governor’s budget proposes continuing certain major CCI components, including: (1) Cal MediConnect, (2) mandatory enrollment in managed care for dual eligibles for their Medi-Cal benefits, and (3) the integration of LTSS other than IHSS under managed care. In effect, the Governor proposes continuing the CCI absent its IHSS components. By ending the CCI and not proposing to continue the IHSS MOE, the Governor would restore the counties’ historical share of IHSS costs.
End of IHSS MOE Provides Significant General Fund Relief While Significantly Increasing Costs for Counties. The termination of the IHSS MOE and restoration of the prior IHSS cost-sharing ratio is projected to shift over $600 million in IHSS General Fund costs back to counties in 2017-18. This shift in costs will create significant short- and long-term fiscal challenges for counties.
Legislature Might Consider Providing Fiscal Relief to Counties. Counties have limited ability to absorb the costs of ending the IHSS MOE. Accordingly, the Legislature might consider providing some form of fiscal relief to counties to mitigate these fiscal challenges. While the administration has signaled an intent to work with counties, the Governor has not released a plan for providing fiscal relief to counties. Short-term fiscal relief could entail a one-time grant or loan from the General Fund. However, because the end of the IHSS MOE also creates long-term fiscal challenges for counties, the Legislature might consider ongoing modifications to counties’ share of costs for the IHSS program.
Governor’s Proposal to Continue Parts of the CCI Is Appropriate . . . The steps taken under the CCI to enhance the coordination and integration of health care and LTSS are steps in the right direction. As such, we are supportive of the Governor’s proposal to extend certain major components of the CCI.
. . . However, the Legislature Might Build on the Governor’s Budget by Considering Ways to Include IHSS Integration in the CCI Pilot. The Governor’s action to terminate the CCI and proposal to extend certain CCI components presents an opportunity for the Legislature to provide its vision for how health care and LTSS should be integrated in the future. As an enhancement to the Governor’s scaled-down version of the CCI, the Legislature could consider changes that build upon the gains that have been made under the CCI. Specifically, the Legislature may want to consider ways to include IHSS integration in the CCI pilot. These could range from providing some level of funding for continued care coordination between managed care plans and counties to piloting a fuller integration of IHSS within managed care in some counties. Depending on the level of IHSS integration within managed care plans, there are various trade-offs and financing considerations that would need to be considered.
This report is available using the following link: http://lao.ca.gov/Publications/Report/3585.
Cal MediConnect HRA Workgroup: Summary of Recommendations
FEB 16, 2017 | DHCS Health Care Delivery Systems | Summary of Recommendations
In 2016, the Department of Health Care Services (DHCS) announced it would be pursuing a comprehensive strategy to strengthen the Coordinated Care Initiative and Cal MediConnect (CMC). One of the key areas DHCS focused on was improving referrals to Long-Term Services and Supports (LTSS). The effort included creating standardized LTSS referral questions for all CMC and Managed Long Term Services and Supports (MLTSS) plans to use in their Health Risk Assessments (HRAs). To accomplish this, DHCS convened a workgroup of 20 participants from a variety of stakeholder groups, including: advocates, LTSS providers, health plans, medical groups, and state agencies.
DHCS is pleased to announce the release of the Cal MediConnect HRA Workgroup: Summary of Recommendations. This report is the final product of that workgroup and provides a set of standardized LTSS referral questions and guidance for plans on how to use them to identify members who may qualify for and benefit from LTSS.
For more information, and to read the final report, click here. Any questions or comments can be sent to email@example.com.
Coordinated Care Initiative Update
JAN 19, 2017 | DHCS Health Care Delivery Systems
Released last week, the Governor's 2017-18 budget proposes to continue Cal MediConnect and Managed Long-Term Services and Supports (MLTSS) until 2020.
The State and DHCS are committed to increasing and improving the coordination of care for dual-eligible individuals. The budget reflects the Administration's commitment to the principles of the Coordinated Care Initiative (CCI) and making the necessary changes in order to make the Cal MediConnect program stronger.
When created, the CCI contained a provision requiring the Department of Finance to determine if the CCI program is cost effective each January, and if not, the entire program would be discontinued the following year.
The Budget estimates that CCI will not be cost effective, thereby triggering a process that ceases all statutory provisions related to CCI as of January 1, 2018. Until then, DHCS is taking this opportunity to restructure parts of the program to make it cost effective.
Based on the lessons learned from CCI, the Budget proposes to extend the Cal MediConnect program, continue mandatory enrollment of dual-eligibles, and continue to integrate long-term services and supports (except IHSS) into managed care for two years. Some of the pieces of the CCI were found to be cost-effective and have the potential to improve the quality of care for those enrolled, and help keep individuals in their homes and communities, thereby leading to likely long term cost reductions.
To read the full post discussing budget implications, click here. Any questions or comments can be sent to firstname.lastname@example.org.
Coordinated Care Initiative Update
DEC 8, 2016 | Health Care Delivery Systems, Department of Health Care Services
This week, The SCAN Foundation and Field Research Corporation released a fourth wave of survey results shedding light on beneficiaries' experiences in Cal MediConnect health plans.
Enrollee confidence in managing their health conditions and satisfaction with their health services remain at high levels. The survey also reported fewer enrollees than opt-outs reported being hospitalized in the past 12 months.
"We're pleased to continue to see strong evidence of Cal MediConnect's positive impact on the lives of dual-eligible Californians," said Jennifer Kent, Director of the Department of Health Care Services. "The decrease in hospital stays for Cal MediConnect enrollees is a sign that coordinated care can improve the health outcomes and quality of life of enrollees. We will continue to work with the health plans and other stakeholders to improve the program and ensure that more eligible beneficiaries learn about and enroll in this important program."
To read more about the wave 4 survey results, click here.
Any questions or comments can be sent to email@example.com.
Coordinated Care Initiative Update
NOV 3, 2016 | Health Care Delivery Systems, Department of Health Care Services
View Update (PDF) / (Word)
In October, the Department of Health Care Services (DHCS) shared the new Cal MediConnect and Managed Long-Term Services and Supports (MLTSS) Resource Guide and Choice Book.
No earlier than November 8th, DHCS will begin mailing these materials and educating eligible beneficiaries about their plan options. If beneficiaries decide not to join a Cal MediConnect plan as part of the Coordinated Care Initiative (CCI) voluntary enrollment strategy, they will be automatically enrolled into MLTSS plans.
Mailings of the new materials will be phased throughout November and December (excluding holidays) to approximately 63,000 eligible beneficiaries. They will continue as beneficiaries become newly eligible, either by having Medicare and gaining Medi-Cal eligibility or by moving into a CCI county. English materials will be mailed in November, while all other languages will be sent out in December.
- Los Angeles County | NOV Mailings: 22000 | DEC Mailings: 17000 | Total: 39000
- Riverside County | NOV Mailings: 4200 | DEC Mailings: 1700 | Total: 5900
- San Bernardino County | NOV Mailings: 3900 | DEC Mailings: 1600 | Total: 5500
- San Diego County | NOV Mailings: 6300 | DEC Mailings: 2900 | Total: 9200
- Santa Clara County | NOV Mailings: 2200 | DEC Mailings: 1300 | Total: 3500
The new MLTSS materials have gone through feedback from stakeholders, the Centers for Medicare & Medicaid Services (CMS), and the University of California's beneficiary user testing process. Click here to learn more about these materials.
Any questions or comments can be sent to firstname.lastname@example.org.
New Version of Advocates Guide to California's Coordinated Care Initiative
OCT 6, 2016 | Justice in Aging
The Coordinated Care Initiative (CCI)—including California's dual eligible demonstration project Cal MediConnect—is well underway in all seven CCI counties including Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. There have been significant changes to the CCI since the release of Version Four of Justice in Aging's Advocates Guide to California's Coordinated Care Initiative in June 2015.
Version Five of the Guide includes:
- A description of new and updated CCI policies
- Additional advocacy tips
- Evaluation results and new resources
If you have saved or printed Version Four, please replace it with Version Five, because the former now contains outdated information. To view the October 6, 2016 webinar video, Coordinated Care Initiative: Enrollment, Evaluation, and Updates, click here.
Cal MediConnect: A Long Way to Go
September 20, 2016 | Source: Justice in Aging
California’s dual eligible demonstration, Cal MediConnect, has been underway for over two years. Evaluation and enrollment data released to date identify both promising aspects and a number of areas where improvements are needed.
In this blog post, Cal MediConnect: A Long Way to Go, Justice in Aging summarizes key evaluation findings and enrollment trends that require focused attention from the Centers for Medicare and Medicaid Services (CMS) and California’s Department of Health Care Services (DHCS).
If Cal MediConnect is to fulfill its goal to deliver improved person-centered and integrated care, we must work collaboratively and directly to address the program’s current deficiencies while also systematizing best practices.
AUG 30, 2016 | California Department of Health Care Services (DHCS)
We are pleased to announce that the following resources are now available: the new Cal MediConnect Beneficiary Toolkit and an updated CCI Physician Toolkit.
New Cal MediConnect Toolkit for Beneficiaries
Robust beneficiary outreach and education are a core part of the design and implementation of the Coordinated Care Initiative (CCI) and Cal MediConnect.
The Department of Health Care Services (DHCS) developed the Cal MediConnect Beneficiary Toolkit to support beneficiaries as well as serve as a resource for health plans, advocates, and community organizations (including Health Insurance Counseling and Advocacy Programs [HICAPs] and the Ombudsman) that engage directly with beneficiaries.
This reader-friendly toolkit provides useful information for dual-eligible beneficiaries who are examining their health care options. The toolkit covers how care coordination can improve health outcomes, the additional benefits provided by Cal MediConnect health plans and how to keep your current health care providers. Beneficiaries and their caregivers should use this toolkit along with information provided in formal notices and guidebooks.
Early evaluation data on the Cal MediConnect enrollment process indicated that beneficiaries could benefit from specific additional information and materials about the CCI. In response, DHCS developed new materials to support beneficiaries and their providers and caregivers in the decision-making process, including this toolkit.
To ensure optimal usability, DHCS undertook an extensive stakeholder engagement process in the development of this toolkit. A broad range of stakeholders reviewed the toolkit, and the UC Berkeley School of Public Health's Health Research for Action conducted user testing with beneficiaries.
To read more about the new toolkit, click here.
Updated CCI Physician Toolkit
DHCS updated the CCI Physician Toolkit to provide health care providers with information about how the CCI is changing health care for dual-eligible beneficiaries. The updated toolkit outlines the coverage options for patients and how these changes could affect the billing process, care coordination, and other aspects of a physician's practice.
For more information about the toolkit, click here.
If you would like a free presentation or training about the CCI for you, your staff, or others interested in learning more about the program, click here to fill out a request form.
Any questions or comments can be sent to email@example.com.
Coordinated Care Initiative Update
AUG 17, 2016 | CalDuals.org | Any questions or comments can be sent to firstname.lastname@example.org.
Streamlined Enrollment to Begin for Cal MediConnect
The Department of Health Care Services (DHCS) will begin streamlined enrollment during the week of August 22, 2016, for Cal MediConnect as part of the Coordinated Care Initiative (CCI).
Streamlined enrollment allows Cal MediConnect health plans to submit enrollment changes to DHCS on behalf of their members. This will provide a simpler method for beneficiaries to enroll in the Cal MediConnect program associated with their Medi-Cal managed care long-term services and supports (MLTSS) health plan as they will no longer have to take the extra step to contact the state enrollment broker, Health Care Options (HCO), to complete their enrollment choice.
Providing streamlined enrollment is part of DHCS' comprehensive strategy for improving the CCI and Cal MediConnect program. Streamlined enrollment builds upon lessons learned about effective beneficiary outreach, including that the best way to educate beneficiaries is through one-on-one conversations that answer their specific questions about their providers, how the program works and how to make a smooth transition.
DHCS has safeguards in place to protect beneficiaries and will work with the plans to ensure the process is smooth and that beneficiary protections are working.
For more information about streamlined enrollment, click here .
Telephone Survey Findings Released
The UCSF Community Living Policy Center and the UC Berkeley Health Research for Action Center conducted an evaluation of Cal MediConnect as part of California's Coordinated Care Initiative (CCI).
As part of this three-year evaluation, researchers conducted a representative telephone survey with 2,139 beneficiaries who were dually eligible in early 2016 to examine their experiences with Cal MediConnect. Researchers compared the experiences of Cal MediConnect beneficiaries with those who opted out and duals who reside in non-CCI counties to identify areas where experiences are significantly better or worse than those who did not participate.
The key insights from the telephone survey are summarized here. For full details of the telephone survey findings and more information regarding the other pieces of this evaluation, click here.
Cal MediConnect Ombudsman Program
The Department of Managed Health Care is soliciting proposals from qualified entities to provide services to California's dual eligible beneficiaries in Coordinated Care Initiative (CCI) counties, including consumer assistance, education, training and outreach. It is anticipated that the contract will begin on October 1, 2016, and end on December 31, 2017. This will ensure beneficiaries can continue to access these critical services from an independent ombudsman program.
You are invited to review and respond to this Request for Proposals (RFP), entitled "Cal MediConnect Ombudsman Program." Potential proposers are encouraged to download the solicitation package as well as any future addendums from Cal eProcure. The deadline for submitting proposals is 4 p.m. Pacific Standard Time (PST) on September 2, 2016. Please contact Christopher Rendall at Christopher.Rendall@dmhc.ca.gov or (916) 324-1618 if you have any questions.
CalMediConnect: How Have Health Systems Responded?
JUL 2016 | Community Living Policy Center, University of California, San Francisco
Brooke Hollister, Carrie Graham, Charlene Harrington, Alice Wong, Luke O'Shea, Elaine Kurtovich, Brenda Nussey, and Pi-Ju Liu
Researchers at the University of California worked with a stakeholder advisory group to design an evaluation of Cal MediConnect (CMC), California's dual financial alignment demonstration. It was decided that the evaluation should include qualitative interviews with stakeholders engaged in CMC to determine how the program has impacted the health system and how the system and stakeholders have responded to CMC. The aims of the health system response study are to: (1) examine organizational impacts and health system responses to the demonstration; and (2) identify challenges, promising practices and recommendations to improve the coordination of care across sites for dual beneficiaries. Additionally, results from the first phase of key informant (KI) interviews will also be used to identify topics for further inquiry and case studies in phase two of the health system response project (beginning in Winter 2017).
Cal MediConnect: How Have Health Systems Responded?
Note: CBAS Response to CMC appears on pages 47 to 50; CAADS Executive Director Lydia Missaelides, MHA, and several CAADS members were among those interviewed.
CCI COMPREHENSIVE STRATEGY UPDATE
JUL 1, 2016 | Health Care Delivery Systems, Department of Health Care Services
Earlier this year, the Department of Health Care Services (DHCS) shared for stakeholder comment a comprehensive strategy for the Coordinated Care Initiative (CCI). This strategy focused on improving the quality of care and care coordination beneficiaries receive through Cal MediConnect, ensuring that beneficiary satisfaction remains high and increases, and generating sustainability for the program. After considerable feedback from stakeholders, DHCS announced final policy decisions in May. Today, DHCS is sharing an update on these policy decisions, as well as an additional document for stakeholder comment.
Voluntary Enrollment Strategy
DHCS announced its intent to pursue a robust voluntary "opt-in" enrollment effort for the remainder of 2016. Today, DHCS is releasing its DRAFT Cal MediConnect Voluntary Enrollment Strategy for stakeholder comment. It is available here.
This strategy, designed to expand awareness of Cal MediConnect and encourage voluntary enrollment, builds on activities DHCS and its partners are already conducting. This strategy also incorporates many of the lessons learned about how best to reach and educate beneficiaries and providers about the CCI and Cal MediConnect. These strategies include streamlined enrollment and mandatory Medi-Cal plan enrollment for managed long-term services and supports (MLTSS).
DHCS is soliciting feedback from stakeholders on the activities included in this strategy, as well as additional activities Cal MediConnect partners can pursue. Feedback is due Thursday, July 14, 2016.
Standardized LTSS HRA Questions & Data Measures
DHCS announced that it would strengthen LTSS referrals and improve care coordination by standardizing the Health Risk Assessment (HRA) referral questions for LTSS to reflect the best practices developed over the early years of the program and expanding data collection and reporting.
DHCS released draft HRA referral questions in June and received valuable stakeholder feedback. In response to that feedback, and given the importance of selecting the most effective questions, DHCS will convene a small workgroup in order to identify and agree on a final list of questions that will best meet the needs of beneficiaries.
DHCS appreciates the feedback it received on the draft revised data measures and will share final measures later this month.
Provider Opt Out Data
DHCS has shared with Cal MediConnect health plans the detailed analysis of beneficiaries who have opted out of the program, and their most frequently used providers, in order to more effectively focus provider education and outreach activities. We have begun discussions with the plans on opportunities for partnership on education and outreach activities.
Best Practices Meetings
DHCS held the first in a series of meetings with Cal MediConnect plans to share best practices and ensure all plans are performing to the highest standard. Moving forward, DHCS will convene these meetings regularly. DHCS is asking that stakeholders submit topics for consideration at future meetings to email@example.com on an ongoing basis.
Continuity of Care
DHCS announced that it would extend the continuity of care period for Medicare services from six months to 12 months to match the Medi-Cal continuity of care period, and modify requirements to just one visit with a specialist within the past 12 months, as is the case with primary care physicians. DHCS is working with CMS and Cal MediConnect plans to update its Dual Plan Letter and prepare for implementation in late Fall 2016.
Streamlined enrollment will provide a simpler method for beneficiaries to enroll in the Cal MediConnect product associated with their existing MLTSS plan. DHCS has begun operational testing with the plans and will begin streamlined enrollment later this summer, with formal notification of the official start date to come.
The new Cal MediConnect and MLTSS Resource Guide and Choice Book has gone through the University of California's beneficiary user testing process and is being finalized. DHCS anticipates ongoing mandatory enrollment of MLTSS-eligible beneficiaries into MLTSS plans will begin in Fall 2016. The final Resource Guide and Choice Book will be made available on CalDuals.org.
The Cal MediConnect Beneficiary Toolkit has gone through the University of California's beneficiary user testing process and a final version will be posted on CalDuals.org by the end of July.
-------- Stakeholder engagement and input is critical to the success of the CCI. All stakeholder feedback on the voluntary enrollment strategy is due by Thursday, July 14, 2016. DHCS is requesting all questions and comments be sent to firstname.lastname@example.org. DHCS is committed to transparency and will share additional materials for stakeholder input as they become available.
Just-in-Time Advocacy Convinces California to Adopt Voluntary Enrollment Strategy for Duals
MAY 2016 | Justice in Aging
Quick action by Justice in Aging prevented more than 100,000 low-income, high health need California dual eligibles from being passively enrolled in new health plans without their knowledge or consent. In May, the state proposed passively enrolling beneficiaries in six counties into California’s Coordinated Care Initiative (CCI). Though coordinated care shows great promise for dual eligibles, passive enrollment can cause beneficiary confusion and lead to service disruptions. We responded quickly by working with other advocates to propose an alternative, voluntary enrollment strategy and submitted comments to the state that were signed by more than 30 groups. The state reversed its policy and announced a voluntary strategy instead. California Healthline reported on the story. A shorter version of the comments can be found here.
Meeting the Mental Health Needs of Dual Eligibles: An Opportunity for Advocates
MAY 24, 2016 | Denny Chan, Justice in Aging
The mental health needs of seniors and persons with disabilities who are dually eligible for Medicare and Medicaid are often overlooked in traditional medical settings, ramping up costs and leading to inadequate care. About 44% of dual eligibles have at least one mental or cognitive condition, while more than half of all Medicare inpatient psychiatric facility patients are duals. Stigma and inadequate screening mechanisms prevent beneficiaries from accessing behavioral health services. These needs affect some groups within the dual eligible population disproportionately. For example, nearly half of the under-65 dual eligible population have severe mental disorders, and this group’s health care costs are about double compared to young duals without severe mental health needs. MORE
IMPORTANT CCI ANNOUNCEMENTS
MAY 6, 2016 | Source: Health Care Delivery Systems, Department of Health Care Services
In early April, DHCS shared for stakeholder comment a comprehensive strategy for the Coordinated Care Initiative (CCI) focused on improving the quality of care and care coordination in Cal MediConnect for beneficiaries, ensuring that beneficiary satisfaction remains high and increases, and generating sustainability for the program.
In total, DHCS received letters and comments that represented the views of more than 40 stakeholder groups. This robust stakeholder engagement is critical to the success of the CCI, and DHCS appreciates everyone who participated in the comment process.
Today, DHCS is sharing an update on its policy decisions, as well as additional materials for stakeholder comment.
In response to stakeholder feedback, DHCS is not moving forward with annual passive enrollment. In lieu of passive enrollment, stakeholders requested DHCS pursue enrollment strategies that support voluntary "opt-in" enrollment. Building on the work already underway by DHCS and the Cal MediConnect plans, DHCS will continue to move forward with a voluntary "opt-in" enrollment effort. These strategies will include streamlined enrollment and mandatory MLTSS plan enrollment. DHCS will continue to monitor participation in the program. Should voluntary enrollment not prove to be a viable option for sustainable enrollment in the program, passive enrollment remains an option in future years.
DHCS will move forward and implement the streamlined enrollment proposal. Streamlined enrollment will provide a simpler method for beneficiaries to enroll in the Cal MediConnect product associated with their MLTSS plan. This builds on lessons learned around beneficiary outreach, including that the best way to educate beneficiaries is through one-on-one conversations that can answer their specific questions about their providers and how to make a smooth transition. DHCS believes that sufficient beneficiary safeguards will be in place and that beneficiaries' enrollment experience will be improved. DHCS will closely monitor this process to ensure beneficiary protections are working and plans are operating appropriately.
Streamlined enrollment would begin in July 2016 and prior to the start of streamlined enrollment, DHCS will work with the plans to ensure the process is smooth and beneficiary protections are in place. As part of streamlined enrollment, both Health Care Options (HCO) and the plan would reach out to the beneficiary to confirm the choice. The HCO call script is available here for stakeholder comment.
The "opt-in" strategy will also include ongoing mandatory enrollment of MLTSS-eligible beneficiaries into MLTSS health plans. Cal MediConnect-eligible beneficiaries will receive the new Cal MediConnect and MLTSS Resource and Guide Book, which is in the final stages of beneficiary user testing and will be ready for use by July or August of 2016. Beneficiaries who became newly eligible for MLTSS or Cal MediConnect since passive enrollment in their county ended will be mandatorily enrolled in a Medi-Cal managed care health plan no sooner than August 2016. Those who become eligible moving forward will be enrolled on a monthly basis.
DHCS will also explore other voluntary "opt-in" strategies in partnership with the Centers for Medicare & Medicaid Services (CMS), health plans, and other stakeholders. At the same time, DHCS will use detailed analysis of beneficiaries who have opted out of the program to more effectively focus provider education and outreach activities, in partnership with the health plans and other partners conducting intensive provider education. This work will be informed by - and be built on - our existing provider outreach and education efforts and materials, including the CCI Physician Toolkit. DHCS will also be share this data with Cal MediConnect health plans to help them in their education and outreach efforts.
Program Quality Improvement Strategies
DHCS also proposed several activities focused on strengthening LTSS referrals and improving care coordination - both of which are at the heart of the CCI. Stakeholders were overwhelmingly supportive of these proposals, and DHCS is moving forward on all of them.
This includes standardizing the Health Risk Assessment (HRA) referral questions for MSSP, IHSS, and CBAS to reflect the best practices developed over the early years of the program and expanding data collection and reporting on ICT and ICP completions, and CBAS, MSSP, and IHSS referrals.
Draft standardized HRA referral questions are available here for stakeholder comment. We look forward to receiving stakeholder input by Friday, May 20th, and will share final questions shortly thereafter. Draft revised data measures will be shared for stakeholder comment later this month.
DHCS will also be moving forward with convening a series of meetings, beginning in summer 2016, with Cal MediConnect plans to share best practices and ensure all plans are performing to the highest standard. DHCS looks forward to working with the plans - and when appropriate other stakeholders - on these meetings.
DHCS will also extend the continuity of care period for Medicare services from 6 months to 12 months to match the Medi-Cal continuity of care period, and modify requirements to just one visit with a specialist within the past 12 months, as is the case with primary care physicians. DHCS is in the process of updating its Duals Plan Letter and will update stakeholders when the policy change is effective.
Finally, DHCS is moving forward with exploring ways to make it easier for beneficiaries to stay enrolled in Cal MediConnect for more than 30 days while the health plan helps the beneficiary reestablish their Medi-Cal eligibility. DHCS will update stakeholders on this work as it moves forward.
New Comments on Dual Eligible Demonstration in CA
APR 28, 2016 | Source: Justice in Aging
In response to proposals from CA, Justice in Aging and other advocates have developed a set of recommendations for ongoing enrollment in Cal MediConnect, California's dual eligible demonstration program. The comments set out in two letters, one short version and one longer, more detailed version, propose an affirmative voluntary enrollment strategy and numerous program improvements that would increase retention of current members and make the program more attractive to new enrollees.
The comments also oppose proposals from the state to conduct a new round of passive enrollment and to implement a new “streamlined enrollment” strategy that would allow health plans to submit enrollment forms on behalf of beneficiaries.
While the comments are specific to California, many of the issues raised are relevant to advocates, policymakers, and researchers in other states.
Additional Justice in Aging materials and toolkits relevant to both California and other states can be accessed here.
DHCS Releases a New Provider Bulletin on Continuity of Care and Billing
APR 18, 2016 | Source: California Department of Health Care Services (DHCS), Health Care Delivery Systems
In order to ensure that beneficiary transitions into Cal MediConnect are smooth and do not result in disruptions of care, the CCI continuity of care policy gives beneficiaries in Cal MediConnect plans the right to continue seeing non-participating physicians for a limited period of time.
DHCS has developed a Provider Bulletin which explains how current out-of-network physicians can continue seeing Cal MediConnect beneficiaries, and the process for billing the correct entity for payment. It also provides information to help combat balance billing.
More information and additional resources for providers can be found on CalDuals.org.
CCI 2016 Proposals and Announcement - Request for Stakeholder Comment
APRIL 7, 2016 | Source: CA Department of Health Care Services (DHCS) Health Care Delivery Systems
DHCS is proposing a number of changes to improve and strengthen the Cal MediConnect program in areas of care coordination, continuity of care, and overall beneficiary experience - proposals developed based on initial evaluation data from the beneficiary perspective and on stakeholder feedback on the program. In addition, in order to sustain the program that data shows is working for beneficiaries, DHCS is proposing to expand enrollment, engagement and education efforts.
For information on these proposals, please review the following materials on CalDuals.org:
Stakeholder engagement and input is critical to the success of the CCI. DHCS is requesting all stakeholder questions and comments be sent to email@example.com. All stakeholder feedback is due by Friday, April 22nd. DHCS is committed to transparency and will share additional materials for stakeholder input. Stakeholder feedback will be reviewed promptly and DHCS will share final policy decisions in early May.
NEW ISSUE BRIEF
The Duals Demonstration: A First Glimpse at Lessons Learned
MAR 9, 2016 | Source: Justice in Aging Health Network Alert
Since the first dual eligible demonstrations rolled out in August 2013, Justice in Aging has followed the process both through the advocates on the ground who counsel clients directly, through the plans we’ve worked closely with, and through our work directly with the state agencies that administer the demonstrations. As national experts on the issues facing dual eligibles we’ve been both an information hub for advocates and feedback loop for policymakers. As such, we’ve been awaiting the release of the first formal evaluations of the demonstrations to see if they match the information we’ve been receiving. They have been released and we’ve had a chance to digest and analyze them and publish an issue brief on the findings.
In late January, the Centers for Medicare and Medicaid Services (CMS) released the first ever evaluation of the federal Financial Alignment Initiatives, known as the dual eligible demonstrations. The “ Report on Early Implementation of Demonstrations Under the Financial Alignment Initiative,” provides extensive detail on the early challenges, successes, and impact of the demonstrations. The report was conducted by the Research Triangle Institute International (RTI) and is the first report in ongoing evaluation of the duals demonstrations.
Justice in Aging put together an issue brief that analyses key findings from the RTI report. We outline six lessons about early demonstration implementation based on our dual eligible advocacy and offer recommendations to inform future implementation of a dual eligible alignment initiative or other significant health care systems change. Read the brief.
Cal MediConnect Performance Dashboard Now Available
MAR 8, 2016 | Source: Sarah Brooks, Deputy Director, Health Care Delivery System, California Department of Health Care Services (DHCS)
Today, the Department of Health Care Services (DHCS) is releasing new data on how Cal MediConnect health plans are performing in six areas related to care coordination, quality, and service utilization.
The metrics in this new Cal MediConnect Performance Dashboard are: 1) Health Risk Assessments, 2) Appeals by Determination, 3) Hospital Discharge, 4) Emergency Utilization, 5) Long Term Care Services and Supports (LTSS) Utilization, and 6) Case Management. The Dashboard can be found here.
The Dashboard shows that, on average, Cal MediConnect health plans are performing well on measures related to care coordination. During the reporting period and across all Cal MediConnect health plans, 88 percent of reachable and willing beneficiaries received on-time Health Risk Assessments and 88 percent of beneficiaries with a case manager/care coordinator were contacted by their case manager/care coordinator or care team. The Dashboard also shows that, on average, 61 percent of hospital discharges during the reporting period resulted in outpatient follow up visits within 30 days, which can lead to better health outcomes for beneficiaries.
As part of ongoing quality-monitoring efforts, DHCS and the Centers for Medicare & Medicaid Services (CMS) work with Cal MediConnect health plans to track certain performance data. Where Cal MediConnect health plans have reported data that is below average, information on steps the plans are taking to improve their performance is included in the Dashboard. DHCS and CMS will continue to work with all Cal MediConnect health plans to measure, sustain, and improve performance on all reporting measures in order to ensure beneficiaries are receiving high quality, coordinated care.
Of the six measures in the March Cal MediConnect Performance Dashboard, three are "quality withhold" measures for Cal MediConnect health plans. This means that for each measure, a portion of a plan's payment is withheld, which can be earned back if they meet the required threshold for the measure.
- Health Risk Assessments (HRAs): An HRA is a survey tool that assesses the full range of a beneficiary's needs, such as medical and behavioral health, chronic conditions, and disabilities. A beneficiary's HRA serves as the foundation for an individualized care plan and helps the Cal MediConnect health plan connect a beneficiary to the care and services they need. Cal MediConnect health plans are required to conduct the HRA within 45 days for beneficiaries that are identified as high-risk, and 90 days for low-risk beneficiaries (see Duals Plan Letter 15-005 for additional information). This metric shows the HRA completion rates across plans, which is a quality withhold measure. Across plans, from April 2014 to September 2015, HRAs were completed for 88 percent of beneficiaries who were reachable and willing to participate in the process. More information on HRAs and previous data can be found here.
- Appeals by Determinations: All beneficiaries in Cal MediConnect health plans have the right to appeal their plan's denial (in part or whole) of a service or item. This metric measures the number of appeal determinations per plan, as well as the outcome of the appeal. Across plans, an average of nearly 1 appeal per 1000 members was resolved during the reporting period, with 86 percent resolved fully favorably.
- Hospital Discharge: When patients receive proper and timely follow up care after being discharged from a hospital, it reduces the likelihood that they will need to be readmitted and it improves their health outcomes. This metric measures the percent of hospital discharges that resulted in ambulatory follow up visits within 30 days of being discharged. Ambulatory care includes medical services received in an outpatient setting without admission to a hospital or other facility. Across plans, the average was 61 percent during the reporting period. This measure is a quality withhold measure.
- Emergency Utilization: Cal MediConnect health plans are responsible for coordinating a beneficiary's complete needs - including behavioral health needs (with serious mental illness coordinated with county providers). This metric measures emergency department visits by Cal MediConnect beneficiaries for behavioral health-related diagnoses. The reduction in emergency room use for beneficiaries with serious mental illness and substance use disorders is a quality withhold measure.
- LTSS Utilization: Beneficiaries in Cal MediConnect health plans can access long-term services and supports, including Community Based Adult Services (CBAS), In-Home Supportive Services (IHSS), the Multi-Purpose Senior Services Program (MSSP), and nursing facility services. This metric measures the total number of beneficiaries in Cal MediConnect health plans receiving these different services. For all Cal MediConnect health plans, IHSS was the most accessed LTSS benefit.
- Case Management: Care coordination is a major benefit of Cal MediConnect. Beneficiaries in Cal MediConnect health plans have access to a care coordinator, an experienced person who helps them with their health care, as well as a care team that includes their doctors and other providers. This metric measures the percentage of members with a case manager/care coordinator who were contacted by their case manager/care coordinator or care team. Across plans, 88 percent of beneficiaries were contacted by their case manager or care team in 2014. This measure is a quality withhold measure.
All data included in this dashboard is reported to DHCS by the Cal MediConnect health plans. A new Cal MediConnect Performance Dashboard will be released quarterly. If you have any questions, please e-mail firstname.lastname@example.org.
New Brief on Integrated Care Models for Dually Eligible Beneficiaries
DEC 17, 2015 | Source: The SCAN Foundation | View Brief
A new brief from the Center for Health Care Strategies describes key features and considerations for various integrated care models that states use to serve Medicare-Medicaid enrollees.
The Promise of Coordinated Care
DEC 17, 2015 | Source: The SCAN Foundation
Two new success stories from Collaborative Consulting on the value of coordinated care:
Wave 2 of Polling Results of California's Medicare-Medicaid Enrollees
DEC 17, 2015 | Source: The SCAN Foundation
Field Research Corporation released its second wave of polling results surveying people enrolling in and opting out of Cal MediConnect (CMC). Findings show that CMC enrollees have continued satisfaction and confidence in their care.
Revised Draft Managed Care Guide and Choice Book for New Dual Eligible Beneficiaries in CCI Counties
SEPT 21, 2015 | Source: Health Care Delivery Systems, CA Department of Health Care Services | View: Draft Medi-Cal Managed Care Plan Guide and Choice Book
From the start, stakeholder engagement and feedback has been an important part of the Department of Health Care Services' (DHCS') work on the Coordinated Care Initiative (CCI). As part of an ongoing commitment to working collaboratively in developing beneficiary materials, DHCS is releasing for stakeholder comment a new draft Medi-Cal Managed Care Plan Guide and Choice Book.
These materials will be mailed to two groups of dual eligible beneficiaries:
- New dual eligible beneficiaries who have Medicare first and later gain Medi-Cal eligibility in CCI counties; and
- Existing dual eligible beneficiaries who move into a CCI county.
These materials will be mailed to the aforementioned beneficiaries as a part of their regular enrollment process. All of these beneficiaries are already required to enroll into a Medi-Cal managed care health plans (MCP) for their Managed Long-Term Services and Supports (MLTSS) in order to receive their Medi-Cal benefits. These draft materials will ensure that this group of beneficiaries receives information on all of their available options - including Cal MediConnect.
The new materials incorporate some of the lessons DHCS has learned to date about how to communicate with dual eligible beneficiaries about the CCI, including lessons learned from stakeholder input and beneficiary testing of previous materials. It is important to note that prior to being finalized these materials will undergo a final literacy review to ensure that they meet readability standards and are not above a sixth-grade reading level. All final materials will also be translated into threshold languages and available in accessible formats, as required.
CCI: An Update One Year Into Implementation -- Webinar Slides, Video Now Available
SEPT 8, 2015 | View: Slides / Video | Justice in Aging
Cal MediConnect Health Risk Assessment Data - August 2015
AUG 20, 2015 | Source: Sarah Brooks, Deputy Director, Health Care Delivery Systems, Department of Health Care Services (DHCS)
Today, the Department of Health Care Services (DHCS) is releasing new data on Health Risk Assessment (HRA) completion rates in the Cal MediConnect program. You can find the new Cal MediConnect HRA Dashboard and more information about HRAs here. Starting with this release, a new dashboard will be available quarterly.
Cal MediConnect HRA Dashboard
Earlier this year, DHCS released an initial HRA dashboard with data from April to September 2014. At that time, the Cal MediConnect health plans were reporting data in different ways, making it difficult to understand individual health plan performance or compare across plans. Since that initial dashboard was released, DHCS and the Centers for Medicare and Medicaid Services (CMS) have worked with the Cal MediConnect health plans to clarify reporting requirements and standardize definitions. All Cal MediConnect health plans resubmitted data for April to September 2014, and that revised data is reflected as part of this dashboard. The previous dashboard should no longer be used to understand plan performance.
The data shows that from April 2014 through March 2015, Cal MediConnect health plans completed 89 percent of HRAs within 90 days of enrollment for beneficiaries who took part in the HRA process and could be reached by the health plan. The data also showed that 35 percent of beneficiaries were unreachable, and 10 percent of beneficiaries were unwilling to participate.
DHCS, CMS, and the Cal MediConnect health plans are working together to share best practices and improve the health plans' ability to reach their beneficiaries in order to complete the HRA process. For example, health plans are partnering with other providers, such as pharmacies, that may have more up-to-date contact information for beneficiaries.
Cal MediConnect HRAs
An HRA is a survey tool that assesses the full range of a beneficiary's needs, such as medical and behavioral health, chronic conditions, and disabilities. A beneficiary's HRA serves as the foundation of an individualized care plan and helps the Cal MediConnect health plan connect a beneficiary to the care and services they need. Cal MediConnect health plans are required to conduct the HRA within 45 days for beneficiaries that are identified as high-risk, and 90 days for low-risk beneficiaries (see Duals Plan Letter 15-005 for additional information).
As part of ongoing quality-monitoring efforts, DHCS and CMS work with Cal MediConnect health plans to track completion rates. Because of the important role that the HRA plays in providing quick, timely, and appropriate care for the beneficiary, the HRA completion rate has been established as a "quality withhold" measure for Cal MediConnect. This means that a portion of each health plan's capitation payment is withheld from payment, and if the health plan meets the required threshold for this measure, the health plan can earn back the withheld payment.
If you have any questions, please e-mail email@example.com.
California Healthline: Duals Allowed to Designate an Assistant
AUG 10, 2015 | Capitol Desk by David Gorn
Duals Allowed To Designate an Assistant
Key Words: enrollment assistant | Medi-Cal managed care plans | Medi-Cal beneficiaries | Health Care Options
Designating an "Enrollment Assistant" to Represent Medi-Cal Beneficiaries with their Enrollment Decisions
SEPT 2015 | Enrollment Assistant Fact Sheet | SOURCE: CA DHCS, Health Care Delivery Systems
In May, the Department of Health Care Services (DHCS) brought forward a proposal that would allow beneficiaries who are unable to update their authorized representative designation in the Medi-Cal eligibility system to designate another individual, or an "enrollment assistant," to make enrollment decisions on their behalf.
Over the past few months, DHCS has shared the details of this proposal with stakeholders and the Centers for Medicare and Medicaid Services (CMS). We have received positive feedback, helpful comments, and suggestions on improving the process and strengthening safeguards for beneficiaries. DHCS has continued to put the pieces in place to implement this change - ensuring that screening questions used by Health Care Options (HCO) are clear, and HCO staff are trained and prepared to respond to beneficiary questions.
We're excited to report that this work is now complete and that enrollment assistants are able to call HCO and make enrollment decisions.
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