If you joined us for last week’s CCI Stakeholder Quarterly Meeting, thank you for participating. We appreciate your time and interest, and your feedback is important.
On the call, we announced that DHCS would be releasing the Physician Toolkit for stakeholder comment. This toolkit has a wealth of knowledge for physicians about Cal MediConnect and the CCI, and we hope it will be useful for them in their practices and in answering questions from their patients. We appreciate your help making the toolkit as effective as possible. Please send any edits or comments on the toolkit to info@calduals.org by Friday, July 25 at noon. Please put “physician toolkit” in the subject line.
You can find the toolkit here. The toolkit includes:
- Cover letter to physicians
- Fact Sheets on:
- Care Coordination
- Continuity of Care
- Physician Services & Payments Under CCI
- FFS Medicare & CCI
- Contracting with Cal MediConnect Plans & Plan Contacts
- Sample Patient Letter & FAQ document
- How Plans Process Crossover Claims
- Tutorial on Plan Lookup Using AEVS
We also wanted to share a link to where you can find the Cal MediConnect Notice and Enrollment Issues Tracker, which was also mentioned on last week’s call.
Finally, you can find new enrollment data on our Enrollment Data page.
Thank you and please let us know if you have any questions.
Please post the below information. It is only fair for the public to know of the lawsuit filed against the State of CA in regards to the Cal MediConnect program. FYI, The hearing has been delayed until August.
The Los Angeles County Medical Association (LACMA) joined other stakeholders, including three independent living centers (Communities Actively Living Independent & Free, Westside Center for Independent Living and Southern California Rehabilitation Services, Inc.) and Dr. Manuel Puig-Lino in Chula Vista, in filing a lawsuit in Sacramento Superior Court seeking to, among other things, halt the implementation of the ill-conceived Cal MediConnect demonstration project, part of the State’s Coordinated Care Initiative.
In addition to other relief, the stakeholders are also asking the court for a preliminary injunction to stop passive enrollment and the implementation of the pilot project, and to disenroll all duals who have been enrolled since the commencement of the Coordinated Care Initiative.
The State is planning to enroll approximately 458,000 duals – about half of the State’s 1.1 million Californians who qualify for both Medicare and Medi-Cal benefits into Medi-Cal managed care plans.
The population includes the elderly, poor and persons with permanent disabilities. Without their knowledge, consent, or understanding, patients will be passively assigned away from their current doctor to one of five medical groups that likely do not understand their conditions, medical histories, physical limitations and social needs.
Dr. William Averill, Executive Board Member of the Los Angeles County Medical Association (LACMA) and renowned cardiologist, said his organization spearheaded the effort to challenge the Cal MediConnect pilot demonstration project in Los Angeles County. “The volume of patients and the confusing passive enrollment of the most vulnerable patients is unacceptable. The cost to healthcare quality will be shouldered by those who can least afford to carry the weight of bureaucracy.”
The lawsuit states that the State of California, Department of Health Care Services is mandated to provide notices and an Opt-Out Choice Form that is at or below sixth- grade reading level. The documents provided by the State are confusing, misleading, disingenuous and threatens the continuity of care for many dual-eligible beneficiaries.
Alan Toy, Executive Director of Westside Independent Living Center states, “ironically, we find that this form has been structured to prevent any real choice, and therefore threatens the basic rights of people in our community to choose the healthcare coverage that best fits their needs.”
Former Los Angeles City Attorney Rocky Delgadillo and current CEO of LACMA believes this program runs counter to our very notion of what America stands for. “The essence of our democracy is based on an individuals’ right to choose, certainly one of the most intimate choices in life, is the doctor patient relationship,” he said. “This is the case of bureaucracy defeating democracy.”
The California Medical Association (CMA) is not a named party in the lawsuit. However, CMA believes the lawsuit raises legitimate issues about the rollout and implementation of Cal MediConnect, specifically concerning adequate notice and information to affected beneficiaries and providers. These issues warrant a fair and quick resolution by the court.
The stakeholders are asking the court for a preliminary injunction to stop passive enrollment and the implementation of the pilot project. The hearing is scheduled for Friday, July 11, 2014 at 1:30 p.m in Superior Court, Sacramento.