As part of our ongoing commitment to stakeholder engagement, moving forward, we will be releasing brief recaps of our monthly stakeholder calls. This month’s call focused on the updated enrollment dashboard, the newly released Continuity of Care Duals Plan Letter, and Health Care Options improvement efforts. Please send ideas and/or topics that you would like hear discussed on our April stakeholder call to info@calduals.org.
Enrollment
The enrollment, opt-out and disenrollment rates remained steady in March, with the opt-out rate in Los Angeles and among IHSS beneficiaries remaining significantly higher than the overall opt-out rate. As of March 1st, there are 124,239 beneficiaries enrolled in the six active CCI counties. Additionally, starting this month, you can now find more detailed enrollment, opt-out, and disenrollment information in the dashboard. You can take a closer look at these numbers and other statistics on the full dashboard by clicking here.
Continuity of Care
The Department is clarifying primary care provider assignments and continuity of care requirements for plans with delegated provider entities. Moving forward as a beneficiary transitions into a Cal MediConnect plan:
- If the beneficiary has an existing relationship with a primary care provider (PCP) that is in the plan’s network, the plan is required to assign the beneficiary to that PCP, unless the beneficiary chooses a different PCP.
- If the plan contracts with delegated entities, the plan is required to assign the beneficiary to a delegated entity that has the beneficiary’s preferred PCP in its network.
- If the beneficiary has an existing relationship with a doctor that is in the plan’s network, and the beneficiary wishes to continue to see the doctor, the plan must allow the beneficiary to continue treatment with the doctor for the continuity of care period regardless of whether the doctor is in the network of the plan’s delegated entity to which the beneficiary is assigned, as long as the continuity of care requirements are met.
We know these issues are important to care transitions and beneficiary satisfaction, and we greatly appreciate everyone who shared their comments on the proposed revisions. The final Duals Plan Letter containing these revisions was released last Friday and can be found here.
Health Care Options
In response to stakeholder concerns and feedback about Health Care Options (HCO), the Department has spent the last several months working with HCO leadership to address issues and improve the beneficiary experience.
Among other things, DHCS has increased its direct engagement at the HCO call center in order to provide training and immediate feedback. DHCS has worked with HCO to implement a more rigorous training process for new customer service representatives. Daily and weekly reports are shared with DHCS and HCO leadership to ensure progress and issues are effectively monitored and that issues are addressed immediately.
These are just some of the important steps we have taken to date, and we know that ensuring quality at HCO is an ongoing project. That is why DHCS and HCO leadership meet twice per week to discuss and elevate issues, share important information, and identify opportunities for continued improvement.
We hope you find the information we share on the monthly stakeholder calls valuable. The Department knows that stakeholder engagement is critical to the success of the CCI. Again, please send ideas and/or topics that you would like hear discussed on our April stakeholder call to info@calduals.org. As always, your comments and feedback are very important to us as we continue to implement the CCI.
Sincerely,
Claudia Crist
Deputy Director, Health Care Delivery Systems
Department of Health Care Services
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Is there anyone that knows when passive enrollment will stop in LA county?