News & Updates
Please join the Department of Health Care Services (DHCS) for the May 2015 Coordinated Care Initiative (CCI) stakeholder call. This month’s stakeholder update call will take place on Thursday, May 19th.
DHCS will discuss the announcements it made related to program quality improvements as well as enrollment sustainability. More information on these announcements, including draft materials for stakeholder comment, can be found by clicking here. DHCS will also provide an enrollment update and answer questions.
Today, DHCS is also releasing a draft list of new data it wants to begin collecting from Cal MediConnect health plans. These new measures are related to Long-term Services and Supports referrals and assessments. Stakeholders can send comments or questions to info@CalDuals.org by Wednesday, May 25th.
Below you will find information about the call along with a registration link.
Date: Thursday, May 19th.
Time: 10:00 am – 11:00 am
Registration: Click here to register.
Please send any questions or comments concerning registration to firstname.lastname@example.org. After registering, you will receive a confirmation email containing information about joining the call. A recording of this call will be posted on www.CalDuals.org. For individuals with disabilities, DHCS will provide assistive services. To request such services or copies in an alternate format, please email email@example.com.
As always, thank you for your interest and engagement as we work on this important initiative.
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 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.
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.
Thank you for your continued support of the CCI.
Find copies of the comments submitted posted below, identified by the submitting entities:
- AgeWell Senior Services
- Alzheimer’s Family Services Center
- Anthem Blue Cross
- California Association of Health Facilities
- California Association of Health Plans
- Central Health Plan of California
- Community Health Group
- Congress of California Seniors
- Council on Aging – Orange County
- Health Plan of San Mateo
- Health Net
- Justice in Aging: Long | Short
- L.A. Care
- Local Health Plans of California
- MOMS Orange County
- Orange County Adult Day Services Coalition
- Orange County Social Services Agency
- State Independent Living Council
- The SCAN Foundation
In order to ensure that beneficiary transitions into Cal MediConnect are smooth and do not result in disruptions in care, the CCI continuity of care policy provides beneficiaries in Cal MediConnect plans with the right to continue seeing non-participating physicians for a limited period of time.
DHCS has developed a Provider Bulletin explaining 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.
DHCS encourages stakeholders to forward this bulletin to providers who may need the information about these important protections.
Recently, we highlighted the Health Plan of San Mateo’s Community Care Settings Pilot, made possible through Cal MediConnect.
The Center for Health Care Strategies, with support from The Commonwealth Fund, developed a profile to describe the innovative pilot program developed by the Health Plan of San Mateo (HPSM).
The profile provides an in-depth account of HPSM’s experiences as it implements the pilot program, which is aimed at helping dually eligible beneficiaries in nursing facilities transition back to their communities and helping those at risk of nursing home placement to remain in their communities.
Lessons learned detailed in the profile may help other health plans, states, and providers develop approaches to better serve dually eligible beneficiaries with extensive LTSS needs.
The profile, entitled “Housing Options for High-Need Dually Eligible Individuals: Health Plan of San Mateo Pilot”, can be found here.
The Coordinated Care Initiative (CCI), including Cal MediConnect, is a historic undertaking to help improve the lives of low-income seniors and people with disabilities in California. DHCS developed the CCI through an intensive consumer and stakeholder process, and throughout the implementation process, DHCS has partnered closely with stakeholders and the Centers for Medicare and Medicaid Services (CMS) to strengthen the program and improve the beneficiary experience – including the quality of care and care coordination.
Two years since enrollment into Cal MediConnect health plans began, there are approximately 123,560 beneficiaries in the program. DHCS believes Cal MediConnect is a good program for dual eligible beneficiaries, and the early research results are showing that to be true. Beneficiaries in the program are satisfied with their care and the care coordination they are receiving.
While these early results are encouraging, DHCS recognizes that for Cal MediConnect to be successful over the long term, DHCS and its partners must continue to strengthen the quality of care beneficiaries receive, and ensure sustainable participation in the program. Earlier today, DHCS shared a comprehensive strategy with proposed policy changes that it believes will do just that. DHCS is looking for stakeholder feedback on the proposals contained in that strategy.
DHCS is proposing a number of changes to improve and strengthen the program in areas of care coordination, continuity of care, and overall beneficiary experience – proposals developed based on that 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 more detailed information on all of these proposals, please review the following materials on CalDuals.org:
- Proposals and Announcements Stakeholder Webinar
- Coordinated Care Initiative Program Improvements
- Ensuring Sustainable Coordinated Care Initiative Enrollment
- Streamlining the Cal MediConnect Voluntary Enrollment Process
- Population Enrollment Chart
- Recording of April 7th webinar
Stakeholder engagement and input is critical to the success of the CCI. DHCS is requesting all stakeholder questions and comments be sent to firstname.lastname@example.org. 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.
Thank you for your continued support of the CCI.
In 2016, the Department of Health Care Services is proposing a number of program changes to strengthen the quality of care provided through Cal MediConnect and to promote sustainable enrollment in the program moving forward. Please join us for a special stakeholder update webinar on April 7, 2016 to learn more about these proposals and next steps for stakeholder input.
Below you’ll find information about the webinar and a registration link.
- Date: Thursday, April 7th
- Time: 2:30 pm – 4:00 pm
- Registration: Click here to register
Our ongoing dialogue with stakeholders is critical to the success of the CCI and we look forward to sharing these important updates. Please send questions to email@example.com. As always, thank you for your continued engagement as we work to improve this important initiative.
Fact Sheet Detailing Two Important Beneficiary Protections—Deeming and Aid Paid Pending
Low income Californians, including beneficiaries dually eligible for Medicare and Medi-Cal, can often temporarily lose Medi-Cal eligibility or move between different eligibility levels. This can often result in disruptions in coverage and care. Under the CCI, a dually eligible beneficiary in a Cal MediConnect health plan who loses full Medi-Cal eligibility can remain in their Cal MediConnect plan for a period of time before being disenrolled—a process known as “deeming.” Deeming periods provide beneficiaries time to resolve eligibility issues. In addition, if a beneficiary is disenrolled from the CCI or Cal MediConnect due to a loss of or change in Medi-Cal eligibility and files an appeal, they have the right to continue receiving services for the duration of the appeals process, provided they make this request—also known as “aid-paid pending”—within 10 days of being notified about the change in eligibility or coverage. More information on deeming and aid-paid pending can be found in a new fact sheet, including how each can minimize disruption in care for dual eligible beneficiaries in CCI counties.
Balance Billing Toolkit for Advocates
When doctors, hospitals, or other providers charge beneficiaries with both Medi-Cal and Medicare for services—it is called balance billing. Balance billing is illegal under federal law. Recently, Justice in Aging released a toolkit for advocates that walks through the basics of balance billing and the federal protections for beneficiaries. It provides examples of how the problems manifest, how to fix them when they arise, and contains letters advocates can use when helping low income clients facing balance billing. The toolkit also includes a webinar that explains balance billing protections and how to work with providers to prevent erroneous billing. Access the toolkit and other balance billing-related materials here.
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. Thank you for your continued interest in the Cal MediConnect program.
Please join the Department of Health Care Services (DHCS) for the March 2016 Coordinated Care Initiative (CCI) Stakeholder Update Call.
Our ongoing dialogue with stakeholders is critical to the success of the CCI and we look forward to continuing our work together to improve health care for Californians. The call will take place on Thursday, March 17th. During the call, we will be reviewing the latest Cal MediConnect enrollment information and discussing other timely topics. We will also have time to hear your feedback and answer questions. Enrollment dashboards are available here.
Call information and registration link:
Date: Thursday, March 17th
Time: 10:00 am – 11:00 am
Registration Link: Click here to register
Please send questions and/or comments to email@example.com. As always, thank you for your interest and engagement as we work on this important initiative.
You can find a recording of this call on the Audio Recordings page, with a transcript to follow.
The Department of Health Care Services is committed to supporting our partners in their efforts to meet the needs of Californians dually eligible for Medicare and Medi-Cal. We know that beneficiaries may often need extra support during hospitalizations and in the transition out of the hospital back into the community or into a nursing facility. Together with the California Hospital Association and Cal MediConnect health plans, we have developed the Cal MediConnect Hospital Case Manager Toolkit, a new resource that can be used in Coordinated Care Initiative (CCI) counties to support Cal MediConnect enrollees before, during, and after hospitalization.
This toolkit gives guidance, answers common questions, and provides important information about Cal MediConnect to hospital case managers and discharge planners. The toolkit can support hospital case managers as they work with beneficiaries through the admissions and discharge processes and also includes details on how to access and build upon care coordination services provided by Cal MediConnect health plans.