News & Updates
Today, DHCS is issuing an updated continuity of care 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.
Earlier this year, 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. These policy changes will be effective starting October 1, 2016. DHCS has updated its Duals Plan Letter and this new provider bulletin also reflects these changes.
In order to ensure that beneficiary transitions into Cal MediConnect are smooth and do not result in disruptions in care, the Cal MediConnect 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.
Today, researchers at the University of California (UC) San Francisco and UC Berkeley released new findings from their three-year evaluation of Cal MediConnect and the Coordinated Care Initiative.
The UC’s evaluation – funded by The SCAN Foundation – includes interviews with various stakeholders including Cal MediConnect health plans, provider groups, long-term care facilities, In-Home Supportive Services (IHSS), Multipurpose Senior Service Program (MSSP), Community Based Adult Services (CBAS), hospitals, state and federal government, and community based organizations. The study evaluates the impact of the Cal MediConnect on beneficiaries as well as the overall health system, identifies areas for improvements, and includes recommendations to better coordinate care for dual eligible beneficiaries.
DHCS appreciates the various evaluation efforts supported by The SCAN Foundation, and is encouraged by early evaluation data showing that beneficiaries in Cal MediConnect health plans are confident in and satisfied with their care.
The report credits Cal MediConnect for building stronger relationships between the plans and various stakeholders including providers, community organizations, and long-term services and supports. For the dual-eligible population, Cal MediConnect continues to provide a platform for increased collaboration among historically independent or ‘siloed’ programs and providers. The report identifies collaboratives as a key factor in promoting communication and shared learning, especially within large counties.
In addition, the study reported strong evidence of Cal MediConnect delivering on its promise of care coordination among the dual-eligible beneficiaries. It recognized Cal MediConnect’s success in developing and expanding innovative care coordination programs among the health plans. The report highlights the significant improvement in the “culture of care.”
The report also identifies several areas for improvement. DHCS and its partners recognize and are finding solutions for the challenges of integrating different health care systems so that care is coordinated and improved for all Cal MediConnect beneficiaries. DHCS appreciates the recommendations of this report, and will integrate this valuable information into new and ongoing projects to improve Cal MediConnect.
Critically, the report calls out the continued need to strengthen connections with long-term services and supports (LTSS), and DHCS is working on several fronts to address this concern. DHCS is taking several steps to encourage broader use of LTSS services. DHCS is working with stakeholders to standardize the Health Risk Assessment (HRA) questions designed to prompt referrals for non-medical or LTSS needs. Furthermore, we are strengthening data collection around LTSS referrals to better track how effectively plans are linking beneficiaries to needed services.
DHCS looks forward to continuing to work with plans and stakeholders to continue to strengthen the program.
UC Report & Key Findings and Recommendations:
More information on various evaluation efforts:
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 firstname.lastname@example.org 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.
Beneficiary Took Kit
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 email@example.com. DHCS is committed to transparency and will share additional materials for stakeholder input as they become available.
Thank you for your continued support of the CCI.
Increasing proportions of Cal MediConnect enrollees are satisfied with their health care services and more confident in managing their health
Today, a third wave of survey results were released shedding light on beneficiaries’ experiences in Cal MediConnect health plans.
These data align closely with the previous two waves, continuing to show that an overwhelming majority of Cal MediConnect enrollees are satisfied with their services and confident in their care. The data also show a statistically significant increase in the number of Cal MediConnect enrollees who expressed satisfaction with key areas of their health care experience.
Of note, 84% of Cal MediConnect enrollees were satisfied with the information they received from their plan explaining program benefits—up 11% from the last wave. An increasing number of beneficiaries were satisfied with their choice in doctors (83%), their choice in hospitals (81%), and the way their team of providers work together (82%) and the amount of time their providers spend with them (87%).
“We’re pleased to see another round of strong evidence of Cal MediConnect’s positive impact on the lives of dual eligible Californians,” said Jennifer Kent, Director of DHCS. “We are working with the health plans and other partners to continue to improve the program and ensure that more eligible beneficiaries know how opting for coordinated care can improve their health and quality of life.”
The survey results also identify areas where improvement is needed, including educating beneficiaries in order to reduce transition issues. Earlier this year, the Department of Health Care Services (DHCS) announced a series of program quality improvements and DHCS looks forward to continue working with Cal MediConnect plans and other partners on strengthening the overall program and improving communications with beneficiaries.
These data are from the third wave of Field Research Group’s Rapid Cycle Polling Project, an ongoing tracking survey funded by The SCAN Foundation to evaluate the experience of beneficiaries transitioning into Cal MediConnect health plans. To learn more about this and other CCI evaluation efforts, visit: http://www.thescanfoundation.org/evaluating-medicare-medicaid-integration.
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.