News & Updates

DHCS Releases HRA Plan Letters for Comment

Posted by on Mar 27, 2017 in NEWS | 0 comments

This week, DHCS released the revised HRA plan letters for stakeholder comment. Any questions or comments can be sent to DHCS_PMMB@dhcs.ca.gov until April 7, 2017.

1)   Medi-Cal All Plan Letter (APL) titled “Care Coordination Requirements for Managed Long-Term Services and Supports”(APL 17-00A)

2)   Medi-Cal APL titled “Requirements for Health Risk Assessment of Medi-Cal Seniors and Persons with Disabilities” and the accompanying attachment “Long-Term Services and Supports Referral Questions.” (APL 17-00B)

3)   Cal MediConnect Duals Plan Letter (DPL) titled “Health Risk Assessment and Risk Stratification Requirements for Cal MediConnect” and the accompanying attachment “Health Risk Assessment and Risk Stratification Requirements for Cal MediConnect.” (DPL 17-00C)

The proposed questions are included in the “attachment” documents.

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.

In February, DHCS released the “Cal MediConnect HRA Workgroup: Summary of Recommendations.” This report 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.  The plan letters take the worgroup recommendations and translate them into formal guidance for the Cal MediConnect and Medi-Cal managed care plans.

Please note that the DPL and APL numbers (17-00A, 17-00B and 17-00C) are only temporary for ease of reference until final numbers are assigned upon release of the finalized plan letters.

Click here for more information about the HRA LTSS workgroup and its process.

Social Worker Resource Guide Now Available

Posted by on Mar 24, 2017 in NEWS | 0 comments

The Department of Health Care Services (DHCS) developed the Social Worker and Case Manager Resource Guide to support social workers and case managers as well as other health advocates and community organizations that engage directly with dual eligible beneficiaries.

This reader-friendly resource guide provides information for social workers and county case managers about the basics of Cal MediConnect health plans, helps identify their clients’ options, and provides guidance in coordinating their clients’ care. The resource guide was developed with questions identified and complied by our on-the-ground outreach team.

Robust outreach and education is a core part of the design and implementation of the Coordinated Care Initiative and Cal MediConnect. DHCS is committed to assess and develop new tools to use in outreach and education activities.

Click here to access the Social Worker Resource Guide

What you need to know about Cal MediConnect in 2017

Posted by on Mar 23, 2017 in NEWS | 0 comments

In January, Governor Brown released his 2017-18 budget proposal which continues Cal MediConnect and Managed Long-Term Services and Supports (MLTSS). The State and the Department of Health Care Services (DHCS) are committed to increasing and improving the coordination of care for dual-eligible individuals.

Below please find the answers to some commonly asked questions about how the budget might impact the Coordinated Care Initiative, Cal MediConnect and MLTSS.
What to Expect

• The Coordinated Care Initiative (CCI) and Cal MediConnect (CMC) will continue in 2017.
• You will not see any change in your coverage. Anyone eligible will continue to have the option of joining a Cal MediConnect health plan.
• That’s exciting news because recent evaluation data shows high satisfaction and low hospitalization rates among Cal MediConnect members.

Frequently Asked Questions

Does the state budget impact my Cal MediConnect coverage?
No, the state budget does not impact your Cal MediConnect coverage. You will not see any changes to your coverage in 2017. You won’t see any changes to your IHSS services- only its funding won’t flow through managed care plans anymore.

I heard that the Cal MediConnect program is going away. Is that true?
No, it is not true. Cal MediConnect is not ending. The State of California fully supports the Cal MediConnect program and it will continue. This means your Cal MediConnect coverage does not change. Cal MediConnect and MLTSS will continue as they are today.

So then, what is changing?
IHSS services you receive and how they are provided to you will not change. Eventually, the way the cost for IHSS is split between the state and counties will change, and it will return to being a Medi-Cal fee-for-service benefit as it has been historically.

If IHSS will no longer be a health plan benefit, will I lose my IHSS?
No. The IHSS program will not change – counties will continue to conduct assessments and determine hours. You will also continue to receive your authorized hours and manage your IHSS caregiver.

Who can I contact about my IHSS?
You can call your county IHSS office, just like you do today.

Will the program still be called the CCI?
Yes. At this time, the state does not have any plans to change the name of the program.

Do/will I have to change doctors again?
No. None of your benefits or health plan options are changing.

Will my Cal MediConnect care coordinator still be able to help me with IHSS issues?
Yes. If you like, your care coordinator will still be able to work together with your IHSS social worker and/or provider to give you the best care possible.

Click here to download a printable version of these questions.

Click here to learn more about the 2017 CCI budget proposal.

March’s Outreach Events Recap

Posted by on Mar 16, 2017 in NEWS | 0 comments

Highlighted Outreach Events

 

Los Angeles County

2/5 – Over 500 people attended a Cal MediConnect Health & Resource Fair at St. Martha’s Parish in Huntington Park. Attendees learned about Cal MediConnect during both English- and Spanish-language presentations, and had their specific questions about Cal MediConnect answered by several bilingual outreach coordinators. Over 25 other collaborative partners distributed information, provided free health screenings, and demonstrated low-impact exercise sessions as part of the event.

 

Los Angeles County

2/8 – Commissioners of the Los Angeles County Commission on Disabilities and the Events and Transportation Committee took part in a Coordinated Care Initiative (CCI) presentation in downtown Los Angeles. The presentation covered Cal MediConnect’s benefits, highlighting care coordination. Following the talk, state outreach staff answered questions and distributed informational materials. Future presentations with other commissioners are scheduled for the coming month.

 

Los Angeles County

2/9 – Hundreds of mental health clinicians and community advocates attended the African American Mental Health Conference hosted by the Los Angeles County Department of Mental Health. State outreach staff provided informational materials about Cal MediConnect for beneficiaries and providers.

Los Angeles County

2/11 – State outreach staff provided information about Cal MediConnect during the 3rd Annual National Alliance on Mental Illness (NAMI) Parent and Caregiver Conference at St. Anne’s in Los Angeles. Coordinators provided information in English and Spanish to dozens of dual eligible beneficiaries, mental health advocates, and clinical providers. This event was organized by The Los Angeles County Department of Mental Health and NAMI – Los Angeles County Council.

San Diego County

2/14 – Providers and beneficiaries took part in a presentation during a monthly meeting at Summercrest Family Services in National City. The presentation and follow-up questions were translated into Spanish by Summercrest staff, with many of the questions focused on billing and program eligibility. Following the event, attendees collected Beneficiary Toolkits and other materials about the CCI.

Los Angeles County

2/24 – Chinese caregivers took part in a presentation during Caregivers & Home Aides Training, a resource fair at the Asian Youth Center in San Gabriel. The presentation was delivered in English and translated into Chinese. Attendees had the opportunity to collect materials in both English and Chinese following the presentation. The event was hosted by the Pilipino Workers Center and Asian Americans Advancing Justice.

 

 

Other Recent Outreach Events

 

Statewide

  • 2/22 – Webinar for Long-Term Care Ombudsman staff

 

Los Angeles County

  • 2/2 – Presentation to members of Community Health Councils Inc.’s Access to Health Coverage Coalition Workgroup (Los Angeles)
  • 2/17 – Webinar for Los Angeles County providers
  • 2/21 – Webinar for Los Angeles County advocates & caregivers
  • 2/22 – Informational table at Koreatown Senior and Community Center (Los Angeles)
  • 2/23 – Informational table at Centro Medico of Huntington Park (Los Angeles)
  • 2/28 – Outreach to seniors at the Elder Abuse Collaborative meeting (Pasadena)
  • 2/28 – Outreach at the Los Angeles County Department of Mental Health’s El Monte Health Neighborhood Meeting (El Monte)

 

Orange County

  • 2/15 – OneCare Connect presentation at 1800 Health (Irvine)
  • 2/21 – OneCare Connect webinar for advocates & caregivers
  • 2/22 – OneCare Connect webinar for providers

 

Riverside and San Bernardino Counties

  • 2/15 – Webinar for San Bernardino and Riverside advocates & caregivers
  • 2/16 – Webinar for San Bernardino and Riverside providers
  • 2/8 – Informational table at Fontana Community Senior Center (Fontana)
  • 2/25 – Informational table at the Disability Sports Festival (Coachella)

 

San Diego County

  • 2/2 – Presentation for attendees of the San Diego Council on Aging monthly meeting (San Diego)
  • 2/8 – Presentation at East County Senior Providers Meeting (El Cajon)
  • 2/9 – Presentation at Community Health Improvement Program Meeting (San Diego)
  • 2/28 – Presentation at North County Community Action Meeting (San Marcos)

 

Santa Clara County

  • 2/6 – Informational table for seniors and the homeless population during the Winter Faith Collaborative Meeting (San Jose)
  • 2/8 Information table staffed for case managers during the 2017 Interact IV SNF Meeting Series at Valley Medical Center (San Jose)
  • 2/9 – Information table staffed for seniors and caregivers at the Dementia Friends Outreach Kick-off (San Jose)
  • 2/13 – Information table staffed for Vietnamese seniors and caregivers at the Vietnamese Family Support Group (San Jose)
  • 2/14 – Informational table at the National Association of Mental Illness’ general meeting (San Jose)
  • 2/15 – Informational table at the Health Care Reform Implementation Stakeholders Meeting (San Jose)

Frequently Asked Questions about the 2017 CCI Budget Proposal

Posted by on Mar 15, 2017 in NEWS | 0 comments

In January, Governor Brown released his 2017-18 budget proposal which continues Cal MediConnect and MLTSS. 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 CCI and making the necessary changes in order to make the Cal MediConnect program stronger.

 

The Department of Health Care Services (DHCS) said that the CCI will be discontinued due to its lack of cost effectiveness but Cal MediConnect and other parts are continuing. What is happening?

The CCI is not ending, it is being restructured for fiscal sustainability. Cal MediConnect and MLTSS will continue much as they are today, but eventually IHSS will no longer be a plan benefit. When created, the CCI included a requirement that the program be cost neutral. Due to changes unrelated to the CCI such as IHSS costs, the State was not able to demonstrate that the program is cost neutral. The State of California fully supports the effectiveness of this program and as such chose to continue it but under a different structure.

When will the counties be responsible for the cost of IHSS?

Due to statutory language, this change will be effective in the new state budget year, July 1, 2017. The State will work with the counties and other stakeholders to find common ground to ensure the program continues.

When will the IHSS program be taken out of CCI?

IHSS will remain a plan benefit in Cal MediConnect and MLTSS for the remainder of the calendar year. IHSS will no longer be a plan benefit beginning January 1, 2018, but will remain available to eligible beneficiaries as a fee-for-service benefit.

What will be the impact of the IHSS funding change for beneficiaries?

None. Beneficiaries’ access to IHSS will not be impacted. The IHSS program will not change – counties will continue to conduct assessments and determine hours and beneficiaries will continue to receive the same number of authorized hours and maintain their same authorities with respect to managing their IHSS workers.

Will it still be called the CCI?

At this time, the State does not have any plans to change the name of the program.

I heard the counties are upset. What if they don’t agree to this change? Will the CCI be discontinued?

The budget proposal is just that—a proposal. The State will work with the counties and other stakeholders to find common ground to ensure the program continues.

What about the Universal Assessment Tool?

The State has been working to develop a tool that could be used as a universal assessment tool, but has determined that the work conducted to date should be redirected. The State plans to assess how the work on the universal assessment tool can be used by the IHSS program in its individual assessment.

Is anything else changing about the program?

DHCS is also going to delay the transition of the Multipurpose Senior Services Program (MSSP) from a fee-for-service waiver program to a full managed care plan benefit until the end of the demonstration in 2020. Current requirements would have the transition occur by the end of 2017.

Click here for more information about the CCI 2017 budget.

Click here to download a printable version of these FAQs.

February’s Outreach Events Recap

Posted by on Feb 17, 2017 in NEWS | 0 comments

Highlighted Outreach Events

 

Los Angeles County

1/11 – State outreach staff gave a CCI presentation and budget update for Long Beach and Los Angeles County administrators and stakeholders at the South Bay Disability and Senior Collaborative Meeting in Long Beach. Following the discussion about plan benefits and the enrollment process, attendees heard about opportunities for future training sessions and monthly webinars available for their staff and the people they serve.

 

Los Angeles County

1/22 – Hundreds of beneficiaries and providers in Los Angeles learned more about Cal MediConnect at an informational booth at Telemundo 52’s Feria de la Salud, called “El poder en ti/tu salud.” Attendees learned about Cal MediConnect’s benefits, care coordination, continuity of care, and other key information.

 

Los Angeles County


1/28 – Over 100 English- and Spanish-speaking beneficiaries in Lynwood attended the Los Angeles County Health Fair at Plaza Mexico in downtown L.A. where CCI outreach coordinators shared information about the program.

 

Riverside County

1/26 – Stakeholders representing the Coachella Valley Resources Collaborative learned more about the CCI during a presentation at the Disability Collaborative in Coachella. The presentation included the latest updates on the CCI, benefits and enrollment procedures, and the availability of resources like the Beneficiary Toolkit.

 

Orange County

1/31 – Providers from Azusa Pacific University learned about the CCI during a food distribution activity at Paradise Valley Community Church in National City. The presentation focused on the value of care coordination, the options available, the extra benefits that are offered with Cal MediConnect, and the enrollment process. In addition to providers and seniors learning more about the program, nurses and nursing students provided health care check-ups to seniors from underserved parts of National City.

Other Recent Outreach Events

 

Los Angeles County

  • 1/6 – Outreach to seniors and staff at Monterey Park Convalescent Hospital
  • 1/6 – Outreach to seniors at Heritage Manor
  • 1/6 – Outreach to seniors and staff at Royal Garden Extended Care
  • 1/11 – Presentation for leadership and billing staff of Family Care Specialists Medical Group
  • 1/11 – Information table staffed at Koreatown Senior and Community Center
  • 1/18 – Information table staffed at Koreatown Senior and Community Center
  • 1/19 – Monthly webinar for advocates
  • 1/20 – Monthly webinar for providers
  • 1/25 – Presentation to seniors and people with disabilities at the East Los Angeles Disability and Senior Collaborative Meeting
  • 1/27 – Information table staffed at Centro Medico de Huntington Park
  • 1/28 – Informational table staffed at City of Monterey Park Lunar New Year Festival
  • 1/25 – Presentation for provider staff at Good Samaritan Hospital
  • 1/28 – Informational table staffed at City of San Gabriel Lunar New Year Festival

Orange County

  • 1/2 – Presentation for the Executive Board of Latino Health Access
  • 1/24 – Monthly webinar for Orange County advocates and caregivers
  • 1/25 – Monthly webinar for Orange County providers

Riverside and San Bernardino Counties

  • 1/17 – Monthly webinar for advocates
  • 1/18 – Monthly webinar for providers

San Diego County

  • 1/5 – Presentation for health plan representatives, county staff, and mental/behavioral health advocates at the Healthy San Diego Behavioral Workgroup Meeting
  • 1/10 – Presentation for advocates and community clinic providers at the Palomar Health Community Action Council Meeting
  • 1/18 – Presentation for the Board of Directors and staff at Kalusugan Community Services
  • 1/18 – Presentation for staff and seniors at Kimball Senior Center
  • 1/18 – Monthly webinar for San Diego providers
  • 1/18 – Monthly webinar for San Diego advocates
  • 1/25 – Outreach to UDW members at the Norman Parker Senior Center Health Fair
  • 1/24 – Presentation for providers, caregivers, community advocates, and county workers at the South Action Community Meeting
  • 1/26 – Presentation for staff at St. Paul’s PACE
  • 1/31 – Presentation for seniors and caregivers at Refugee Integration Services, Paradise Valley Community Church
  • 1/31 – Presentation for seniors at Summercrest Senior Services

Santa Clara County

  • 1/2 – Informational table staffed at the Vietnamese Family Support Group
  • 1/3 –  Informational table staffed at the Santee and McLaughlin Area Senior Tenants Neighborhood Meeting
  • 1/4 –  Information table staffed at the Alma Neighborhood Senior Board Meeting
  • 1/10 – Informational table staffed at Guadalupe Neighborhood Association
  • 1/11 –  Informational table staffed at Self Help for the Elderly
  • 1/11 –  Informational table staffed at the Carlton Senior Living Center
  • 1/16 –  Informational table staffed at the Mountain View Senior Center
  • 1/16 – Informational table staffed at the Iola Williams Senior Neighborhood Association
  • 1/17 – Informational table staffed at the Southside Senior Citizen Center
  • 1/17 – Informational table staffed at Senior Nutrition Center
  • 1/18 – Informational table staffed at West Evergreen Neighborhood Association
  • 1/18 – Informational table staffed at the Cypress Community and Senior Center
  • 1/19 – Informational table staffed at the Santa Clara Senior Center
  • 1/19 – Monthly webinar for providers
  • 1/20 – Informational table staffed at the Eastside Neighborhood Center
  • 1/23 – Informational table staffed at Morgan Hill Centennial Recreation Center
  • 1/24 – Informational table staffed at Saratoga Senior Center and Adult Care Center
  • 1/25 – Informational table staffed at Los Altos Senior Center, Hillview Community Center
  • 1/26 – Informational table staffed seniors at Silver Creek Senior Living
  • 1/27 – Informational table staffed at Boxer’s Mayfair Village Senior Apartments

Cal MediConnect HRA Workgroup: Summary of Recommendations

Posted by on Feb 16, 2017 in NEWS | 1 comment

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 proud 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.

The workgroup met five times over four months for discussion, collaboration, and multiple rounds of review. They assembled a comprehensive set of risk factors that may indicate a need for LTSS services. To address the spectrum of challenges a beneficiary may face, the workgroup identified four different categories: social determinants, functional capacity, medical conditions, and behavioral health conditions. Next, they identified questions from the DHCS proposed LTSS referral questions that addressed those risk factors. To account for the remaining risk factors or aspects of risk factors that were not accounted for in existing questions, the workgroup crafted new questions. To improve accessibility for all beneficiaries, the questions were adjusted to meet health literacy and cultural competency requirements.

The final report is being shared with stakeholders. DHCS is currently revising HRA guidance plan letters for CMC plans ( DPL 15-005), MLTSS plans (APL 14-010) and plans serving Seniors and People with Disabilities (PL 14-005). The Dual Plan Letter and All Plan Letters will be circulated for public comment before being finalized for plans.

As Cal MediConnect moves forward in 2017, the state and DHCS are committed to strengthening access to LTSS for dual-eligible beneficiaries. DHCS looks forward to these recommendations being used by Cal MediConnect plans to continue to provide coordinated care to their members.

January’s Outreach Events Recap

Posted by on Jan 13, 2017 in NEWS | 0 comments

Highlighted Outreach Events

 

Los Angeles County

Bell.Community.Event_1_(12.09.16.) - Copy12/10 – State outreach coordinators provided information about Cal Mediconnect to beneficiaries, caregivers and families at Bell Community Center’s Feria de Salud (Health Fair). Attendees learned about the benefits of Cal MediConnect, care coordination, continuity of care, eligibility, and important contact information. They also received fact sheets on Cal MediConnect and care coordination as well as Beneficiary Toolkits.

Orange County

Ventana_Photo_1 - Copy12/13 – Ventana Affordable Senior Housing in Fullerton hosted a OneCare Connect Informational Forum and Resource Fair. Outreach coordinators delivered CCI presentations in both English and Korean, which covered plan benefits, enrollment, care coordination, authorizations, continuity of care, and how to become an authorized representative. A medical provider also addressed the audience and answered specific questions. Following the presentations, seniors had the opportunity to get other questions answered one-on-one and learn about other community resources from collaborating agencies during a resource fair.

Orange County

LHA_Photo.3(12.14.16) - Copy12/14 – State outreach coordinators gave a presentation to beneficiaries and staff about the CCI and OneCare Connect at Latino Health Access in Santa Ana. Participants learned about the program’s options, enrollment process, new benefits, care coordination, continuity of care, and the authorized representative process. Following the main presentation, presenters fielded questions about OneCare Connect’s benefits. Finally, collaborative partners shared pertinent Medicare and Medi-Cal information and answered participant questions.

Other Recent Outreach Events

 

Los Angeles County

  • 12/2 – Information table at Providence Gardens Senior Apartments’ Senior Health Fair in Long Beach
  • 12/9 – Tabling at the Homeless Care Days at MacArthur Park for beneficiaries who are experiencing homelessness in Los Angeles (English/Spanish)
  • 12/15 – Webinar for providers
  • 12/16 – Information table for beneficiaries, families and caregivers at the Southern California Women’s Health Conference and Expo in Pasadena (English/Spanish/Korean/Mandarin)
  • 12/17 – Information table for beneficiaries, families and caregivers at the Inspired Enrichment Community Development Center Community and Health Fair in South Los Angeles (English/Spanish)

Riverside and San Bernardino Counties

  • 12/20 – Webinar for advocates
  • 12/21 – Webinar for providers

Santa Clara County

  • 12/5 – Information table for seniors at the Vietnamese Family Support Group in San Jose
  • 12/6 – Information table for seniors at the Santee and McLaughlin Area Tenants Neighborhood meeting in San Jose

Coordinated Care Initiative 2017 Budget Update

Posted by on Jan 13, 2017 in NEWS | 8 comments

Governor released his 2017-18 budget proposal which continues Cal MediConnect and MLTSS.

 

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 CCI and making the necessary changes in order to make the Cal MediConnect program stronger.

When created, the Coordinated Care Initiative (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.

Other changes under the Budget include:

  • IHSS would no longer be included as a health plan benefit, but would continue to be available to eligible beneficiaries as a fee-for-service benefit, just as it was before implementation of the CCI
    • Funding changes implemented under the CCI would end, and funding for IHSS would no longer be included in the capitation rates for plans
    • Plans and counties would be encouraged to collaborate on care coordination
  • DHCS, in conjunction with the Department of Aging (CDA), is proposing to delay for two years the transition of the Multipurpose Senior Services Program from a fee-for-service benefit to a benefit fully supported under the managed care plans
  • Considering the budget proposal, the State does not plan to proceed with the Universal Assessment Tool. However, the State recognizes that a number of the proposed items developed through this process cover important topics that could be useful if addressed during the IHSS in-home assessment, and plans to assess if and how they may be leveraged by the IHSS program.

DHCS has been open about the challenges that have come with trying to integrate two very different health care systems in a way that provides improved and better coordinated care. We will continue to work closely with our plan, provider, and stakeholder communities as any changes to the program are rolled out.

To listen to a recording of the stakeholder call on 1-12-17 which discusses the budget announcement, click here.

New initiative to improve health outcomes and lower costs for Southern California nursing home residents announced by state, federal agencies

Posted by on Jan 5, 2017 in NEWS | 0 comments

Hospitalization can be dangerous and disruptive for nursing facility residents. Almost 45 percent of hospitalizations of nursing residents enrolled in both Medicare and Medi-Cal are potentially avoidable. Los Angeles and Orange Counties are among the highest-cost areas for nursing facility residents nationwide, driven by high rates of hospitalizations and subsequent stays in Medicare-paid skilled nursing facilities.

In 2017, the Centers for Medicare & Medicaid Services (CMS) and the California Department of Health Care Services (DHCS) will launch a new initiative to improve health outcomes and reduce costs for nursing facility residents in Los Angeles and Orange Counties. Through this initiative, health plans participating in the Cal MediConnect program, a capitated financial alignment model demonstration, will develop and implement interventions to reduce avoidable hospitalizations for nursing facility residents.

These quality improvement activities will be assessed annually. At the same time, CMS and DHCS will test new payment adjustments to better reflect typical costs of care for this population. Previously, payments to health plans underestimated Medicare spending, and Cal MediConnect plans served a disproportionately low number of nursing facility residents. These quality improvement activities and new payment adjustments amend the existing parameters for Cal MediConnect.

DHCS and CMS in 2014 began the Cal MediConnect demonstration, which tests a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience, along with access to new services. Under the demonstration, California and CMS contract with Medicare-Medicaid health plans to coordinate the delivery of and be accountable for Medicare- and Medi-Cal-covered services for participating Medicare-Medi-Cal enrollees.

Plans are responsible for providing a comprehensive assessment of enrollees’ medical, behavioral health, long-term care services, functional, and social needs. Enrollees and their caregivers work with an interdisciplinary care team to develop person-centered, individualized care plans. About 115,000 Californians are enrolled in Cal MediConnect.

For more information on Cal MediConnect, please visit https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/California.html or www.calduals.org.