Recording

Coordinated Care Initiative: Dual Eligibles Demonstration DVD
Strategic and operational considerations for hospitals

Webinar Recorded Live April 23, 2013
Program Rated 4.35 out of 5 by participants

Overview

The long-awaited Coordinated Care Initiative (CCI) Memorandum of Understanding (MOU) between CMS and DHCS was released on March 27.  The MOU signals the launch of “Cal MediConnect,” a three-year demonstration which will include eight of California’s most populated and complex counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara.

All dual eligible beneficiaries and the providers who serve them will be impacted by the CCI. Two major components of the CCI include: the integration of long-term care services and supports into managed Medi-Cal, and the transition of 456,000 dually-eligible individuals into managed Medicare. The MOU also sets in place a three-way partnership for contracting between CMS, DHCS and selected managed care plans.

Implementation of CCI will require major operational changes for hospitals. Providers need to understand and prepare now for this major new initiative which begins Oct. 1, 2013. This webinar provideS opportunities to review and discuss issues contained in CHA’s Coordinated Care Initiative white paper.

Find out what you need to know to make your best decisions moving forward.

Agenda

Overview of the CCI demonstration

  • Intent of the CCI — savings, care coordination
  • National and state impact of duals’ care

Key features of the Initiative

  • Counties covered and exclusions, potential expansion
  • Beneficiary profile — who will be impacted and how

Timelines — what needs to be done, and by when

  • Beneficiary enrollment, default enrollments, excluded duals
  • Plan and provider contracts — negotiations, readiness review

Implications for hospitals

  • Contracting — network adequacy, provider payment rules, obligations 
  • Impact on utilization, reimbursement, payment rates
  • Physician alignment concerns
  • Case management — care authorization, utilization review, discharge planning
  • Care coordination and transitions going forward
  • Valuing the continuum of care — making the case for services
  • Behavioral health — coverage and payment, coordination with county services

Recommended for:

Chief executives, operating and financial officers, financial services directors and revenue cycle managers.

Faculty

Lloyd A. Bookman is a founding partner in the Los Angeles law office of Hooper, Lundy & Bookman, PC (HLB). He has specialized in Medicare and Medicaid reimbursement and compliance since 1979. Mr. Bookman also represents health care providers in fraud and abuse matters involving false claims and anti-kickback issues, in self-referral matters — serving as counsel in civil and administrative litigation and investigations — and as special counsel in criminal matters.

Felicia Sze is senior counsel with HLB in their San Francisco offices. Her practice focuses on Medi-Cal, Medicare and managed care reimbursement and regulatory compliance for health care providers. She has defended health care providers in False Claims Act cases and in class action unfair business practice lawsuits brought by patients. Ms. Sze has also represented providers in challenges to Medi-Cal rate reductions and in the defense of quality assurance fees.

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