CHA News Article

DHCS Announces Coordinated Care Initiative Program Changes
Shares additional materials for stakeholder comment

The Department of Health Care Services (DHCS) has announced updates to the Coordinated Care Initiative (CCI) and has released materials for stakeholder comment. Comments may be submitted to info@calduals.org by May 20. DHCS had originally proposed that CCI beneficiaries who became eligible prior to January 2016 — but had never before received a passive enrollment notice — would be notified about Cal MediConnect beginning in June 2016, and passively enrolled in Cal MediConnect in September and October of 2016; beneficiaries who became eligible beginning in January 2016 would be passively enrolled in 2017. DHCS now intends to move forward with a voluntary “opt-in” enrollment effort and announced that, if voluntary enrollment does not prove to be a viable option for sustainable enrollment in the program, passive enrollment remains an option in future years.

DHCS also announced it will implement its streamlined enrollment proposal, allowing Cal MediConnect health plans to collect the required information from beneficiaries and directly submit enrollment requests to the state’s enrollment broker, Health Care Options (HCO), for processing. Plans would submit enrollment requests to HCO on a daily basis for processing, and HCO would process the request after ensuring the beneficiary is eligible for Cal MediConnect. Once the enrollment request is processed, HCO would send a regular confirmation notice to the beneficiary, as it does today when a beneficiary makes an enrollment choice. In addition, HCO would follow up with the beneficiary by phone to confirm that the enrollment choice was processed.

DHCS believes this process will allow health plans to facilitate a better customer service experience for beneficiaries and simultaneously make the enrollment process more efficient. Streamlined enrollment is scheduled to begin July 2016. Prior to the start of streamlined enrollment, DHCS will engage plans to ensure smooth implementation and beneficiary protections. As part of streamlined enrollment, both HCO and the plan will reach out to the beneficiary to confirm the choice. The HCO call script is available here for stakeholder comment.

DHCS’ voluntary opt-in enrollment effort will include ongoing mandatory enrollment of beneficiaries who are eligible for Medicaid managed long-term services and supports (MLTSS) into MLTSS health plans. Cal MediConnect-eligible beneficiaries will receive a 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 August 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 continues to explore other voluntary opt-in strategies in partnership with the Centers for Medicare & Medicaid Services, health plans and other stakeholders. In addition, DHCS announced it will use detailed analysis of beneficiaries who have opted out of the CCI program to more effectively focus provider education and outreach activities.

Lastly, DHCS will implement several proposed activities focused on strengthening MLTSS referrals and improving care coordination. These proposals include:

  • Extending the continuity of care period for Medicare services from six to 12 months to match the Medi-Cal continuity of care period, and modifying 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.
  • Standardizing the health risk assessment (HRA) referral questions for the Multipurpose Senior Services program (MSSP), the In-Home Supportive Services program (IHSS), and community-based adult services (CBAS) to reflect the best practices developed over the early years of the program, and expanding data collection and reporting on interdisciplinary care team and individualized care plan completions as well as CBAS, MSSP and IHSS referrals. Draft standardized HRA referral questions are available on the DHCS website for stakeholder comment. DHCS has requested stakeholder input by May 20 and will share final questions with stakeholders shortly thereafter. Draft revised data measures will be shared for stakeholder comment later this month.
  • 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.
  • 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.

More information about Cal MediConnect is available at www.calduals.org.

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