Coordinated US Initiative on Emissions Research Introduction and Goals
California’s Coordinated Care Initiative
description
Transcript of California’s Coordinated Care Initiative
California’s Coordinated Care InitiativeJuly 2014
2
Roadmap
• About the Coordinated Care Initiative• Cal MediConnect• Medi-Cal Managed Long Term Services and Supports
• Timeline and Enrollment
• Participating in Cal MediConnect
• Additional Resources
The Coordinated Care Initiative: Where
San Bernardino
Riverside
San Diego
AlamedaSan Mateo
Santa Clara
Los Angeles
Orange*
3*Participation in Orange County pending readiness reviews.
Medicare
• Doctors
• Hospitals
• Prescription drugs
Medi-Cal
4
Medicare and Medi-Cal Today
Who: 65+, under 65 with certain disabilities Who: low-income Californians
• Long-term services and supports• MSSP: Multipurpose Senior
Services Program • IHSS: In-Home Supportive
Services • CBAS: Community-Based Adult
Services • Nursing facilities
• Durable medical equipment
• Medicare cost sharing
Cal MediConnect
• Optional
• Combines Medicare and Medi-Cal benefits into one managed care health plan
• Additional services, including care coordination
Medi-Cal Managed Long-Term
Services and Supports (MLTSS)
5
The Coordinated Care Initiative: Two Parts
• Mandatory
• Beneficiaries will now receive Medi-Cal benefits through a managed care health plan, including LTSS and Medicare wrap-around.
Who: many full dual eligible beneficiaries
Who: Medi-Cal only beneficiaries, full dual eligibles who opt out of
Cal MediConnect, other identified groups eligible for Medi-Cal
6
Cal MediConnect
• Who: Medi-Medi beneficiaries
• Optional
• Original Medicare and Medi-Cal services
• One number for all your health care needs
• Vision benefit: one routine eye exam annually and a $100 co-pay for eye glasses/contacts every two years
• Transportation benefit: 30 1-way trips per year in addition to the existing transportation benefit
• Care Coordination
7
• Cal MediConnect plans will give providers information and resources to support care coordination.
• Health Risk Assessments (HRAs)• Primary, acute, LTSS, behavioral health and functional needs
• Interdisciplinary Care Teams • Beneficiary, plan care coordinator, key providers
• Individualized Care Plans• Care teams will develop and implement ICPs
• Plan Care Coordinators• Facilitates communication between plans, providers, beneficiary
Cal MediConnect Care Coordination
Care Coordination: Example
Patient X recently had a stroke and is back living at home.
8
Before Cal MediConnect, the patient would have to navigate Medicare, Medi-Cal and county agencies to get needed social services – often relying on their doctor’s office staff for help.
Under Cal MediConnect, a plan care coordinator will ensure the patient has: • Transportation to
appointments• Coverage for prescriptions• Meals on Wheels • Other support for activities
of daily living
9
You can combine your Medicare A, B & D with your Medi-Cal benefits into a Cal MediConnect plan
Select one of the participating
Cal MediConnect plans in your county
If you have Medicare and Medi-CalOption 1: Choose Cal MediConnect
10*Participation in Orange County pending readiness reviews.
Los Angeles• Care1st, CareMore, Health Net,
LA Care and Molina Health
Orange*• CalOptima
San Diego• Care 1st, Community Health
Group, Health Net and Molina Health
San Mateo• Health Plan of San Mateo
Alameda• Alameda Alliance and Anthem
Blue Cross
Santa Clara• Anthem Blue Cross and Santa
Clara Family Health Plan
San Bernardino• Inland Empire Health Plan and
Molina Health
Riverside• Inland Empire Health Plan and
Molina Health
Cal MediConnect Plan Options
11
People not eligible for Cal MediConnect
You can’t join Cal MediConnect if you:• Are younger than 21.
• Receive developmental disability waiver services from a Regional Center.
• Do not meet your Medi-Cal share of cost, if you have one.
• Have End-Stage Renal Disease (ESRD), except in San Mateo County.
• Have other health coverage, such as retirement, veterans or private coverage.
• Live in a veterans home.
• Receive services through one of the following waiver programs; Nursing Facility/Acute Hospital, HIV/AIDS, Assisted Living, or In Home Operations (you must disenroll from these programs to enroll in Cal MediConnect, you will not be passively enrolled).
• Are enrolled in PACE (you must disenroll to be eligible for the Cal MediConnect; will not be passively enrolled).
• Live in some rural zip codes in Los Angeles, Riverside and San Bernardino Counties.
12
Medi-Cal Managed Long-Term
Services and Supports
• Who: Medi-Cal only beneficiaries, full dual eligibles who opt out of Cal MediConnect, other identified groups eligible for Medi-Cal
• Mandatory
• Same Medi-Cal services beneficiaries currently receive• Hearing aids
• Bathrooms aids (grab bars, shower chairs)
• Non-emergency medical transportation (wheelchair vans and litter vans)
• Incontinence supplies
• Medi-Cal long-term services and supports (MLTSS) will now be coordinated by a managed care plan• MSSP: Multipurpose Senior Services
Program
• IHSS: In-Home Supportive Services
• CBAS: Community-Based Adult Services
• Nursing facilities
13
• Your Medicare including your Part D plan, will stay the same
• You will continue to use the same Medicare providers
• Your Medi-Cal benefits are now assigned to the Medi-Cal health plan
If you have Medicare and Medi-CalOption 2: Keep your Medicare as it is and join a Medi-
Cal health plan
Enroll in only a Medi-Cal Plan
Select one of the participating
Medi-Cal plans in your county
14
If you have only Medi-CalYou must choose a Medi-Cal plan for your Medi-Cal
benefits
Enroll in a Medi-Cal Plan
Select one of the participating
Medi-Cal plans in your county
15*Participation in Orange County pending readiness reviews.
Los Angeles• Health Net (Molina), LA Care
(Anthem, Care 1st, Kaiser)
Orange*• CalOptima
San Diego• Care 1st, Community Health
Group, Health Net, Molina, and Kaiser
San Mateo• Health Plan of San Mateo
Alameda• Alameda Alliance and Anthem
Blue Cross
Santa Clara• Anthem Blue Cross and Santa
Clara Family Health Plan
San Bernardino• Inland Empire Health Plan
(Kaiser) and Molina (Health Net)
Riverside• Inland Empire Health Plan
(Kaiser) and Molina (Health Net)
MLTSS Plan Options
16
PACE Program of All-inclusive
Care for the Elderly
• Who: Medi-Medi beneficiaries and Medi-Cal beneficiaries
• Option available to those who are determined eligible
If you:
• Are 55 or older
• Live in your home or community setting
safely
• Need a high level of care for a disability
or chronic condition
• Live in a ZIP code served by a PACE
health plan
You may be eligible to enroll in a PACE program
17
PACE PlansLos Angeles• Altamed Senior
BuenaCare and Brandman Centers for Senior Care
Orange*• CalOptima PACE
San Diego• St. Paul’s PACE
Alameda• Center for Elders’
Independence and On Lok Lifeways
Santa Clara• On Lok Lifeways
San Bernardino• InnovAge PACE
Riverside• InnovAge PACE
When to Expect Notices
• Beneficiaries will receive notices 90, 60, and 30 days prior to your coverage date.
• For most people their coverage date is the first day of their birth month.
• Cal MediConnect official information from the state will only arrive in blue envelopes.
18
General Timeline• April 2014 Enrollment in San Mateo
• May 2014 Enrollment in San Diego, Riverside, and San Bernardino begins
• July 2014 Enrollment in Los Angeles begins*
• January 2015 Enrollment in Alameda, Santa Clara, and Orange begins*
19*Enrollment in Orange County and select Los Angeles plans pending readiness reviews.
20
Timeline SpecificsIndividuals who receive passive enrollment notices:
• Already in Managed Medi-Cal – enroll/benefit added in 1 month
• Not in Managed Medi-Cal – enroll by birth month
• In CCI-health plan DSNPs – enroll in one month in January
21
Timeline SpecificsIndividuals who are eligible for Cal MediConnect but WILL NOT receive passive enrollment notices:
• Enrolled in non-CCI plan DSNP
• Enrolled in Medicare Advantage
• Enrolled in VA, waiver system, etc.
These populations will be asked to selected a Managed Medi-Cal (MLTSS) plan.
22
Blue Envelope
23
Cal MediConnect Notices
24
90 Day Notice 60 Day Notice 30 Day Notice
MLTSS
25
90 Day Notice 60 Day Notice 30 Day Notice
Choice FormSection 3: Cal MediConnect
PlanTo select a Cal MediConnect plan, complete section 3 ONLY.
Section 5: Medi-Cal PlanTo “Opt-Out” of Cal MediConnect, fill out section 5 ONLY. Choose the Medi-Cal plan you are already in or select the Medi-Cal plan you want to join.
Section 7: PACE PlansTo select a PACE plan complete section 7 AND also complete section 3 OR 5 as back-up options.
26
Use the Choice Form to Choose the Plan you Want
• If you have both Medicare and Medi-Cal and you do nothing:• You will be assigned to a Cal MediConnect plan
that is the best match for you.
• If you have only Medi-cal and you do nothing:• You will be assigned to a Medi-Cal plan that is the
best match for you.
• This way you will not lose your Medicare or Medi-Cal benefits or services.
27
Enrollment: Health Care Options
28
Call Health Care Options to: • Enroll in a Cal MediConnect plan, or• Enroll in a Medi-Cal plan (and keep your
Medicare as it is today), or• Enroll in a PACE plan
1-844-580-7272
Enrollment
29
• The use of independent agents/brokers will not be permitted and all MMP enrollment transactions must be processed by the State enrollment broker (Health Care Options).
• If an individual is cross walked into a Cal MediConnect plan in some cases the broker may still receive payment from the health plan.
www.calduals.org
30
Additional Resources
• Health Insurance Counseling and Advocacy Program (HICAP)• Call HICAP for free unbiased counseling
• Email [email protected]• Twitter @CalDuals
31