« The Dual Agenda: April 15, 2015 Issue
State Highlights
California
The California Department of Health Care Services (DHCS) released a Duals Plan Letter to clarify primary care provider assignments and continuity of care requirements for plans with delegated provider entities in the Cal MediConnect program. The letter outlines several scenarios affecting continuity of care:
- If the beneficiary has an existing relationship with a primary care provider (PCP) who is in the plan's network, the plan is required to assign the beneficiary to that PCP, unless the beneficiary chooses a different PCP.
- If the plan contracts with delegated entities, the plan is required to assign the beneficiary to a delegated entity that has the beneficiary's preferred PCP in its network.
- If the beneficiary has an existing relationship with a doctor who is in the plan's network, and the beneficiary wishes to continue to see that doctor, the plan must allow the beneficiary to do so for the continuity of care period.
In other news, DHCS officials met with the leadership of Health Care Options (HCO) to respond to recent stakeholder concerns and share feedback improve the beneficiary experience. HCO is the branch of DHCS that provides beneficiaries with resources to make informed choices about Medi-Cal benefits, including providing outreach and education about Social Service and Community-Based Organization locations. DHCS has worked with HCO managers to implement a more rigorous training process for new customer service representatives. Daily and weekly reports are shared with DHCS and HCO leadership to ensure customer issues are effectively monitored and addressed promptly.
Massachusetts
On April 1, The Disability Advocates Advancing our Healthcare Rights (DAAHR) coalition hosted a meeting on Accountable Care Organizations (ACOs) within MassHealth, the state’s Medicaid program. The meeting was attended by Executive Office of Health and Human Services (EOHHS) Assistant Secretary for MassHealth, Daniel Tsai,tt and a roomful of consumers and advocates. Key takeaways from the meeting were:
- ACOs may soon have contracts to manage both medical care and Long-Term Services and Supports for all people on MassHealth.
- Consumers and advocates need to encourage MassHealth to require these new ACOs to make major monetary investments in existing community-based services.
- There needs to be flexibility in how healthcare dollars are spent. This includes integrating support for housing, heating subsidies, Personal Care Attendant (PCA) services, certified peer specialist services, gym memberships, clothing and other ancillary services that promote health maintenance.
New York
The New York Department of Health recently posted two Frequently Asked Questions web pages, one related to the transition of nursing home populations and the other on the Conflict-Free Evaluation and Enrollment Center (CFEEC). The CFEEC was created to be the single entity responsible for conducting independent enrollee evaluations to assist in the care planning process for the Fully Integrated Duals Advantage (FIDA) program, those seeking Community Based Long-Term Care (CBLTC), as well as for those in the Managed Long-Term Care (MLTC) program. The timeline for implementation of the CFEEC is outlined here.
Ohio
The Ohio Consumer Voice for Integrated Care (OCVIC) coalition, led by UHCAN Ohio, has launched a newsletter for geriatric providers advocating better care for MyCare Ohio patients. The newsletter is intended to include news, information and advocacy opportunities to assist provider efforts to improve care for patients who are enrolled in MyCare Ohio.
Ohio is one of five states working to leverage the expertise of providers from within the geriatrics and gerontology fields into the work of the Voices for Better Health project.
Rhode Island
The Rhode Island Voices for Better Health partners are playing a key role in the Reinventing Medicaid Working Group announced by Governor Gina Raimondo in late February, including presenting testimony at public meetings. The goals of the workgroup are to: (1) improve quality, affordability, and efficiency (2) eliminate waste, fraud and abuse (3) and make Rhode Island a leader in innovation.
In other news, the Long Term Care Coordinating Council presented enrollment updates on the Integrated Care Initiative (ICI) at its meeting on April 8. As of April 1, 21,333 individuals were enrolled in the ICI. Of those, 17,470 are enrolled in Rhody Health Options and 3,863 in Connect Care Choice Community Partners. Rhode Island is pursuing its ICI in two waves. The first focuses on managing Medicaid long-term services and supports (LTSS) and improving the coordination of primary care, behavioral health services and home and community-based services. Phase One services are available for dually eligible beneficiaries, as well as Medicaid beneficiaries receiving LTSS. The second phase will be focused on moving to full integration of Medicaid and Medicare services for dually eligible beneficiaries pursuant to an approved demonstration project with the Centers for Medicare and Medicaid Services.
Virginia
The Virginia Department of Medical Assistance Services (DMAS) recently shared key stakeholder updates:
- DMAS updated its enrollment dashboard for the Commonwealth Coordinated Care (CCC) program, the state’s dual eligible demonstration project. As of March 10, 27,765 individuals are enrolled in the program and 25,995 have opted out.
- DMAS and the Centers for Medicare and Medicaid Services (CMS) have completed a review of Medicare Medicaid Plan networks and health plans that have been approved to offer CCC services in several additional localities. Additional network approvals mean the CCC program will move forward with automatic assignment in these new localities. Eligible beneficiaries received their automatic assignment letters April 1 and their coverage will begin effective June 1.
- DMAS shared an evaluation update that includes findings from focus groups hosted in 2014 and a review of CCC’s care coordination observations, particularly focused on the health risk assessment (HRA) and interdisciplinary care team (ICT)
- There were five broad themes that emerged from the focus groups:
- Learning about the CCC through a confusing landscape
- Providers and family members influencing enrollment decisions
- Promoting the CCC to better meet needs of LTSS beneficiaries
- LTSS beneficiaries recognizing CCC value
- Engaging in more person-centered service delivery
- There were five broad themes that emerged from the focus groups:
- A few takeaways from the care coordination review are:
- During the HRA for those in the community well category, it was observed that the care coordinator and provider staff conducted team assessments during follow-up appointments, engaged enrollees in dialogue about preventive care and educating about health/social services
- The ICT for those in the community well category found that the care coordinator, care manager, & social Worker worked with enrollee to resolve housing issue, exchanged information with enrollee on health/social services and care plan.