« The Dual Agenda: November 5, 2014 Issue

State Highlights

California

The advocacy efforts of the National Senior Citizens Law Center (NSCLC) and other advocates led to the release of revised guidance by the California Department of Health Care Services (DHCS) that will strengthen the critical consumer protections around continuity of care in the Cal-MediConnect demonstration.

In other news, the California Department of Health Care Services (DHCS) posted a new fact sheet of Frequently Asked Questions about the January 2015 enrollment.

Massachusetts

MassHealth, the state’s Medicaid program, released the October One Care enrollment report. As of October 1, the total number of enrollees is 17,465. The total number that has opted out is 25,840. The state will be sharing more information on implementation at its open meeting on November 6.

Michigan

On October 29, the Medicare-Medicaid Coordination Office posted the Michigan three-way contract.

New York

On October 29, the Medicare-Medicaid Coordination Office posted the New York three-way contract.

Ohio

A new blog post by UHCAN Ohio, a lead organization in the Ohio Consumer Voices for Integrated Care coalition, delivers its recommendations to the state to get MyCare Ohio on track to success. Key recommendations include:

• Speed up the processing time for enrollees switching plans and notify the past and current plan of the changes so that the enrollee does not experience a gap in services
• Expand enrollee assistance capacity in order to help enrollees navigate the new system
• Provide additional funding to the Aging and Disabilities Resource Network (ADRN) to help with options counseling
• Work with the plans and develop an Outreach Strategy for current and potential MyCare Ohio providers to avoid provider confusion and mass provider opt-outs
• Provide monthly reports to advocates on problems and complaints received
• Develop mechanisms to involve enrollees and their families in policy discussions at the plan and state level
• Ensure that  MCOs understand the importance of social, as well as medical, services in the success of MyCare and provide clear guidance regarding such things as timely authorization of such services
• Work more closely with the MCOs and oversee their understanding and openness to using the consumer-directed model when appropriate
• Work with CMS on expanding and refining the evaluation process in order to assess the initial and ongoing implementation process in Ohio and make necessary changes to either the three-way contracts or state policy and procedures to assure that the addition of the opt-out provision for Medicare does not encounter difficulties affecting consumer access to quality care, and to determine whether continuation or expansion of the demonstration would result in improved member outcomes and access to needed care

South Carolina

On October 16, the Medicare-Medicaid Coordination Office posted the South Carolina three-way contract.

Virginia

On October 27, the Medicare-Medicaid Coordination Office posted information for providers on Virginia’s Commonwealth Coordinated Care (CCC) continuity of care provisions.