July 22, 2014 Coordinated Care Initiative (CCI): What to Expect & How to Prepare Amber Cutler, Staff Attorney National Senior Citizens Law Center www.NSCLC.org 1 The National Senior Citizens Law Center is a non-profit organization whose principal mission is to protect the rights of low-income older adults. Through advocacy, litigation, and the education and counseling of local advocates, we seek to ensure the health and economic security of those with limited income and resources, and access to the courts for all. For more information, visit our Web site at www.NSCLC.org. Glossary • Coordinated Care Initiative (CCI) – Cal MediConnect • • • • Dual Eligible (Dual) Duals-Special Needs Plan (D-SNP) Fee-for-Service (FFS) Long Term Support and Services (LTSS) – In-Home Supportive Services (IHSS), Community Based Adult Services (CBAS), Multipurpose Senior Services Program (MSSP), Nursing Facility • Medi-Cal Managed Care • Program of All-Inclusive Care for the Elderly (PACE) • Seniors and Persons with Disabilities (SPDs) 3 CCI = three big changes CCI Change Description Mandatory Medi-Cal Managed Care Duals and previously excluded SPDs must in enroll in Medi-Cal Managed Care LTSS Integration LTSS added to Medi-Cal Managed Care plan benefit package Medicare Integration (Cal MediConnect) For duals, integration of Medicare and Medi-Cal benefits into one managed care plan. 4 The current Medi-Cal, LTSS, and Medicare delivery systems are different What Current System Medi-Cal (medical services) Medi-Cal (LTSS services) Medicare OR OR FFS Managed care FFS Managed care FFS (default) *Behavioral Health 5 CCI moves services into managed care What New System Medi-Cal (medical services) Medi-Cal (LTSS services) Medicare Managed Care *Behavioral Health 6 Managed Care: Plans paid to provide covered services via network providers What Senior/Person with Disability $$ Health Plan Provider Provider DHCS & Medicare Provider $$ DHCS & Medicare 7 CCI impacts duals & seniors and persons with disabilities with Medi-Cal Medi-Cal and Medicare (Dual Eligibles) Impacted Medi-Cal only (SPDs) Not Impacted Medicare Only 8 Medi-Cal managed care is mandatory Even if a Dual Opts Out of Cal MediConnect, must still enroll in Medi-Cal MC Medi-Cal Only Duals Medi-Cal Managed Care 9 Medi-Cal Managed Care Medical Medi-Cal MANAGED CARE LTSS 10 LTSS and Managed Care CBAS IHSS MANAGED CARE MSSP Nursing Facility 11 Cal MediConnect Benefits Required Benefits Required Benefits • Medicare A, B, D • Medi-Cal services including • LTSS: IHSS, CBAS, SNF, MSSP • Vision • One routine eye exam annually; $100 towards eye glasses/contacts every two years • Transportation • 30 1-way trips per year • Care Coordination 12 Cal MediConnect Benefits Care Coordination Care Coordination • Person-centered • Focus on least restrictive setting • Health Risk Assessment • Individualized Care Plan • Interdisciplinary Care Team Available at:http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/DPL2013/DPL13004.pdf 13 Cal MediConnect Benefits Care Plan Option Services CPO Services • HCBS-like supports and services • Discretionary • In addition to, not in lieu of required benefits • Assessed during Health Risk Assessment (HRA) • Plan appeal process Available at: www.calduals.org; Summary available at: http://dualsdemoadvocacy.org/california CPO All Plan Letter: http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/DPL2013/DPL13-006.pdf 14 Cal MediConnect Benefits Carved Out Benefits Carved Out Benefits • County Administered and Financed • Specialty Medi-Cal Mental Health Benefits • Examples: intensive day treatment, portion of inpatient psychiatric services not covered by Medicare, day rehab, crisis intervention , adult residential treatment services • Medi-Cal Drug Benefits • Examples: Methadone therapy, day care rehab, naltrexone for narcotic dependence • Dental Benefits 15 How to Prepare • Get Everyone to the Table Early and Often – Health Plans, County DMH, LTSS Providers (NURSING FACILITIES), Ancillary Service Providers, Community Based Providers (Independent Living Centers, Alzheimer’s Association, Meals on Wheels, Homeless Advocacy Groups), Medical Providers (PCPs, Specialists, Hospitals, Clinics), Legal Advocates, HICAP, AAA, Senior Centers, Regional Centers, etc. • Create Subcommittees – Communications, Behavioral Health, LTSS 16 Learn from Other Counties • San Diego – integration • Alameda – collaborative and created great resources • Los Angeles – creative outreach • Santa Clara – HICAP outreach efforts • San Francisco – LTCI Strategic Plan 17 Want to know more? • DREDF • NSCLC Duals Website - www.dredf.org – Advocate’s Guide – News – Sign up for alerts http://dualsdemoadvocacy.org/ • Contact us: – Denny Chan – dchan@nsclc.org • Department of Healthcare Services – Amber Cutler – acutler@nsclc.org - www.calduals.org 18