Cal MediConnect

Care Coordination Initiative and the Duals Demonstration

CAPG and HASC Contracting Committee MeetingOctober 3, 2013

Martha SmithChief Dual Program Officer

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Implementation: Network Strategy

• Organized Care Delivery System – Built off Medi-Cal Managed Care & Medicare Dual Eligible Special Needs

Plan (D-SNP) Model for traditional medical services– Behavioral Health integration with MHN and Department of Mental Health.

• Long-Term Services & Supports (LTSS) provider network– including Long-Term Care facilities, Multi-Purpose Senior Services Programs

(MSSP), Community Based Adult Services (CBAS), In Home Supportive Services (IHSS) and other community based organizations

– intended to mirror current system (at least initially).

• Plans have to meet State and Federal requirements for Readiness Reviews – Network capacity – increases to network will be required– Geo-access – services available where Duals beneficiaries live– Timeliness – Cultural and Linguistic– Accessibility (PARS vs FSR)

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Implementation: Network Strategy (continued)

• Contracting with Medical Groups and Hospitals

–Initial contract documents/amendments, inclusive of participation requirements

HRA/IHA requirements Specific requirements for encounter reporting Specific requirements for quality measures reporting (STARs-like) Risk sharing related to LTSS

–Similar contract methodology as Medicare Advantage Collection of member level coding data will be critical Professional and Institutional Capitation (dual risk) Delegation for D-SNP Model of Care

–Minimally compliant network contracted and submitted in June The final network composition will be dependent on finalizing adequate rates with the

State and CMS

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Implementation: Development and Communication Activities

•Communications– FAQs have been posted publicly– Educational presentations targeted toward non-contracted providers,

often through hospital medical staff forums– Interested providers that may not be in the network are being referred

to local medical groups/IPA’s for anchoring purposes with these contracted organizations.

• Training– Provider training curriculums are being developed, specific to the

Demonstration with emphasis on LTSS to be used after contracts are executed.

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For More Information

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