healthy families program transition to medi-cal september 13, 2012
TRANSCRIPT
Healthy Families Program Transition to Medi-Cal
September 13, 2012
Update:
Network Adequacy
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Network Adequacy
• Requests for health and dental plan provider network data: Sent to plans August/early September
• Health and dental plan responses: Due September 14
• DMHC and DHCS joint review and evaluation of data
• Network adequacy assessment: Provide to Legislature 60 days prior to the start of Phase 1
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Update:
HFP Subscriber
General Notice
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Notices
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• HFP Notices: General Notice, 90-Day, 60-Day, 30-Day.
• Medi-Cal “Welcome” notice post-transition.• Stakeholder engagement for notices.• Will translate in the Medi-Cal threshold
languages.• Center for Health Literacy will review for
Reading Level.
Review Draft
Strategic Plan
Due: October 1, 2012
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Program Overview and Legislative Requirements
• Transfer HFP subscribers to Medi-Cal no sooner than January 1, 2013, over 4 phases
• Strategic Plan due October 1, 2012• Certify Phase 1 network adequacy November 1, 2012 • Submit Implementation Plans 60 days prior to start of
each phase• Monthly ongoing reporting commencing February 15,
2013
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Goals of Transition
•Facilitate a smooth transition •Minimize disruption in services •Maintain eligibility gateways •Ensure access to care •Ensure continuity of care
Program Overview and Legislative Requirements
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• Phase 1 (No sooner than January 1, 2013)
– Individuals enrolled in a Healthy Families Program health plan that is a Medi-Cal managed care health plan shall be enrolled in the same plan. Approximately 411,654 children will transition.
• Phase 2 (No sooner than April 1, 2013)
– Individuals enrolled in a Healthy Families Program health plan that is a subcontractor of a Medi-Cal managed health care plan, to the extent possible, shall be enrolled into a Medi-Cal managed care health care plan that includes the individuals’ current plan. Approximately 261,060 children will transition.
• Phase 3 (No sooner than August 1, 2013)
– Individuals enrolled in a Healthy Families Program plan that is not a Medi-Cal managed care plan and does not contract or subcontract with a Medi-Cal managed care plan shall be enrolled in a Medi-Cal managed care plan in that county. Enrollment shall include consideration of the individuals’ primary care providers. Approximately 152,602 children will transition.
• Phase 4 (No sooner than September 1, 2013)
– Individuals residing in a county that is not a Medi-Cal managed care county shall be provided services under the Medi-Cal fee-for-service delivery system. Approximately 42,753 children will transition.
Program Overview and Legislative Requirements
Summary of Phases
Key Activities for Phase 1 Planning
– Review and Analysis of Provider Network Review Data from Plans (health and dental)
– All County Welfare Director Letter Reviews with Stakeholders and Counties; Release of 2nd drafts
– DHCS IT, MCED, Counties, Consortia and MAXIMUS determine data transfer protocols
– Welcome Package review with stakeholders – State Plan/Waiver Amendment development and submission– Provide Strategic Plan to Legislature by October 1, 2012– Deliver Certification of Network Adequacy to the Legislature by
November 1, 2012
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• Committed to collaboration and coordination of transition
• Ensure transparency and public/stakeholder engagement in the process
• DHCS Managed Care, Eligibility, and Dental Division Stakeholder Meetings
• MRMIB Monthly Board Meetings, CAA Network, HFP Advisory Panel
• DMHC Quarterly Plan and Advocate Meetings
• Combined Webinars, Children’s Groups, and Small Stakeholder Groups
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Communication
Eligibility and Enrollment
• Outreach to Subscribers/Families– General Notice, and 90, 60, 30 Day Notices for Each
Phase– What We Tell Families Grid
• County Coordination– Eligibility Determinations– Eligibility Data Reports and Performance Standards
• MAXIMUS Coordination– Cost-Sharing: Premium Management and Co-Payments
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Health and Dental Plan Transition
• Health Plans– Network Adequacy– Continuity of Care
• Dental Plans and Fee-for-Service– Network Adequacy– Continuity of Care– Fee-for-Service Provider Enrollment
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Health and Dental Plan Transition
Performance Measures
•Health Plans– Child-Only HEDIS Measures– Ongoing Network Adequacy– Beneficiary Satisfaction Surveys
•Dental Plans and Fee-for-Service
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Health and Dental Plan Transition
DMHC Oversight• Pre- and Post-Transition Network
Adequacy Assessments
• Ongoing Fiscal Solvency Examinations, Medical Surveys, and Transition-Related Health Plan Filings
• DMHC Help Center
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Federal Approvals
• DHCS– Title XIX (Medi-Cal) State Plan Amendment– Medi-Cal 1115 Bridge to Reform Waiver
• MRMIB– Title XXI (HFP) State Plan Amendment
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Considerations for Input
• Is any additional content needed?
• Have all key areas been addressed?
• Are there any major omissions of information?
• What are suggested changes to the layout of the plan?
• What data elements should be included?
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Next Steps
• 5:00 PM, Thursday, September 20, 2012– Deadline to Submit Comments on Draft Strategic
Plan
• Upcoming Stakeholder Webinars– 2 – 4pm, Tuesday, October 23, 2012– 1 – 3pm, Friday, December 7, 2012
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Questions and Answers
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DHCS Information/Questions
DHCS Healthy Families [email protected]
http://www.dhcs.ca.gov/services/Pages/HealthyFamiliesTransition.aspx
MRMIB Information/Questions
http://mrmib.ca.gov/MRMIB/HFPTransition.html20
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