Long Term Care Integration Project (LTCIP)

For more information phone 858-495-5853 or send us an email.

  

- ANNOUNCEMENTS - 

 Next LTCIP meeting will be on Friday, September 12, 2014

 

IMPORTANT UPDATE | COORDINATED CARE INITIATIVE (CCI) 7/2014

The DSNP Policy Proposal has been passed.  The ALL PLAN LETTER 14-007 dated June 26, 2014 provides guidance relating to requirements that Dual-Eligible Special Needs Plans (D-SNPs) have with the State under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), as amended by the Affordable Care Act of 2010.  This guidance covers MIPPA-compliant contracts to D-SNPs and Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) for 2015 and for the duration of the Duals Demonstration project, Cal MediConnect.  To read the policy click here.

COORDINATED CARE INITIATIVE (CCI) 6/2014

MSSP beneficiaries slated for CCI enrollment in August 2014 did not receive enrollment notices in May and June.  The Department of Health Care Services reports that it has delayed MSSP enrollment until October 1 to properly provide notice to MSSP beneficiaries.  The revised San Diego County enrollment timeline can be found here.

COORDINATED CARE INITIATIVE (CCI) 4/2014 

The Department of Health Care Services has created a Cal MediConnect Enrollment dashboard that will be updated every month. The Dashboard presents Cal MediConnect Enrollment data on a county by county basis covering multiple aspects of the enrollment process such as the number of current enrollees, number of opt-outs, projected enrollment numbers, notice mailing schedule and the State's Health Care Options call center statistics.  April's Cal MediConnect Dashboard can be found here.  For future Cal MediConnect Enrollment Dashboard reports please look in the CCI/Cal MediConnect ToolKit.

On March 25th, 2014, the Department of Health Care Service (DHCS) announced a change to its Coordinated Care Initiative (CCI) enrollment timeline and strategy in order to continue to move forward to provide high quality, coordinated care to beneficiaries eligible for Medicare and Medi-Cal.  DHCS has adjusted the enrollment dates for subpopulations in order to increase consumer clarity, prevent the need for multiple transitions in a single year, ensure sufficient time for noticing of fee-for-service (FFS) populations, and ensuring plan readiness. 

Cal MediConnect Ombudsman Program

Cal MediConnect participants can ask questions and resolve problems regarding their health care through the Cal MediConnect Ombudsman Program.  Housed within the Department of Managed Health Care (DMHC) and initiated with help from the Department of Health Care Services (DHCS), the Ombudsman service will be performed by an independent, third party firm, the Legal Aid Society of San Diego.  The Legal Aid Society of San Diego, and a number of experienced subcontractors throughout the demonstration counties, will be available to provide ombudsman services to Cal MediConnect beneficiaries allowing for more objective analysis and observation.

The Cal MediConnect ombudsman program is designed to:

  • assist enrollees filing appeals and complaints where needed
  • investigate, negotiate and resolve enrollee problems/complains with Cal MediConnect plans
  • refer enrollees to relevant entities and programs as needed

The ombudsman will offer independent, local, person-centered, and linguistically and culturally competent assistance with Cal MediConnect issues.  For help with navigating Cal MediConnect please call (855) 501-3077 (TTY 1-855-874-7914). Hours of Operation: Monday through Friday, 9 a.m. to 5 p.m. and you can visit their website at www.healthconsumer.org.

CCI Population Estimate for San Diego County (2/2014)

New population estimates were published in a Background Paper for the Senate Budget & Senate Health Oversight Hearing on Coordinated Care Initiative.  To read the full report click here.

  • San Diego County Dual Eligible Population - 55,798
  • San Diego County Eligible Medi-Cal-Only Enrollees into Medi-Cal Managed Care - 64,000
  • Total CCI Population in San Diego County - 119,798

Beneficiary Notification Process

Those who need to select a new plan, will receive three different notices, sent 90, 60 and 30 days ahead of their enrollment date.  This is the same for beneficiaries eligible for Cal MediConnect and beneficiaries in Medi-Cal fee-for-service who need to choose a managed care plan for their long-term services and supports (MLTSS).  Those beneficiaries who are NOT eligible for Cal MediConnect and who are already enrolled in a Medi-Cal managed care plan will now receive one 30 day notice, instead of a 45 day notice, prior to the change in their benefit package.  For the latest status of the CCI Enrollment Notices please click here.

Cal MediConnect: 

  • 90, 60 and 30 day notices  
  • The 60 day notice, an enrollee will receive a Guidebook and choice form

MLTSS beneficiaries NOT in a Medi-Cal Managed Care Plan: 

  • 90, 60 and 30 day notices

MLTSS beneficiaries currently in a Medi-Cal Managed Care Plan: 

  • 30 days prior to the change in benefit package

Please note: All notices from the State will be in BLUE envelopes (example)

Want to learn more about the Long Term Care Integration Project?

For more information about LTCIP please contact Brenda Schmitthenner, the Manager of the LTCIP, at (858)495-5853 or at brenda.schmitthenner@sdcounty.ca.gov.