Coordinated Care Initiative Cal MediConnect

COORDINATED CARE INITIATIVE (CCI) 9/25/14

On September 10, 2014, the Department of Health Care Services released an All Plan Letter (APL) 14-0010 related to Care Coordination Requirements for Managed Long-Term Services and Supports. This APL clarifies care coordination requirements for Managed Long-Term Services and Supports for Medi-Cal managed care health plans participating in CCI. On September 15, 2014, DHCS hosted a stakeholder webinar focused on continuity of care. For more recent DHCS activities related to CCI, please visit the Cal Duals website: http://www.calduals.org.

COORDINATED CARE INITIATIVE (CCI) 7/20/14

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 offers 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.

The Coordinated Care Initiative Advisory Committee

The Coordinated Care Initiative Advisory Committee was established by the managed care health plans participating in the Coordinated Care Initiative in May 2012. The purpose of this committee is to provide recommendations to the managed care health plans about program operations, benefits, access to services, adequacy of grievance processes, and consumer protections. The Advisory Committee provides input to the health plans in the development, implementation and continued operation of the demonstration in San Diego County.  To view meeting agendas and approved minutes please click on the links listed below.

For the most current information about the Coordinated Care Initiative and Cal MediConnect, please go to the Cal Duals website: www.CalDuals.org.  Also, please visit our CCI/Cal MediConnect Virtual Resource Toolkit below which houses a wealth of information about CCI and Cal MediConnect including San Diego County's CCI Advisory Committee meeting agendas and minutes as well as specific information about CCI in San Diego County. 

CCI/Cal MediConnect Virtual Resource ToolKit Description

The resources included in this ToolKit are meant to provide information about California’s Coordinated Care Initiative (CCI).  PLEASE NOTE the ToolKit contains some important historical documents.  Therefore, we have ensured that all materials indicate the date, whether on the document itself or noted next to the link, in which it was published.  

 

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