DHCS suspends planned passive enrollment for duals project The Department of Health Care Services (DHCS) announced last week that it would not move forward with its planned annual passive enrollment of dual eligible beneficiaries under the Coordinated Care Initiative (CCI) after it received feedback from the California Medical Association (CMA) and 40 other stakeholders asking the agency to pursue enrollment strategies that support voluntary "opt-in" enrollment. Instead, DHCS said it will implement a voluntary "opt-in" enrollment effort beginning in July 2016. The new streamlined enrollment strategy will include mandatory Managed Medi-Cal Long-Term Supports and Services (MLTSS) plan enrollment. ... June 8, 2016 Managed Care, Medi-Cal, Medicare Medi-Cal, Medicare, Cal-MediConnect, Department of Health Care Services, Dual Eligible 0 0 Comment Read More »
CMA opposes proposed changes to duals demonstration The Department of Health Care Services (DHCS) recently released a series of proposals that would change the Coordinated Care Initiative (CCI) enrollment process to 1) passively enroll beneficiaries into Cal MediConnect; and to 2) streamline enrollment by allowing plans to eliminate or dramatically reduce the role of the enrollment broker. The California Medical Association (CMA), in partnership with Justice in Aging and other patient advocacy groups, signed a joint letter strongly opposing the proposals. The Coordinated Care Initiative was authorized by the state in July 2012 in an effort to save ... April 28, 2016 General, Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, DHCS, Regulatory Advocacy 0 0 Comment Read More »
CMA publishes duals project FAQ The 2012 California state budget authorized a three-year demonstration project that transitions dual eligibles into managed care and allows them to receive medical, behavioral, long-term supports and services and home-and-community-based services coordinated through a single health plan. The Cal MediConnect project was approved in 8 counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. No more than 456,000 individuals will be allowed to enroll into Cal MediConnect. Los Angeles’ enrollment will be capped at 200,000. To help physicians and their patients better understand the program, ... October 21, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
DHCS releases duals project toolkit The California Department of Health Care Services (DHCS) has published a physician toolkit to help providers and their patients understand the Cal MediConnect duals demonstration project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups, including the California Medical Association. The toolkit contains several documents, including an overview and several fact sheets that include information on the following: How to submit crossover claims to Medi-Cal plans Contracting with Cal MediConnect plans How crossover claims ... October 6, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
DHCS announces new continuity of care rules for duals demonstration project The California Department of Health Care Services (DHCS) recently announced new continuity of care rules for the Cal MediConnect duals demonstration project. The project – an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities – transitions a large portion of the state's dual eligible beneficiaries to managed care plans. Although the program already had continuity of care provisions, the new rules make it easier for a patient to continue receiving needed care from out-of-network physicians without interruption. The new continuity of care ... September 19, 2014 Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Cal MedConnect, Dual Eligible 0 0 Comment Read More »
DHCS revises Cal MediConnect 'Choice Forms' After advocacy from the California Medical Association (CMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MediConnect duals demonstration project and remain in traditional Medicare fee for service. The project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that transitions a large portion ... September 11, 2014 Medicare Department of Health Care Services, DHCS, Dual Eligible, Medicare, Cal MediConnect 0 0 Comment Read More »
Cal MediConnect lawsuit unsuccessful Last week, the Sacramento Superior Court denied a request to delay implementation of the Cal MediConnect project. In a last minute challenge to the program, the Los Angeles County Medical Association (LACMA) joined a coalition of plaintiffs, including three Los Angeles independent living centers, to file a lawsuit in Sacramento Superior Court to stop the implementation of the project. The Cal MediConnect project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. ... August 8, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
Another delay for the Cal MediConnect project for dual eligibles The California Department of Health Care Services (DHCS) recently announced yet another delay for the Cal MediConnect project for dual eligibles. Implementation in Orange County has been delayed indefinitely, following a Centers for Medicare and Medicaid Services (CMS) audit of CalOptima—which is the county's only Medi-Cal managed care plan. The audit uncovered a number of serious issues that must be resolved before the duals transition can move forward in Orange County. Previously, Orange County was scheduled to begin passive enrollment on April 1, 2014. According to DHCS, implementation of Cal ... February 12, 2014 Medi-Cal, Medicare Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 0 Comment Read More »
Duals demonstration project delayed in three counties The California Department of Health Care Services (DHCS) has delayed passive enrollment for three of the eight counties affected by the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The project in these three counties—Alameda, Santa Clara and Los Angeles—will begin instead with a voluntary period, during which patients can choose early enrollment with a Medi-Cal managed care plan, or wait until the automatic passive enrollment period, which will begin no earlier than July 1, 2014. The project—known as Cal MediConnect—was authorized by the state in July 2012 ... December 16, 2013 Managed Care Dual Eligible, Insurance/Reimbursement, Medicare, Medi-Cal 0 0 Comment Read More »
State delays duals pilot project until April 1 The California Department of Health Care Services (DHCS) announced today that it would delay by three months implementation of the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The program, called CalMediConnect, is now expected to begin no earlier than April 2014. The project was authorized by the Assembly in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that would see a large portion of the state's ... August 15, 2013 Managed Care, Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 0 Comment Read More »
