MOU Summaries

For a clear and comprehensive understanding of the Duals Demonstration’s recently signed Memorandum of Understanding, The SCAN Foundation and National Senior Citizens Law Center (NSCLC) have created helpful summaries.

Both documents provide a background on the Duals Demonstration (now known as “Cal MediConnect”) as a whole, the scope of the implementation, the proposed timeline as well as eligibility details. Additionally, they provide details surrounding the enrollment processes, network adequacy, beneficiary protections and quality controls. To view The SCAN Foundation PDF, click here. To view the NSCLC PDF, click here.

Sequestration’s Impact on Alameda County Senior Services

Sequestration’s Impact on Alameda County Senior Services 
What We Know and What We Don’t Know

The automatic cuts known as sequestration took effect on March 1, 2013. Under the requirements of the 2011 Budget Control Act (amended in January) both defense and non-defense programs were automatically cut, reducing total funding by $85.3 billion in the first year. Half the cuts were made to non-defense programs, including a cut to discretionary appropriations of 5%, or $25.8 billion.

Nestled in the discretionary budget category are programs funded through the Older Americans Act – the home and community-based supports that served over 49,000 seniors in Alameda County last year. But that’s where the hard data ends and our frustrating search for information begins.

What will the impact of sequester cuts be on Older American Act-funded programs in Alameda County? With only two months remaining in the current fiscal year and every organization that provides OAA services needing to plan their budgets and programs for next fiscal year, we don’t know. California’s Department of Aging has released only sketchy information to our local Area Agency on Aging. Worse, the CDA has waffled. First, the CDA described an approach to program cuts that would allow the AAA to buffer the current fiscal year impact with annual One-Time-Only funds, but last week the CDA changed its approach but offered no concrete details.

Without knowing the impact, our ability to marshal resources to mitigate the cuts is limited. SSC has begun calling on our colleagues in Sacramento for help in seeking information. We may be coordinating legislative visits in the near future and will ask stakeholders to join us. Stay tuned.

Return to the Senior Services in Alameda County page here.

California Assembly Committee on Aging and Long Term Care – AB 518

May 2, 2013 – Over a year ago a court settlement saved Adult Day Health Care (ADHC) from being eliminated as a Medi-Cal benefit, and created the Community Based Adult Services (CBAS) benefit, which provides the same service. However, the settlement agreement is a temporary measure that expires after 18 months.

On May 8, the California Assembly Appropriations Committee will hear AB 518, by Assemblymember Mariko Yamada. The bill would, essentially, codify the court settlement, ensuring that the CBAS benefit cannot be dropped when state health officials eventually renew the federal waiver that spawned it. 

To voice your support, call:
Assemblymember Mike Gatto (Dist. 43)
Appropriations Committee Chair
(916) 319-2043

Assemblymember Bill Quirk (Dist. 20, Hayward)
Appropriations Committee Member
(916) 319-2020
Governor Jerry Brown
(916) 445-2841

Email Governor Brown via this link.

 

Return to the Senior Services in Alameda County page here.

Duals Demonstration MOU Signed

March 27, 2013 – Today the Department of Health Care Services (DHCS) and the federal Centers for Medicare and Medicaid Services (CMS) announced that they have signed a Duals Demonstration Memorandum of Understanding (MOU). The Duals Demonstration is a key part of California’s Coordinate Care Initiative (CCI), and will integrate funding streams, health care, and Long Term Services and Supports for dual eligible beneficiaries.

The MOU does not address other parts of the CCI, such as the mandatory enrollment of Medi-Cal Only and Dual eligibles into Medi-Cal managed care, or the transition of Medi-Cal-covered LTSS in to managed care.

Looking at DHCS’s MOU Fact Sheet and CMS’s Announcement, there are significant changes from the state’s original proposal. What does the new MOU mean for Alameda County? Here are some highlights. We’ll have more in coming weeks.

  • A new launch date of no sooner than January April 2014. In Alameda County most consumers would be passively enrolled over 12 months by birthday month, with some exceptions. For instance, consumers who are currently in Alameda Alliance for Health’s Duals Special Needs Plan (DSNP) will all be passively enrolled into Alliance’s Duals Demonstration Plan in March June 2014.

  • New Benefits – all participating plans are required to offer vision, dental, and non-emergency transportation benefits to enrollees.

  • Beneficiary protections are consistent with other capitated Financial Alignment Demonstrations, and there will be Ombudsman services to support individual advocacy of Medicare-Medicaid enrollees and to identify systemic problems and provide oversight for the Demonstration.

  • Continuity of Care Requirements are in place to help ensure enrollees do not experience disruptions in care through the transition period. Enrollees will have access to current providers and service authorizations for up to 12 months for Medicaid and up to 6 months for Medicare (more later on the criteria that must be met for this to happen).

  • No lock in – Consumers will be able to opt out of the Duals Demonstration at any time or change Demonstration plans. Consumers who are in Medi-Cal Managed Care Plans will be able to change plans at any time (but would not be able to opt out of Medi-Cal Managed Care), and it is important to know that legislation is moving through the state legislature that would create an open enrollment period with lock-in for the rest of the year for all Medi-Cal consumers.

  • Home and Community Based Waivers will remain open.

  • The size of the Duals Demonstration is limited to 456,000 statewide, and capped at 200,000 in Los Angeles County. Based on a first look at the numbers, this limit will not affect Alameda County consumers’ ability to enroll in the Duals Demonstration.

Click here to download the state’s MOU Fact Sheet. Click here to go to the MOU Document.

Return to the Coordinated Care Initiative page here.

Alameda Alliance for Health Uses Key Principles to Inform Planning

In a proactive response to the changing managed care environment, Alameda Alliance has created a new LTSS unit that will be primarily responsible for the Long-Term Supports and Services that are moving under managed care when the Coordinated Care Initiative launches. At the January 31st SSC Panel Discussion, Alameda Alliance’s Director of Outreach and Education for LTSS, Elizabeth Edwards, outlined five guiding principles which the Alliance is operating from as they prepare for the Coordinated Care Initiative:

1. Honor consumers’ existing relationships with medical and LTSS providers.

2. Supplement medical care through a robust assessment process and by developing plan based and community based care coordination activities.

3. Engage CBOs that provide significant services to the Duals Demonstration population.

4. Enhance scarce resources but not supplant existing funding sources.

5. Define and measure success as no disruption in care.

 

To realize these principles, the Alliance will be connecting with medical providers, supportive services providers over the next several months and beyond:

● Medical Providers – The Alliance’s work will include determining which medical providers are significant to consumers, and reaching out to these providers to create contracts and continue information sharing. (Community based organizations can assist in this process by sharing medical provider contact lists with the Alliance.)

● LTSS Providers – The Alliance will contract with the MediCal LTSS providers (IHSS, MSSP, SNFs) much like they are currently contracted with CBAS/ADHC providers. These contractual relationships will allow the providers to share any recent in depth assessments of consumers upon enrollment in Alliance, allowing Alliance to be better informed about new members’ status and service needs. Elizabeth described the assessment as key to ensuring that Alliance is able to “get folks into care that need it and find the people who are not getting the services that they actually need and make that transition easy for them.”

From the CBAS transition, the Alliance learned that the expertise currently existing within the community is an incredible asset. The Alliance wants to “make it possible for those community providers to… do what they’ve been doing.” Yet Elizabeth acknowledges that resources are scarce in the county and waiting lists abound, and that the Alliance cannot provide funding to fill all these gaps.

 

To return to the Changing Landscape page, click here.

For a report on the entire January 31st SSC Panel Discussion, click here.

 

Adult Day Health Care Benefit Transitions to Managed Care


It’s
 been
 15
 months
 since
 a
 court‐mediated
 settlement
 preserved
 Medi‐Cal
 coverage
 for
 Adult
 Day
 Health
 Care
 and
 created
 a
 new
 ADHC
 benefit
 called
 Community‐Based
 Adult
 Services
 (CBAS).
 
Since
 then,
 the
 Adult
 Day
 Services
 Network
 of
 Alameda
 County
 (ADSNAC)
 has
 been
 working
 with
 its
 members
 (six
 organizations
 that
 run
 thirteen
 adult
 day
 programs
 throughout
 Alameda
 County)
 and
 with 
the 
county’s
 two 
Medi‐Cal
 Managed
 Care
 Plans 
to
 transition 
programs
 and 
patients
 into
 Medi‐Cal
 managed 
care.


Having 
experienced
 the 
transition 
of 
a
 Medi‐Cal covered 
LTSS 
into 
managed
 care,
 Anne
 Warner‐Reitz,
 ADSNAC
 Executive
 Director,
 provided
 an
 informed
 template
 for
 the
 coming 
Coordinated 
Care
 Initiative.

Ms.
 Warner‐Reitz
 acknowledged
 the
 CBAS
 implementation
 was
 complicated
 by
 the
 state’s
 flawed
 eligibility
 process.
 
 About
 35%
 of
 the
 people
 who
 had
 been
 receiving
 ADHC
 services
 in
 Alameda
 County
 were
 initially
 found
 ineligible
 for
 the
 new
 CBAS
 coverage.
 It
 took
 a
 year
 in
 a
 laborious
 and
 difficult
 fair‐hearing
 process
 to
 reinstate
 eligibility
 for 
most 
of
 those
 participants.
 During 
that 
time,
 two
 ADHC 
centers 
closed 
and
 other
 providers
 were
 severely
 stressed
 as
 they
 worked
 to
 provide
 services
 under
 the
 double 
burden
 of
 rate 
cuts
 and
 delayed
 reimbursement.

One
 of
 the
 assets
 that
 eased
 transition
 difficulties
 was
 the
 goodwill
 and
 shared
 communications
 that
 occurred
 between
 the
 plans,
 agencies
 and
 providers.
 Early,
 the
 ADHC
 centers
 invited
 medical
 directors
 and
 other
 managed
 care
 plan
 staff
 to
 the
 centers.
 The
 plans
 and
 centers
 executed
 data‐sharing
 agreements,
 then
 shared
 assessment
 and
 outcome 
information
on 
patients 
they 
had 
in 
common, 
discovering 
that
 ADHCs
 knew
 significantly
 more
 about
 patients’
 health
 and
 had
 played
 a
 clear
 role
 in
 stabilizing
 patient’s
 with
 complex
 medical
 conditions.
 These
 conversations
 allowed
 the
 plans
 to
 recognize
 ADHC’s
 value
 and
 its
 role
 in
 a
 patient’s
 care
 plan,
 and
 built
 relationships,
 good
 will
 and
 common
 understanding
 that
 proved
 helpful
 as
 they
 developed
 the
 business 
relationships,
 protocols 
and
 procedures 
to
 implement
 CBAS.

Now,
 with
 a
 few
 exceptions,
 Medi‐Cal
 CBAS
 coverage
 is
 available
 only
 through
 a
 Medi‐ Cal
 Managed
 Care
 Plan.
 There
 is
 an
 expedited
 enrollment
 process
 so
 that
 people
 who
 need
 ADHC
 services 
can 
be 
enrolled 
in 
a 
plan
 quickly.

 ADSNAC
 has
developed 
a
 guide 
to
 help
 navigate
 the
 eligibility
 and
 enrollment
 process,
 available
 at
 http://www.adsnac.org/cbas.htm.
 

To return to the Changing Landscape page, click here.

For a report on the entire January 31st SSC Panel Discussion, click here.