Coordinated Care Initiative (Duals Project) Update
By the California Medical Association
Background
The 2012 budget authorized the Coordinated Care Initiative (CCI), which would allow persons eligible for both Medicare and Medi-Cal (dual eligibles) to receive medical, behavioral, long-term supports and services (LTSS), and home- and community-based services coordinated through a single health plan in eight counties (Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara). CCI contains two main components: 1) Cal MediConnect-transitioning individuals who are eligible for both Medi-Cal and Medicare (duals) away from fee for service and into managed care; and 2) Integration of long-term supports and services (LTSS) into managed care. No more than 456,000 individuals would be allowed to enroll into Cal MediConnect.
Update
Recently, the state began mailing notices to dual beneficiaries about their choices regarding the duals demonstration. Three separate notices will be mailed out 90, 60, and 30 days before the start of the passive enrollment period.
- The first notice, will be sent 90 days before the start of the passive enrollment period, and will simply alert the beneficiary to the implementation of the duals demonstration program.
- The second notice will be sent 60 days ahead of the passive enrollment period, and will include information about plan benefits and provider networks to help them select a plan. Notices have been already been sent to beneficiaries in Riverside, San Bernardino, and San Diego counties.
- The third notice, will be sent 30 days ahead, and will provide the beneficiary with information about their specific plan. If the beneficiary has not selected a plan, the state will assign the beneficiary to a plan.
The state has chosen to do a “choice form” in order to give patients the opportunity to either choose a Cal MediConnect plan or opt out of the Cal MediConnect program. The choice form will be part of the choice guidebook, which will be mailed after the 60-day notice but before the 30-day notice. This form would allow patients to choose a plan in order to enter Cal MediConnect or choose a Medi-Cal only plan (which is mandatory for this population). We don’t believe these forms are simple or clear for patients and have voiced these concerns to the Department of Health Care Services.
CMA Action
Unfortunately, the Department of Health Care Services has not taken CMA’s suggestions for clarifying the beneficiary notices, resulting in the distribution of notices that may be confusing to patients and their physicians. CMA has developed resources to help physicians explain to patients their choices regarding participation in the CCI. In addition to a detailed fact sheet that explains the opt-in and opt-out process of the demonstration, CMA has developed patient letters that physicians can use as a guide when discussing Cal MediConnect with patients. The letters are available as a Word document format so physicians can tailor them to fit their needs. Letters are geared towards patients who are with the “contracting physician”, the “non-contracting physician” and for PACE patients. Please see the information below.
General Information
Patient Letters: