Healthy families program transition to medi cal september 13 2012
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Healthy Families Program Transition to Medi-Cal September 13, 2012. Update: Network Adequacy. Network Adequacy. Requests for health and dental plan provider network data: Sent to plans August/early September Health and dental plan responses: Due September 14

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Presentation Transcript

Update:

Network Adequacy


Network adequacy
Network Adequacy

  • Requests for health and dental plan provider network data: Sent to plans August/early September

  • Health and dental plan responses: Due September 14

  • DMHC and DHCS joint review and evaluation of data

  • Network adequacy assessment: Provide to Legislature 60 days prior to the start of Phase 1


Update:

HFP Subscriber

General Notice


Notices
Notices

  • HFP Notices: General Notice, 90-Day, 60-Day, 30-Day.

  • Medi-Cal “Welcome” notice post-transition.

  • Stakeholder engagement for notices.

  • Will translate in the Medi-Cal threshold languages.

  • Center for Health Literacy will review for Reading Level.


Review Draft

Strategic Plan

Due: October 1, 2012


Program overview and legislative requirements
Program Overview and Legislative Requirements

  • Transfer HFP subscribers to Medi-Cal no sooner than January 1, 2013, over 4 phases

  • Strategic Plan due October 1, 2012

  • Certify Phase 1 network adequacy November 1, 2012

  • Submit Implementation Plans 60 days prior to start of each phase

  • Monthly ongoing reporting commencing February 15, 2013


Program overview and legislative requirements1
Program Overview and Legislative Requirements

Goals of Transition

  • Facilitate a smooth transition

  • Minimize disruption in services

  • Maintain eligibility gateways

  • Ensure access to care

  • Ensure continuity of care


Program overview and legislative requirements summary of phases
Program Overview and Legislative RequirementsSummary of Phases

  • Phase 1 (No sooner than January 1, 2013)

    • Individuals enrolled in a Healthy Families Program health plan that is a Medi-Cal managed care health plan shall be enrolled in the same plan. Approximately 411,654 children will transition.

  • Phase 2 (No sooner than April 1, 2013)

    • Individuals enrolled in a Healthy Families Program health plan that is a subcontractor of a Medi-Cal managed health care plan, to the extent possible, shall be enrolled into a Medi-Cal managed care health care plan that includes the individuals’ current plan. Approximately 261,060 children will transition.

  • Phase 3 (No sooner than August 1, 2013)

    • Individuals enrolled in a Healthy Families Program plan that is not a Medi-Cal managed care plan and does not contract or subcontract with a Medi-Cal managed care plan shall be enrolled in a Medi-Cal managed care plan in that county. Enrollment shall include consideration of the individuals’ primary care providers. Approximately 152,602 children will transition.

  • Phase 4 (No sooner than September 1, 2013)

    • Individuals residing in a county that is not a Medi-Cal managed care county shall be provided services under the Medi-Cal fee-for-service delivery system. Approximately 42,753 children will transition.


Key activities for phase 1 planning
Key Activities for Phase 1 Planning

  • Review and Analysis of Provider Network Review Data from Plans (health and dental)

  • All County Welfare Director Letter Reviews with Stakeholders and Counties; Release of 2nd drafts

  • DHCS IT, MCED, Counties, Consortia and MAXIMUS determine data transfer protocols

  • Welcome Package review with stakeholders

  • State Plan/Waiver Amendment development and submission

  • Provide Strategic Plan to Legislature by October 1, 2012

  • Deliver Certification of Network Adequacy to the Legislature by November 1, 2012


Communication
Communication

  • Committed to collaboration and coordination of transition

  • Ensure transparency and public/stakeholder engagement in the process

  • DHCS Managed Care, Eligibility, and Dental Division Stakeholder Meetings

  • MRMIB Monthly Board Meetings, CAA Network, HFP Advisory Panel

  • DMHC Quarterly Plan and Advocate Meetings

  • Combined Webinars, Children’s Groups, and Small Stakeholder Groups


Eligibility and enrollment
Eligibility and Enrollment

  • Outreach to Subscribers/Families

    • General Notice, and 90, 60, 30 Day Notices for Each Phase

    • What We Tell Families Grid

  • County Coordination

    • Eligibility Determinations

    • Eligibility Data Reports and Performance Standards

  • MAXIMUS Coordination

    • Cost-Sharing: Premium Management and Co-Payments


Health and dental plan transition
Health and Dental Plan Transition

  • Health Plans

    • Network Adequacy

    • Continuity of Care

  • Dental Plans and Fee-for-Service

    • Network Adequacy

    • Continuity of Care

    • Fee-for-Service Provider Enrollment


Health and dental plan transition1
Health and Dental Plan Transition

Performance Measures

  • Health Plans

    • Child-Only HEDIS Measures

    • Ongoing Network Adequacy

    • Beneficiary Satisfaction Surveys

  • Dental Plans and Fee-for-Service


Health and dental plan transition2
Health and Dental Plan Transition

DMHC Oversight

  • Pre- and Post-Transition Network Adequacy Assessments

  • Ongoing Fiscal Solvency Examinations, Medical Surveys, and Transition-Related Health Plan Filings

  • DMHC Help Center


Federal approvals
Federal Approvals

  • DHCS

    • Title XIX (Medi-Cal) State Plan Amendment

    • Medi-Cal 1115 Bridge to Reform Waiver

  • MRMIB

    • Title XXI (HFP) State Plan Amendment


Considerations for input
Considerations for Input

  • Is any additional content needed?

  • Have all key areas been addressed?

  • Are there any major omissions of information?

  • What are suggested changes to the layout of the plan?

  • What data elements should be included?


Next steps
Next Steps

  • 5:00 PM, Thursday, September 20, 2012

    • Deadline to Submit Comments on Draft Strategic Plan

  • Upcoming Stakeholder Webinars

    • 2 – 4pm, Tuesday, October 23, 2012

    • 1 – 3pm, Friday, December 7, 2012



Contact us
Contact Us

DHCS Information/Questions

DHCS Healthy Families [email protected]

http://www.dhcs.ca.gov/services/Pages/HealthyFamiliesTransition.aspx

MRMIB Information/Questions

[email protected]

http://mrmib.ca.gov/MRMIB/HFPTransition.html


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