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Coordinated Care initiative quarterly stakeholder meeting July 10, 2014 - PowerPoint PPT Presentation


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Pamela Mokler , Vice President, LTSS, Care 1 st Vicki Macedo, Program Specialist, HHSA AIS Mark Sellers, Asst. Deputy Director, HHSA AIS. Coordinated Care initiative quarterly stakeholder meeting July 10, 2014. Health & Human Services Agency Aging & Independence Services

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Coordinated Care initiative quarterly stakeholder meeting July 10, 2014

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Pamela Mokler, Vice President, LTSS, Care 1st

Vicki Macedo, Program Specialist, HHSA AIS

Mark Sellers, Asst. Deputy Director, HHSA AIS

Coordinated Care initiativequarterly stakeholder meetingJuly 10, 2014


  • Health & Human Services Agency

    • Aging & Independence Services

    • Behavioral Health Services

    • Children’s Services

    • Public Health Services

    • Self-Sufficiency

    • Support Divisions

County of San Diego


Area Agency on Aging/ADRC

Adult Protective Services/Senior Mental Health Team

In Home Supportive Services

Multipurpose Senior Services Program ( & “MSSP-Like”)

Long Term Care Ombudsman

Call Center

PA/PG/PC

Veteran Services

Senior Nutrition

Community Services – IG, CM, RSVP, Health Promotions

Community-Based Care Transitions Program

Aging & independence Services


San Diego CCI Health Plan Options


AB 1040- CA Long Term Care Integration Pilot Project (LTCIP) –

Planning Committee formed 1999 with the following mission:

“Develop a comprehensive, integrated continuum of acute and long-term care (health, social, and supportive services) for the aged, blind, and disabled (ABD).”

Began with 50 participants – now over 800 members strong:

Multiple Medical, Behavioral Health, Social Service Providers, Consumers, Caregivers and Advocates


www.sdltcip.org


  • Cal MediConnect Health Plans established to provide them recommendations about operations, access to services, outreach & education, etc.

  • Communications Sub-Group: coordinated outreach to consumers, providers, physicians, pharmacists, hospitals/clinics, etc.

  • Coordination Guide Sub-Group: coordination between the Health Plans & IHSS/PA & MSSP

San Diego cci advisory committee


San Diego cci advisory committee Membership

  • Cal MediConnect Health Plans

  • HHSA/AIS

  • Public Authority

  • Dual-eligible consumers

  • Hospital Association

  • SD Medical Society

  • Consumer Center

  • HICAP

  • CBAS

  • PACE

  • Advocates

  • Community Clinics

  • HCBS Providers

  • SNF

  • Harbage Consulting Firm

  • Behavioral Health

  • Disability Rights


Workgroup: All 5 Health Plans, AIS IHSS Managers/Program Staff, Public Authority

Commitment: A single protocol

CCI Advisory Committee: review & approval

IHSS Coordination Guide Development


IHSS is a core service that is needed to keep members with ADL/IADL deficiencies living in the community

We need to make it easier for our members to transition from hospital to home with IHSS services, than it is to transition from a hospital to a SNF! – especially on a Friday evening! We need expedited IHSS assessments and extended hours.

All IHSS recipients’ needs are not the same! Programs need to be FLEXIBILE to meet changing needs of members/clients.

Health plan perspective


  • Application Process flow chart – especially helpful for the Health Plans at the beginning of the process

  • Call Center and Web Referral processes – giving them the contact information they would need and letting them know what type of information they will need to provide on referrals.

  • The establishment of “expedited” referral criteria and the development of an “expedited” referral process

IHSS Coordination Guide key elements


  • Differentiatingbetween “expedited referrals” and situations where “urgent service referrals” are appropriate

  • Explaining form requirements and how the Health Plans may play a key role in assisting the member with this

  • Providing phone numbers to each district office, as well as a zip code list of which office handled which zip code, so that Health Plans could contact the clerical staff at each office with questions.

IHSS Coordination Guide key elements


  • Expedited applications will be processed within 10 business days of receipt by the IHSS Social Worker. Health Plans will be contacted if there are problems that prevent or delay the process. Examples could include but are not limited to the following:

    • Refusal of services by the Health Plan Member

    • Failure to cooperate or provide required information

Expedited IHSS applications


Expedited criteria

Someone who has critical care

needs and:

  • No one is available to provide in-home care

  • Is unsafe in his/her own home

  • Is at risk of hospitalization (or re-hospitalization) without additional assistance

Someone who has critical care needs:

  • That cannot be fully met without additional assistance from IHSS

  • Is unsafe in his/her own home

  • Is at risk of hospitalization (or re-hospitalization) without services in place


Other indicators for an expedited referral could include:

  • A diagnosis of a terminal illness.

  • A rapid decline in health.

  • Client Is transitioning out of a hospital, and no one is available to provide in-home care or the care needs can’t be fully met.

    If necessary the IHSS Social Worker may conduct a needs assessment in the hospital. Once the Member transitions home, the IHSS Social Worker must complete an in-home needs assessment within 10 business days from the date of discharge.

Additional expedited indicators


A Notice of Action (NOA) will be issued providing information on services and the number of hours authorized, or the reason for any denial of services

IHSS will inform the Health Plan of any ineligibility to IHSS services

The client has 90 days from the date of the Notice of Action to file an appeal

Approval/denial on expedited apps


AIS was willing to be flexible

AIS was willing to expedite referrals for Plan members transitioning from hospital or SNF to home

Agreement from all 5 Health Plans, Public Authority and AIS on a single, core protocol

Shared value for the consumer-driven foundation of the IHSS program

Health plan perspective: Important accomplishments


Partnerships/relationships are everything!!

Broad coordination is critical!

Training, re-training…and more training!

Slow beginning for IHSS – applications (standard and expedited) and CCT’s – Why?

Continuous efforts at delivering information and resources to consumers & IP’s

HICAP/Consumer Center for Health Education & Advocacy calls – steady, but settling, burst at start of the month

CCI Implementation Challenges & opportunities


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