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1115 Waiver Proposals. California Children’s Services Program. Medi-Cal Managed Care Plan. Fully-capitated, at risk Knox-Keene licensed plan providing services to entire population All children with all CCS eligible medical conditions Disenrollment from Healthy Families plan

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1115 Waiver Proposals


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1115 waiver proposals

1115 Waiver Proposals

California Children’s Services Program

medi cal managed care plan
Medi-Cal Managed Care Plan
  • Fully-capitated, at risk
  • Knox-Keene licensed plan providing services to entire population
  • All children with all CCS eligible medical conditions
  • Disenrollment from Healthy Families plan
  • Mandatory enrollment
medi cal managed care plan3
Medi-Cal Managed Care Plan
  • Managing and/or coordinating all of the child’s health care needs
  • Benefits
    • Medically necessary services to treatment the ‘whole child’
    • Same range of currently covered services
      • Primary and preventive care
      • Medically necessary services to treat the CCS condition
    • Care coordination
  • Outreach and Assessment
medi cal managed care plan4
Medi-Cal Managed Care Plan
  • Provider network
    • CCS approved providers
      • Hospitals
      • Individual providers
      • Special care centers
medi cal managed care plan5
Medi-Cal Managed Care Plan
  • Medical home and care coordination
    • Personal physician
    • Active family participation in decision-making
    • Information technology
    • Care coordinators to support physicans
medi cal managed care plan6
Medi-Cal Managed Care Plan
  • Medical home and care coordination
    • Participation in quality improvement activities
      • Providers
      • Patients and families
medi cal managed care plan7
Medi-Cal Managed Care Plan
  • Administration
    • 24/7 nurse advise line
    • Member services
    • Member education
  • Quality monitoring and improvement
specialty health care plan
Specialty Health Care Plan
  • Fully capitated, at risk
  • Knox-Keene licensed plan only providing services to children with CCS eligible medical conditions
  • Managing and/or coordinating all of the child’s health care needs
  • Mandatory enrollment
  • Disenrollment from
    • Medi-Cal managed care plan
    • Healthy Families plan
specialty health plan
Specialty Health Plan
  • Provider network
    • CCS approved providers
      • Hospitals
      • Individual providers
      • Special care centers
specialty health care plan10
Specialty Health Care Plan
  • Benefits
    • Medically necessary services to treat the ‘whole child’
    • Same range of currently covered services
      • Primary and preventive care
      • Medically necessary services to treat the CCS condition
    • Care coordination
specialty health care plan11
Specialty Health Care Plan
  • Medical home and care coordination
    • Personal physician
    • Active family participation in decision-making
    • Information technology
    • Care coordinators to support physicans
specialty health care plan12
Specialty Health Care Plan
  • Medical home and care coordination
    • Participation in quality improvement activities
      • Providers
      • Patients and families
  • 24/7 access to care
  • Reimbursement
  • Quality monitoring and improvement
specialty health care plan13
Specialty Health Care Plan
  • Administration
    • 24/7 nurse advise line
    • Member services
    • Member education
    • Member outreach and assessment