Cal MediConnect Care Coordination Initiative and the Duals Demonstration

1. Cal MediConnectCare Coordination Initiative and the Duals Demonstration CAPG and HASC Contracting Committee Meeting October 3, 2013 Martha Smith Chief Dual Program Officer

2. Implementation: Network Strategy Organized Care Delivery System Built off Medi-Cal Managed Care & Medicare Dual Eligible Special Needs Plan (D-SNP) Model for traditional medical services Behavioral Health integration with MHN and Department of Mental Health. Long-Term Services & Supports (LTSS) provider network including Long-Term Care facilities, Multi-Purpose Senior Services Programs (MSSP), Community Based Adult Services (CBAS), In Home Supportive Services (IHSS) and other community based organizations intended to mirror current system (at least initially). Plans have to meet State and Federal requirements for Readiness Reviews Network capacity – increases to network will be required Geo-access – services available where Duals beneficiaries live Timeliness Cultural and Linguistic Accessibility (PARS vs FSR)

3. Implementation: Network Strategy (continued) Contracting with Medical Groups and Hospitals Initial contract documents/amendments, inclusive of participation requirements HRA/IHA requirements Specific requirements for encounter reporting Specific requirements for quality measures reporting (STARs-like) Risk sharing related to LTSS Similar contract methodology as Medicare Advantage Collection of member level coding data will be critical Professional and Institutional Capitation (dual risk) Delegation for D-SNP Model of Care Minimally compliant network contracted and submitted in June The final network composition will be dependent on finalizing adequate rates with the State and CMS

4. Implementation: Development and Communication Activities Communications FAQs have been posted publicly Educational presentations targeted toward non-contracted providers, often through hospital medical staff forums Interested providers that may not be in the network are being referred to local medical groups/IPA’s for anchoring purposes with these contracted organizations. Training Provider training curriculums are being developed, specific to the Demonstration with emphasis on LTSS to be used after contracts are executed.

5. For More Information https://www.healthnet.com/portal/provider/home.ndo