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5. Coordinated Care Initiative (CCI) BASICS: Santa Clara County Amber Cutler, Justice in Aging Silvia Yee, DREDF March 4, 2015

7. Founded in 1979, by people with disabilities and parents of children with disabilities, the Disability Rights Education and Defense Fund (DREDF) is a leading national law and policy center, based in Berkeley, CA, dedicated to protecting and advancing the civil and human rights of people with disabilities. For more information, visit us at www.DREDF.org

8. What • Mandatory Medi-Cal for all SPDs • LTSS Integration • Medicare Integration Coordinated Care Initiative:In a Nutshell Who When • April 1, 2014* • Dual eligibles • Medi-Cal only SPDs Where • 7 counties: Alameda, Los Angeles, Orange,Riverside, San Bernardino, San Diego, San Mateo, Santa Clara Why • Coordinate Care • Save Money

9. Glossary • Coordinated Care Initiative (CCI) • Cal MediConnect (CMC) • Dual Eligible (Dual) • Duals-Special Needs Plan (D-SNP) • Fee-for-Service (FFS) • Long Term Services and Supports (LTSS) • In-Home Supportive Services (IHSS), Community Based Adult Services (CBAS), Multipurpose Senior Services Program (MSSP), Nursing Facility • Medi-Cal Managed Care • Program of All-Inclusive Care for the Elderly (PACE) • Seniors and Persons with Disabilities (SPDs)

10. What CCI = three big changes

11. What The current Medi-Cal, LTSS, and Medicare delivery systems are different Current System Medi-Cal (medical services) Medicare Medi-Cal (LTSS services) OR OR FFS (default) Managed care Managed care FFS FFS *Behavioral Health

12. What CCI moves services into managed care New System Medi-Cal (medical services) Medicare Medi-Cal (LTSS services) Managed Care *Behavioral Health

13. What Managed Care: Plans paid to provide covered services via network providers Senior/Person with Disability Provider Provider Provider $$ $$ DHCS & Medicare $$

14. What Managed Care: Plans paid to provide covered services via network providers Senior/Person with Disability DHCS & Medicare $$ Health Plan Provider Provider Provider

15. CCI impacts duals & seniors and persons with disabilities with Medi-Cal Who Medi-Cal and Medicare (Dual Eligibles) Impacted Not Impacted Medicare Only Medi-Cal only (SPDs)

16. Who Total Impact: 1,125,000

17. Santa Clara County Impact Who Two Timelines in Santa Clara County • Who • SPDs • Duals not subject to enrollment in CMC What Medi-Cal Managed Care (MLTSS) August 1 • Who • Dual Eligibles What Cal MediConnect January 1

18. When MLTSS Enrollment • Enrolled by Birth Month • SPDs • Examples: SPDs living in nursing facilities, SPDs with a share of cost • Duals not subject to enrollment in CMC • Examples: Duals with ESRD diagnosis, duals receiving services at a regional center, duals enrolled in Kaiser, duals enrolled in a MA plan* August 1 Exception: Approximately, 6,750 CMC duals received notices May-July. 2,250 were enrolled in Medi-Cal plans.

19. When Cal MediConnect Enrollment • Duals Only • By birth month, generally. • Exceptions: • Already enrolled in a Medi-Cal plan (January) • In a CMC D-SNP (January) • In MSSP • Part D reassignees 2015 (January) January 1

20. A less blurry version of this grid is available at: http://www.calduals.org/wp-content/uploads/2014/06/Enroll-6.12-Santa-Clara.pdf

21. What Only Duals can enroll in Cal MediConnect Duals Only Passive Enrollment Cal Medi Connect

22. Opt-In What Medicare Medi-Cal FFS Medicare PACE Opt-Out Choose Cal MediConnect Plan Medicare Advantage Dual (subject to passive enrollment) Choose Medi-Cal Plan Do Nothing Assigned to Medi-Cal Plan Enrolled into Cal MediConnect Plan A beneficiary can disenroll from Cal MediConnect or change plans at anytime for any reason. The disenrollment is effective the first day of the next month.

23. Medi-Cal managed care is mandatory Even if a Dual Opts Out of Cal MediConnect, must still enroll in Medi-Cal MC Duals Medi-Cal Only Medi-Cal Managed Care

24. What Cal MediConnect Benefits

25. Santa Clara Plans Cal MediConnect Medi-Cal Plans PACE ON LOK

26. Medicare Advantage Passive Enrollment in 2015 • Duals enrolled in a D-SNP operated by a CMC plan are subject to passive enrollment in January 2015 (can’t keep their D-SNP) [CARE MORE] • Duals enrolled in a D-SNP not operated by a CMC plan [Care1st] are NOT subject to passive enrollment in Cal MediConnect if enrolled by 12/31/14. Must still choose a Medi-Cal plan (Starting January 2015). • Duals enrolled in a Medicare Advantage plan are not subject to passive enrollment in Cal MediConnect. Must still choose a Medi-Cal plan.

27. When Most beneficiaries will receive three notices 30 Day 60 Day ENROLLMENT 90 Day ENROLLMENT 4/1/15 April DOB 1/1/15 2/1/15 3/1/15 7/1/15 August DOB 5/1/15 ENROLLMENT 8/1/15 6/1/15

28. When 90 Day • Informational Notice 60 Day • Notice with Default Plan/Part D Insert • Cal MediConnect Guidebook • Choice Booklet and Choice Form • PART D Disenrollment Notice 30 Day • Final Reminder Notice

29. 90-Day Cal MediConnect Notice

30. 60-Day Cal MediConnect Notice

31. Part D Insert

32. 90-Day Medi-Cal Managed Care Notice

33. 60-Day Medi-Cal Managed Care Notice

34. Why DHCS stated goals of the CCI

35. Wrap Up Should your client enroll in Cal MediConnect?

36. Wrap Up Factors to Consider in Making Decision to Enroll in Cal MediConnect • Does plan have networks that include client’s current medical providers? • Does plan have strong relationship with social service providers? • Does client have a course of treatment that should not be interrupted? • How important are the additional benefits of vision and transportation to client? • Will a plan improve your client’s care coordination?

37. Cal MediConnect Choice Form To “Opt-Out” of Cal MediConnect, fill out Option B ONLY. If you are already in a Medi-Cal plan, Choose the Medi-Cal plan you are already in Choose a Cal MediConnect Plan: Fill out Option A ONLY To choose PACE, fill out PACE bubble and EITHER A or B as a backup

38. Wrap Up What can you do? • Influence program development • Stakeholder meetings • Talk to plan • Legislative advocacy • Prepare to provide counsel • Report problems 34

39. Wrap Up Local advocates can help individuals • HICAP 1-800-434-0222 • Cal MediConnect Ombudsman 1-855-501-3077

40. Wrap Up Want to know more? • NSCLC Duals Website • Advocate’s Guide • Fact Sheets • Sign up for alerts http://dualsdemoadvocacy.org • Contact us: • Amber Cutler – acutler@justiceinaging.org • Denny Chan – dchan@justiceinaging.org • Disability Rights Education & Defense Fund (DREDF) • www.dredf.org • Department of Healthcare Services • www.calduals.org