Update on CCI and Overview of Managed Care Data Sharing

Update on CCI and Overview of Managed Care Data Sharing Department of Health Care Services November 30, 2012

Update on CCI Implementation • MOU between CMS and DHCS is being finalized. • Readiness Review Tool and Process • Demonstration 3-Way Contracts • Recently released for stakeholder review: • Assessment and Care Coordination Standards • LTSS Standards

Current Data Exchanges between DHCS and Managed Care Plans • DHCS Data to Health Plans: Upon enrollment into managed care, DHCS sends the health plan up to 12 months of Fee-for-Service claim and treatment authorization data for each member. • Health Plan Data to DHCS: After members are enrolled, health plans submit encounter data to DHCS. For example, Encounter Data Element Dictionary (35C-File) used by the COHS: http://www.dhcs.ca.gov/provgovpart/Documents/PdClms_S35C_FileDED.pdf

Health Plan Data Sharing with Counties • Health Plans use a member and/or care coordination database. • To provide counties access to health plan databases, Plans are considering whether county social service agencies are “Business Associates” for HIPAA purposes. • Business Associate is the standard process for provider access to health plan data.

Update on CCI and Overview of Managed Care Data Sharing

Update on CCI and Overview of Managed Care Data Sharing

Presentation Transcript

Managed Care

Statewide Medicaid Managed Care Overview

Managed Care

Managed care

Managed care

Medicaid Managed Care Introduction and Update

viNGN CCI Build Update

Managed Care

Children’s Medicaid Managed Care Design Update

MRT Behavioral Health Managed Care update

More on managed care

Children’s Managed Care Design Update

Managed Care Update

MANAGED CARE

Managed Care

Managed Care

More on managed care

Managed Care

Managed Care – Data-driven Planning and Spending

Managed Care Update

Update on CCI and Overview of Managed Care Data Sharing