Dual Eligibles Coordinated Care Demonstration – Cal MediConnect
California’s Medi-Cal program and the federal Medicare program are partnering to launch a three-year demonstration beginning in 2014 that would promote coordinated health care delivery to seniors and people with disabilities who are dually eligible for both programs.
The duals demonstration — now called the Cal MediConnect Program — aims to create a seamless service delivery experience for dual eligible beneficiaries, with the ultimate goals of improved care quality, better health and a more efficient delivery system.
Cal MediConnect is part of California’s larger Coordinated Care Initiative (CCI). Building on many years of stakeholder discussions, the CCI was enacted in July 2012 through SB 1008 (Chapter 33, Statutes of 2012) and SB 1036 (Chapter 45, Statutes of 2012). Further updates and clarifications to this initiative were enacted in June 2013 through SB 94 (Chapter 37, Statutes of 2013).
The Cal MediConnect program will be implemented no sooner than April 2014 in eight counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara.
Behavioral Health Coordination
Cal MediConnect – Dual Eligibles health plans will be required to their members access to all needed behavioral health services (mental health and substance use disorder treatment) currently covered by Medicare and Medi-Cal.
All Medicare behavioral health services will be the primary responsibility of the Cal MediConnect HMO plans, but Medi-Cal specialty mental health services and Drug Medi-Cal will remain the responsibility of county agencies (i.e. they will be “carved out”) in our case OPTUM.
Cal MediConnect plans and county agencies will be required to coordinate to ensure people have seamless access to care.
Each health plan must have a Memorandum of Understanding (MOU) with its county behavioral health agencies. These MOUs outline roles and responsibilities, patient information sharing, and a “strategy for shared accountability.” Under this strategy, one quality measure each year of the demonstration relates to the plan-county coordination for behavioral health services. If the plan successfully achieves this measure, it will earn back a percent of its capitation payment and then will be required to give a portion of the funds earned back to the county as an incentive payment.
Attached you will find The Coordinated Care Initiative and Behavioral Health Services for your review.
Cal MediConnect website: http://www.calduals.org/