Policy Advisory Group AGENDA th Monday, January 8 , 2018 9:30am-12:00noon CCALAC, 700 S. Flower Street, Suite 3150 (Conf. Room A) Los Angeles, CA 90017 Call-in: (888) 585-9008 Conference Room #: 529-954-253
Time Item – Presenter Action* Corresponding Document**
9:30am Call to Order and Introductions – Al Ballesteros A
9:35am Agenda and December Minutes – Al Ballesteros A • December 11th Minutes (2)
9:45am Federal Issues – Louise McCarthy, Joanne Preece, Sara Watson A. Federal Budget & Appropriations I/D • Federal Updates Memo** (4) 1. Health Centers Funding Cliff • Immigration Memo**(7) • P&I Memo(9) 2. Tax Reform • P&I List of Members in Districts**(10) B. Immigration I/D C. NACHC Policy & Issues Forum (P&I) I/D
10:30am State Issues – Louise McCarthy, Joanne Preece, Becky Lee A. 2018 State Budget/Landscape I/D • State Landscape Memo**(14) B. Dental Transformation Initiative: Domain 4 I/D • DTI Memo**(17) • Medi-Cal Changes Effective 2018 and Beyond C. Medi-Cal Changes Effective 2018 and Beyond I/D Memo (21) D. CPCA State Initiatives I/D • State Initiatives Memo (24) 1. APM • Covered California Memo**(26) 2. P4P 3. State Plan Amendment E. Covered California I
11:00am County Issues – Louise McCarthy, Joanne Preece, Becky Lee, Sara Watson A. LA County Initiatives I/D • LA County Initiatives Memo**(27) 1. Whole Person Care • LA Safety Net Integration Summit Memo(29) • LA Safety Net Integration Summit Break Out 2. Homelessness Groups Summary (30) 3. Prevention & Population Health Task Force • LADPH SPA Meetings Memo (34) B. Behavioral Health I/D • Managed Care Memo**(36) 1. Integration Summit Report Out • MHLA Annual Report (link only) 2. Behavioral Health Task Force • MHLA November Renewal Report (39) 3. DMH Indigent Services Contracting C. LADPH Service Planning Area (SPA) Meetings I/D D. Managed Care I/D E. My Health LA - Annual Report I
11:40am Other Business – Louise McCarthy, Elaiza Torralba A. New PAG Co-Chair Elections A • Meeting Evaluation** B. Meeting Evaluation
12:00pm Adjournment – Al Ballesteros A
Next Policy Advisory Group Meeting – Monday, February 12th, 2018
* A = Action D = Discussion I = Information ** handout provided in complete packet of materials
Policy Advisory Group Meeting Minutes December 11th, 2017 9:30am – 12:00pm CCALAC Conference Room A
Attendees: Maria Paz, Katja Nelson, Alex Cotte, Franklin Gonzales, Chona De Leon, Corrinne Sanchez, Tamra King, Al Ballerteros, Lisa Abdishoo, Nik Gupta, Julie Hudman, Patti Wagonhurst, Jann Hamilton Lee, Richard Veloz, Roderick Seamster
Teleconference: Tim Pusateri, Kimberly Wyard, Saalija Khan, Carmen Ibarra, Dr. Elisa Nicholas, Eduardo Gonzales, Karen Lauterbach, Maria Dia
Staff: Louise McCarthy, Nina Vaccaro, Joanne Preece, Becky Lee, Elaiza Torralba, Candace Metoyer, Sara Watson, Lauren Richard
TOPIC / PERSON DISCUSSION ACTION Welcome and Al Ballasteros, Co-Chair, called the meeting to order at 9:34am. Introductions Approval of Agenda Al asked for motions to approve the agenda and past meeting minutes. Motion made by: Nik Gupta and Minutes Seconded by Cliff Sheipe. Motion carries.
Federal Issues A. Federal Budget & Appropriations ACTION: (immigration, 1. Health Centers Funding Cliff – Update on status of health centers funding. No funding included in position on bills) Motion: CR. Discussion ensued regarding advocacy strategy. Corinne Sanchez, Second: 2. Tax Reform – Updates on tax reform bill per memo. Richard Veloz. Motion B. Health Related Developments carries. No opposition. 1. HHS Director Nominee – Discussion re new HHS nominee. Concern re he is very experienced in regulatory process, can chip away at ACA. C. Immigration – Recommended members take position on 3 federal immigration bills (per memo). Discussion regarding initial information for employers regarding employees who lose DACA and TPS status, detailed FAQ expected soon from Public Counsel. State Issues A. SB 323 (Mitchell) Implementation – Staff reviewed CPCA FAQ and flow chart. No actions. B. UHW Ballot Initiative – Louise shared information regarding a 2018 ballot initiative that may have clinic implications. No need for position at this time. C. Meeting with Dental Director Report Out – Verbal update regarding Dr. Kumar visit to CCALAC Dental Roundtable. D. CPCA State Initiatives – Joanne discussed CPCA initiatives including APM, SPA, P4P (per memo). 1 2
County Issues A. LA County Initiatives – Discussion of below items per memo. No actions. 1. Whole Person Care 2. Homelessness 3. Meeting with Dr. Ghaly B. Behavioral Health – Becky discussed upcoming Integration Summit, Louise provided update on DMH contracting. 1. BSCF Behavioral Health Task Force 2. Integration Summit 3. DMH Indigent Services Contracting C. Managed Care – CCALAC informed members of new Managed Care Advisory Workgroup, asked people who want to participate to contact Joanne. D. LADPH Service Planning Area (SPA) Meetings – Update on SPA meetings, upcoming meeting dates and highlights of past meetings. Introduced Sara Watson. E. Care Harbor Report Out – Elaiza reviewed memo regarding Care Harbor preliminary data. F. My Health LA (MHLA) – Discussion regarding items in the memo, including enrollment is over 146K – keep enrolling, county using rollover funding from last year.
Other Business A. March 2018 PAG Date – Joanne informed members that PAG in March 2018 will be conference call on No actions. Monday, March 5 at 3:00pm. P&I prep webinar to be held separately later that same week. B. NACHC P&I Prep – Discussion of logistics per memo. Clinics by district list will be provided in January. CCALAC staff encouraged members to book hotel ASAP. Adjournment There being no further business, the meeting ended at 12:02 pm. Meeting adjourned by Chair.
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Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: Federal Updates (Information/Discussion)
This memo provides information and updates related to the health center funding cliff, the federal budget and appropriations process and the recently passed tax reform law.
Federal Budget and Health Centers Funding On December 7, Congress passed a “Continuing Resolution” (CR) extending government funding through December 22, allowing Congress to avert a government shutdown and theoretically buying time to address a number of unresolved issues. The December 7 CR did NOT include a fix to the health center funding cliff, nor did it include a long-term solution to fund the Children’s Health Insurance Program (CHIP).
On December 21, the House and Senate passed another CR (House vote 231-188; Senate vote 66-32), this time funding the government until January 19. The December 21 CR contained short-term “patch” funding for Health Centers ($550 million), CHIP ($2.85 billion), the National Health Service Corps ($65 million) and Teaching Health Centers ($15 million). These figures come from HRSA and are reportedly the minimum necessary to fund each program through March. To fund these programs through March, the bill cuts the Prevention and Public Health Fund by $750 million over three years.
What Does Patch Funding Mean for 330 Grantees? According to NACHC, without the “patch” funding in the December 21 CR, grantees with a January start date were slated to get two months of funding, and those with a February start date to get one month. The “patch” in the House CR should give grantees with January, February, and March start dates funding through March.
If March 31 passes without new mandatory funding appropriated, HRSA still has the $1.5 billion in discretionary funding for the health centers program. HRSA could theoretically decide to frontload that funding and continue to fund health centers in full using the $1.5 billion until that funding also runs out. This is only speculative, HRSA has not stated what they would do in this situation.
What’s Next? Congress has until January 19 to pass another spending bill. It is unclear at this point whether the next bill will be another CR or a larger omnibus package to finish out the 2018 fiscal year. Leaders from both parties in the House and Senate (Sen. Majority Leader Mitch McConnell, Sen. Chuck Schumer, Speaker Paul Ryan and Rep. Nancy Pelosi) met recently with White House officials to discuss how to move forward on reaching a deal to raise the current budget caps and to keep the government open January 19. However, there are no reports of a breakthrough on either a budget deal or any of the major policy issues.
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
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Congressional leaders need to reach agreement in two areas: 1) They need to reach agreement on the overall approach, either another short-term CR to keep the government running beyond January 19 (possibly through mid-February or late March), or a long-term omnibus budget deal that will raise spending caps and fund the government through the end of the fiscal year, September 2018. Prior to the holiday recess it looked like they were working toward an omnibus, but now another CR looks likely. 2) They need to reach agreement on the major policy issues. The December short-term CRs left many of Congress’ most contentious issues unresolved, including a long-term solution for CHIP and health centers, a fix for the Deferred Action for Childhood Arrivals (DACA) program, disaster relief funding, and ACA market stabilization, including Cost Sharing Reduction (CSR) payments for health insurers.
Funding Cliff Advocacy NACHC is not engaging the entire advocacy network yet. Health centers are encouraged to continue engaging with their members of Congress and CPCA and NACHC are both providing templates for a potential media strategy. CPCA has also been circulating a petition.
CCALAC is having internal conversations regarding our advocacy strategy for the coming weeks. We remain committed to saving our collective advocacy energy and bandwidth for when and where it will be most impactful.
NACHC provided the following talking points and messaging suggestions for health centers that are engaging with their representatives: • According to HRSA estimates, the current continuing resolution with the partial mandatory funding “patch” provides only enough money to fund health centers with start dates in January, February, and March, through March 31. • Because HRSA needs time to process grants for upcoming grant cycles, and because of the dangerous uncertainty created by this piecemeal approach, Congress cannot wait until March to put in place long-term funding for health centers. • Congress must act immediately to provide at least 2 years of health center funding as part of the next spending bill, whether it is another CR or an omnibus. • Even with the limited patch funding attached to the last Continuing Resolution, the ongoing uncertainty for health center operations remains. Health centers cannot sustainably maintain operations with a month-to-month, piecemeal approach. • We are asking every Member of Congress to help by taking public actions, including writing letters to leadership, signing onto dear colleague letters, writing op-eds, making floor speeches and otherwise engaging with leadership to elevate this issue and ensure that a long-term funding fix does not get pushed back another month. CCALAC will monitor NACHC and CPCA advocacy alerts in the coming weeks and will engage members if and when we believe our efforts will be meaningful and impactful. Refer to the advocacy actions page on the CCALAC website for updates, advocacy actions and talking points.
Tax Reform While health centers (and CHIP) spent the last few months navigating the uncertainty associated with expired funding, Congress spent much of December focused on their goal of getting a tax reform bill on the President’s desk before Christmas.
The biggest concerns in the tax reform bill for CCALAC and other health advocates are the repeal of the Affordable Care Act’s individual mandate penalty and the massive cuts that will almost inevitably have to be made to other programs down the road to account for the tax cuts adding $1 – $1.5 trillion to the deficit (analyses vary). The Congressional Budget Office projects that removing the individual mandate, which takes effect in 2019, will raise health insurance premiums by 10% every year and increase the number of uninsured Americans by 4 million in 2019 and 13 million by 2027. 700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
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CR Waived PAYGO Rules, Protecting Medicare from Automatic Cuts The December 21 CR included a waiver for something called “PAYGO rules” which would have triggered automatic sequester cuts that would have resulted in a $25 billion cut to Medicare next year. The PAYGO rules are intended to ensure that Congress pays for the bills it passes over the course of a year and discourage Congress from enacting legislation that will add to the debt. In the case of the tax reform bill, Congress had to waive their own budgeting rules to prevent the tax bill from triggering billions in automatic cuts to Medicare (among other programs – however, Medicaid and Social Security are exempt from PAYGO sequester cuts).
Republicans Signal Entitlement Cuts on the Horizon The biggest concern remains that the tax bill is just the first step in the Republican fiscal agenda. Numerous Republicans, including House Speaker Paul Ryan, have started proclaiming publicly that the next thing they plan to take on is entitlement reform. Citing massive federal deficits (a sizable portion of which will be created by the tax bill), Republicans are looking to justify overhauling Medicaid, SNAP, and other anti-poverty programs in 2018.
Please email Joanne Preece at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
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Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: Immigration Update (Information/Discussion)
This memo provides updates on immigration-related issues impacting health centers, their patients and communities.
DACA Update The Trump administration announced on September 5, 2017 the rescission of the Deferred Action for Childhood Arrivals (DACA) program. Congress has until March 5, 2018 to find a legislative solution. There was a push in December to include a DACA fix in the government spending bills; however that did not occur.
Currently, an estimated 122 DACA recipients are losing their status and work permits every day. If Congress does not act by March 2018, that number is expected to jump to 1,400 per day. Without Congressional action, all 800,000 DACA recipients will lose their status over the next two years.
Democrats want a DACA fix included in a government spending bill. Many Republicans would also like to see a DACA fix, however some want to include tougher immigration controls and more border-security measures. Most recently, lack of clarity from the President about his intentions for border wall is rumored to be holding up negotiations. Republicans and Democrats working on a possible immigration deal say they have not received Trump's specific demands. Trump indicated in a recent interview with The New York Times that he would insist on a border wall in exchange for a DACA fix, saying “I wouldn’t do a DACA plan without a wall.” Negotiators seem unclear whether to interpret Trump’s remarks are referring to a physical wall, or whether the “wall” is more of a metaphor for tighter security.
Some Republicans have said that a deal to fund the government might have to move separately from a bill that provides a DACA fix; however, Democrats say Republican leadership and administration officials have agreed to keep the spending and immigration talks linked. At this point, it is unclear if immigration will remain part of the January spending bill negotiations or move a separate bill.
FAQ Available for Employers of DACA/TPS Recipients Public Counsel has created a comprehensive Immigrant Work Authorization FAQ for Employers. The termination of the DACA program, the phasing out of certain Temporary Protected Status (TPS) designations, and the heightened focus on immigration issues under the new administration have raised a number of questions for employers.
Public Counsel has created a comprehensive resource, Immigrant Work Authorization FAQ for Employers, addressing some of the most common questions they are receiving in the area of employee hiring and Employment Eligibility Verification Form (Form I-9) compliance.
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
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The law on the topics discussed in the resource is highly context-specific, and Public Counsel has requested that rather than disseminate the FAQ directly to members, we invite members to contact Public Counsel to receive the FAQ and/or additional support.
How to Access the Immigrant Work Authorization FAQ for Employers If your organization would like to receive the FAQ and/or needs legal assistance in this area, please reach out to CCALAC and we will connect you to Public Counsel.
Health centers may also contact Public Counsel’s Community Development Project at (213) 385-2977, ext. 200. The Community Development Project provides free legal assistance to qualifying low-income entrepreneurs and qualifying nonprofit organizations that share the mission of serving low-income communities and addressing issues of poverty within Los Angeles County.
Please contact Joanne Preece at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
8 Member Driven. Patient Focused.
Date: January 2, 2018
To: Policy Advisory Group
From: Joanne Preece and Sara Watson, Government Affairs
Re: 2018 NACHC Policy & Issues (P&I) Forum (Information/Discussion)
The National Association of Community Health Centers’ (NACHC) 2018 Policy & Issues (P&I) Forum will take place March 14 ‐ 18, 2018 at the Marriott Wardman Park Hotel in Washington, D.C. The 2018 P&I Forum comes as health centers face an uncertain funding future, coupled with proposals to restructure key federal programs, including Medicaid and Medicare. The voice and participation of all health center advocates are essential to make the case for continued investment in the health center program.
Travel & Scheduling CCALAC will coordinate legislative visits for each of the Congressional offices from LA County. Members should plan to fly in and arrive by Monday, March 12, with legislative visits starting Tuesday, March 13. Due to the large size of LA County’s Congressional delegation, meetings may be scheduled through the close of business Friday, March 16.
Book your hotel rooms now ‐ the host hotel and surrounding hotels sell out very early!
Registration – Coming Soon Registration information will be available in mid‐January. Watch Friday Update for registration links. Please remember to register with both CCALAC and CPCA! NACHC P&I Forum Conference registration will also be available in January and is separate from CCALAC and CPCA registration.
P&I Prep Webinar – Thursday, March 8 CCALAC’s P&I Prep webinar is scheduled for 3:00 – 4:00pm on Thursday, March 8. Webinar information will be sent to all registered P&I participants (members and affiliates). CCALAC staff will review meeting logistics, talking points and materials. NACHC will provide an overview of the federal landscape. All P&I participants are encouraged to participate.
CaliforniaHealth+ Advocates will also host a webinar prior to P&I. The date and time will be advertised in the CPCA weekly update and sent to everyone that registers with CaliforniaHealth+ Advocates.
District List – Check Now! CCALAC will provide a list of clinics in each Congressional district. Since the data is from 2016, please check the list and make sure your organization is listed in all the correct districts. Email Sara Watson at [email protected] with updates.
Please contact Joanne Preece at [email protected] or Sara Watson at [email protected] with any questions.
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
9 Member Driven. Patient Focused.
Legislative Information for CCALAC Members
CCALAC Members by U.S. Congress Districts /U.S. House Representatives
District 23 – Kevin McCarthy (R) (House Majority Leader) Antelope Valley Community Clinic Tarzana Treatment Centers
District 25 – Steve Knight (R) Antelope Valley Community Clinic Bartz-Altadonna Community Health Northeast Valley Health Corporation Planned Parenthood Los Angeles Tarzana Treatment Centers
District 27 – Judy Chu (D) ChapCare Chinatown Service Center Garfield Health Center Herald Christian Health Center Planned Parenthood of Pasadena and San Gabriel Valley
District 28 – Adam Schiff (D) All for Health, Health for All All-Inclusive Community Health Center AltaMed APLA Health and Wellness Asian Pacific Health Care Venture City Help Wellness Center Comprehensive Community Health Centers Institute for Multicultural Counseling and Education Services Los Angeles LGBT Center Mission City Community Network Planned Parenthood Los Angeles QueensCare Health Centers Saint Anthony Medical Centers Saban Community Clinic
District 29 – Tony Cárdenas (D) AAA Comprehensive Healthcare Comprehensive Community Health Center El Proyecto del Barrio Eisner Health M.E.N.D. Mission City Community Network Northeast Valley Health Corps Planned Parenthood Los Angeles Valley Community Healthcare
Updated 1.3.18- sw 10 District 30 – Brad Sherman (D) Eisner Health El Proyecto del Barrio Mission City Community Network Northeast Valley Health Corporation Planned Parenthood Los Angeles Tarzana Treatment Centers
District 32 – Grace Napolitano (D) AltaMed Asian Pacific Health Care Venture ChapCare BAART Community Healthcare East Valley Community Health Centers El Proyecto del Barrio Mission City Community Network Planned Parenthood Los Angeles Our Saviour Center / Cleaver Family Wellness Center Southern California Medical Center
District 33 – Ted Lieu (D) Planned Parenthood Los Angeles Saban Community Clinic South Bay Family Health Care Venice Family Clinic Westside Family Health Center
District 34 – Jimmy Gomez (D) AltaMed APLA Health and Wellness Arroyo Vista Family Health Center Asian Pacific Health Care Venture BAART Community Healthcare Chinatown Service Center Clinica Msr. Oscar A Romero Complete Care Community Health Centers Comprehensive Community Health Centers Eisner Health Institute for Multicultural Counseling and Education Services JWCH Institute KHEIR CLINIC Los Angeles Christian Health Centers Northeast Community Clinic Planned Parenthood Los Angeles Planned Parenthood of Pasadena and San Gabriel Valley QueensCare Health Centers Saint Anthony Medical Centers St. John’s Well Child and Family Center
District 35 – Norma Torres (D) East Valley Community Health Center Mission City Community Network Planned Parenthood Los Angeles Parktree Community Health Center
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org 11 District 37 – Karen Bass (D) The Achievable Foundation APLA Health and Wellness Benevolence Health Centers Central Neighborhood Health Foundation Eisner Health Northeast Community Clinic Planned Parenthood Los Angeles St. John’s Well Child and Family Center T.H.E. Health and Wellness Centers UMMA Community Clinic Venice Family Clinic Watts Healthcare Corporation Westside Family Health Centers
District 38 – Linda Sánchez (D) AltaMed ChapCare Family Health Care Center of Greater Los Angeles JWCH Institute Planned Parenthood Los Angeles Southern California Medical Center The Children’s Clinic, Serving Children and Their Families
District 40 – Lucille Roybal-Allard (D) AltaMed BAART Community Healthcare Bienvenidos Community Healthcare Central City Community Health Center Central Neighborhood Health Foundation Eisner Health Family Health Care Centers of Greater Los Angeles JWCH Institute Northeast Community Clinic Planned Parenthood Los Angeles QueensCare Health Centers South Central Family Health Centers UMMA Community Clinic Universal Community Health Center
District 43 – Maxine Waters (D) APLA Health and Wellness Mission City Community Network Northeast Community Clinic Planned Parenthood Los Angeles Saint Anthony Medical Centers St. John’s Well Child and Family Center South Bay Family Health Care T.H.E. Health and Wellness Centers Watts Healthcare Corporation Wilmington Community Clinic
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org 12 District 44 – Nanette Barragán (D) AltaMed APLA Health and Wellness BAART Community Healthcare Eisner Health Harbor Community Clinic JWCH Institute Northeast Community Clinic Planned Parenthood Los Angeles St. John’s Well Child and Family Center South Bay Family Health Care The Children’s Clinic Watts Healthcare Corporation Wilmington Community Clinic
District 47 – Alan Lowenthal (D) APLA Health and Wellness Planned Parenthood Los Angeles The Children’s Clinic Tarzana Treatment Center
Please email Sara Watson at [email protected] with any updates or changes.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org 13 Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece and Becky Lee, Government Affairs
Re: State Budget & 2018 Landscape (Information/Discussion)
This memo provides an overview of the 2018 political landscape in California, including state legislation, budget and changes in the composition and leadership of the state legislature.
State Legislation The State Legislature operates in a two-year bill cycle, and 2018 is the second year. Bills that did not get out of their House of origin in 2017 must move by January 31 or they will effectively be dead. From now until February 16, the Legislature can introduce new bills. Any CPCA-sponsored bills will be introduced prior to this date.
CPCA is exploring a number of possible bills for 2018 including the following: • SB 456 (Pan) is the 2017 bill to allow FQHCs to contract and be reimbursed outside of PPS for “services that follow the patient.” This bill became a two year bill to allow for continued dialog between CPCA and DHCS around the definition of these services. • AB 2053 (Gonzalez), was the consolidated licensing bill from 2016. The Governor signed the bill and it took effect January 1, 2017. CPCA and DHCS have since determined that some of the language does not reflect the intent of the bill with regards to consolidated clinic sites’ ability to bill under the parent site’s PPS rate or alternatively. DHCS is currently requiring all consolidated sites to secure their own PPS rate through the traditional rate-setting process. CPCA is expected to run a bill updating the relevant portions of the bill language. • CPCA has been having exploratory conversations with legislative staff and some members around possible bill ideas related to Adverse Childhood Experiences (ACES) and Trauma Informed Care (TIC). These discussions may result in a bill this year or in future years. • CPCA has also had conversations with offices around bill ideas relating to immigration and access to health care. It is unclear if a bill will materialize from these discussions.
CPCA and CCALAC will also be closely monitoring developments related to two high profile bills from 2017: • SB 562 (Lara & Atkins), the single-payer bill led by the California Nurses Association (CNA). While health centers are supportive of the concept of universal access to health care, SH 562 was not fleshed out enough in 2017 to consider taking a position. Assembly Speaker Anthony Rendon declined to move the bill forward in his chamber last year, citing that lack of specifics and no plan to cover the estimated $400 billion cost. The move to hold the bill angered sponsors who are pushing hard to move the bill in 2018. During the recess, a select committee convened twice to discuss, broadly, the future of coverage in the state, although they did not focus specifically on any one bill. • AB 1250 (Jones-Sawyer) is the county contracting bill that CPCA and CCALAC opposed in 2017. The bill is currently sitting with the Senate Rules Committee, and since it is out of its house of origin, it can remain in its current position 700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
14 until fairly late in the legislative session. Changes in Senate leadership may impact the bill’s prospects and it is possible the sponsoring organizations may be looking at a different approach given the opposition last year. CPCA is messaging to members that there is no immediate urgency to take action on this bill. They will continue to monitor the bill closely and will engage members if/when needed.
CCALAC will monitor the developments of CPCA sponsored bills and new and continuing legislation of interest to members and will bring updates and recommendations to the Policy Advisory Group in the coming months.
State Budget Governor Jerry Brown is expected to present a draft budget (“Governor’s budget”) on January 10. Next, the budget committee in each house will introduce the Governor’s budget proposal in bill form. From March to May, there will be many subcommittee hearings on various pieces of the Governor’s budget proposal. Subcommittees can elect to revise, reject, or accept provisions of the budget bill.
By mid-May we will see an updated state revenue forecast, and a revised version of the budget will be introduced, this is known as the “May Revise.” The Legislature typically waits for the May Revise before final budget decisions are made on major programs.
After the completion of hearings, each budget subcommittee will vote and then send recommendations to the full budget committees. The budget committee of each house will send a revised budget bill to the floor for a vote on its version of the budget bill. Differences between the Assembly and Senate versions of the budget bill will be resolved in a conference committee (and/or in conversations between Senate and Assembly leadership).
Both houses will vote on a final version before sending it to the Governor by June 15. The Governor will then have 12 working days to sign the budget bill. The last couple years, the Governor has not made “blue pencil” changes to the budget passed by the legislature; however, he does have the option to veto budget items before signing.
Budget Outlook In November, the Legislative Analyst’s Office projected that California will have a surplus of $7.5 billion in discretionary reserves for 2018-19. Assemblymember Phil Ting (D, San Francisco), who chairs the Assembly Budget Committee, released a budget blueprint in December that proposes eliminating the legal residency requirements for Medi-Cal, as the state has already done for children up to age 19. Governor Brown, however, is expected to remain fiscally conservative in his January budget proposal. We will be watching closely for proposals related to 340B; CPCA says they do not have a clear indication from the state whether they plan to propose changes to the program again this year.
State Legislature On the Assembly side, three resignations have cost the Democrats their supermajority for the time being. The vacancies could complicate any policy efforts that would take a two-thirds vote in both houses.
Former Assemblymembers Raul Bocanegra (AD 39, Pacoima) and Matt Dababneh (AD 45, Woodland Hills) resigned in the wake of sexual harassment allegations. Former Assemblymember Sebastian Ridley-Thomas (AD 54, Los Angeles) resigned citing serious health issues. The special election to fill AD 39 will be held April 3 and June 5. Special election dates have not been set for AD 45 and AD 54.
In January, Assemblymember Wendy Carrillo (AD 51, Los Angeles) was sworn into the Legislature. Carrillo won a special election and will serve out the term of former Assemblymember Jimmy Gomez, who was elected to Congress in a special election last year (filling the Congressional seat formerly occupied by now State Attorney General Xavier Becerra). Assemblymember Carrillo now sits on the Assembly Health Committee.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
15 In the Senate, Senator Tony Mendoza (SD 32, Artesia) recently agreed to take a one-month paid leave of absence while an investigation is conducted into sexual misconduct allegations made against him.
Senate Pro Tem Transition Senate President Pro Tem Kevin de León announced that Senator Toni Atkins (SD 39, San Diego) is the consensus pick of the Senate Democratic Caucus to succeed him as Senate leader. She will be formally elected in January and a transition will take place later this year. Atkins will become the first woman to ever lead the California Senate.
Committee Changes Expected Resignations, leaves of absence, and new leadership will likely cause some shuffling of committee assignments and Chair positions in both the Assembly and Senate. CCALAC will provide a full update on which members of the Los Angeles delegation hold leadership positions and sit on key committees at the February PAG meeting.
Governor’s Race The 2018 California gubernatorial election will be held on November 6, 2018, to elect the next Governor of California. The top three candidates, in alphabetical order by last name, are state Treasurer John Chiang, Lieutenant Governor Gavin Newsom, and former Los Angeles Mayor Antonio Villaraigosa. A recent LA Times article said that the California governor’s race is likely to be decided in Los Angeles County, where 1 in 4 of the state’s voters live.
Please contact Joanne Preece at [email protected] and/or Becky Lee at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
16 Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC
From: Becky Lee, Policy Analyst
Re: Dental Transformation Initiative: Domain 4 (Information)
Overview The goals of Domain 4 are to increase dental prevention; caries risk assessment and disease management, and continuity of care among Medi-Cal children by Local Dental Pilot Programs (LDPP) using strategies focused on urban or rural areas, care models, delivery systems, workforce, local case management initiatives and/or education. This memo provides an overview of the two LDPP in Los Angeles County.
University of California, Los Angeles UCLA will create the Los Angeles Caries Prevention Program (LA-CPP) with the goal to prevent and manage early childhood caries (ECC), and increase continuity of care for children insured by Medi-Cal and Denti-Cal in Los Angeles (LA) County. This work builds upon a previous First 5 LA initiative.
The LA-CPP aims to activate approximately 1,500 primary care providers and 2,000 clinical support staff to provide early preventive oral health services to 500,000 children ages 0-6 during appropriate well-child visits, utilize referral and patient care tracking enabling technology to facilitate dental home referrals and medical-dental care integration (i.e., LADR), and participate in performance and quality improvement efforts to initiate sustainable local clinical solutions
Participating Entities • Altarum Institute • First 5 LA • Western University • Health Net of California • American Academy of Pediatrics– Chapter 2 • LA Care • California Academy of Family Physicians – LA • Liberty Dental Plan Chapter • Dental Quality Alliance • California Society of Pediatric Dentistry • RAND • Southern California Society of Dentistry for • DataStat Children • LA County Office of Education – Head Start
Overview of program aims and core objectives and activities: Program Aim Core Program Objectives and Activities
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17 Aim 1: Improve oral health for 500,000 • Train 1,600 dental providers in contemporary caries prevention children in Los Angeles County and management and to utilize the Los Angeles Dental Registry (LADR) to receive dental referrals and document caries risk assessments and patient care management plans. • Train 1,500 medical providers to integrate preventive oral health services, conduct caries risk assessments, and to utilize LADR to refer patients to appropriate follow-up care. • Conduct an intensive Quality Improvement Learning Collaborative (QILC) for participating medical and dental providers operating in co-located FQHCs and high-capacity private-sector dentists based on the Institute for Healthcare Improvement (IHI) Breakthrough Series model to support collaborative care improvements for preventive oral health services and care coordination across care settings. Aim 2: Redesign provider incentives to better • Establish a Performance Improvement Continuing Medical support the delivery of appropriate care Education (PI CME) and Maintenance of Certification (MOC) Part IV quality improvement incentive for medical providers that participate in the training program. • Establish a Continuing Dental Education (CDE) incentive for dental providers that participate in the training program. • Introduce payment incentives that encourage increasing preventive services, technology adoption, caries risk assessments and referrals to dental homes. Aim 3: Develop new linkages for early • Increase coordination across programs and engage LA County WIC, intervention and care coordination, and Head Start/Early Head Start programs and other community increase the utilization of existing partners in oral health integration. community systems to combat access- • Build community connections through SmileConnectSM, an online related disparities at the community level. oral health networking platform. • Improve caregiver education and awareness through LA Best Babies Network.
Clinic involvement LA-CPP will develop a communications campaign to recruit medical and dental providers and will outreach to CCALAC. CCALAC will provide updates to member clinics when these efforts are underway.
California State University Los Angeles and University of Southern California Cal State LA and USC are working collaboratively on their Local Dental Pilot Program that will implement a comprehensive approach to increase the proportion of children and young adults (0-20) who receive preventive dental services, establish positive oral health habits in families, increase continuity of dental care, and provide other health and social services to support these goals. They aim to serve 32,400 children and young adults over four years, with a target in service planning areas 3, 4, 6, 8.
Participating Entities • Herman Ostrow School of Dentistry of • El Nido Family Centers University of Southern California • Kaiser Permanente Educational Opportunity • Children’s Hospital Los Angeles- USC University Program Center for Excellence in Developmental • East Los Angeles College Disabilities (UCEDD)
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
18 • California State University Los Angeles Division • Montebello Unified School District of Student Affairs • Family Resource Network of LA County • Clinica Monsenor Oscar A. Romero • Fiesta Educativa, Inc. • Children’s Dental Health Clinic • FUERZA • Public Health Foundation WIC • United American Indian Involvement, Inc. • USC School of Early Childhood Education • Centro de Ninos y Padres • Para Los Ninos • Visionary Youth Center, Hollywood Housing • Boys and Girls Club of Metro Los Angeles Corporation Consortium • To Help Everyone Health and Wellness Centers
Overview of program aims and core objectives and activities: Program Aim Core Program Objectives and Activities Aim 1: Increase access to dental health care • Deploying mobile care teams to the community to provide oral for underserved populations health screenings • Connecting children and their families to local dental homes for continuity of care using an interdisciplinary approach Aim 2: Identify contextual barriers to • Assessing families’ existing resources, capacities and challenges children’s oral health concerning oral health • Developing and implementing protocols to assess families’ values, attitudes, knowledge, and behaviors related to oral health • Integrating this knowledge in the design and delivery of program interventions Aim 3: Increase access to dental health care • Complementing the goals of Aim 1 through specialized outreach for children/youth in the urban American and recruitment strategies Indian Alaska Native urban community • Hiring designated staff to strengthen these efforts • Integrating best practice knowledge from Indian Health Service protocols Aim 4: Utilize findings from the assessment • Developing Individualized Oral Health Care Plans, referenced in Aim 2 • Creating education materials on various topics of relevance to the population that are congruent with the cultural and developmental contexts of the audience • Delivering educational content to target audiences utilizing an interdisciplinary team approach delivering oral health • Educational materials individually and to community groups utilizing mobile technology to • Engage families to practice what they have learned about oral health Aim 5: Increase the involvement of • Developing strategies to educate practitioners about the professionals in related fields (child importance of oral health and its link to general health and development, education, and general health wellbeing care) in raising awareness among their • Educating healthcare providers (pediatricians, OB/GYN’s, primary clients of the importance of preventative and care physicians, nurses, nutritionists, etc.) to deliver and regular maintenance of oral health care in incorporate oral health care into primary care children, youth and young adults
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
19 Aim 6: Disseminate findings from this project to appropriate consumer, professional, and legislative audiences
Clinic Involvement Clinics involved in this project will be a dental home and/or community agency and will provide access to client populations in program sites who will receive interventions.
Contact Becky Lee at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
20 Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC
From: Becky Lee, Policy Analyst
Re: Medi-Cal Changes Effective 2018 and Beyond—Updated (Information)
The following memo includes updates and upcoming changes to Medi-Cal:
FQHC and Acupuncture Visits—Current CPCA has confirmed with DHCS that acupuncture services provided by a licensed acupuncturist have been added to the FQHC visit definition. This change occurred because of the restoration of optional benefits. The provider manual still list the visit must occur by a physician and DHCS has acknowledged this must be updated to reflect the expanded definition.
There has been no public notice, even though this change has been in effect for almost a year (the SPA was approved December 12, 2016). CPCA is working with DHCS now to get out the implementation information immediately. There was an error in how this was communicated, which DHCS acknowledges.
Full Restoration of Adult Dental Benefits—Current Senate Bill 97 (Chapter 52, Statutes of 2017) fully restored adult optional dental benefits that were not restored in May 2014. This policy is effective January 1, 2018. Restored benefits will include, for example: Laboratory processed crowns, posterior root canal therapy, periodontal services, and partial dentures, including denture adjustments, repairs, and relines. The full dental benefits are listed in the Dental Provider Handbook, Section 5, Manual of Criteria, posted on the Denti-Cal website. More information is available on the DHCS Medi-Cal Dental Program website.
Impact to clinics The full restoration of adult dental benefits is expected to have little impact to most clinics on the Medi-Cal side because of the PPS billing structure.
Impact on MHLA CCALAC is in the process of investigating how the restoration of adult dental benefits may impact MHLA dental services. Under the MHLA contract: Contractor shall bill and be paid in accordance with the State’s Denti-Cal Program approved codes and published rates in effect at the time of service, except those codes that require prior authorization or are restricted. Such codes requiring prior authorizations or which are restricted are not covered by the Program.
MHLA is reportedly investigating which, if any, of the new codes are restricted or require prior authorization, in which case they would not be covered under MHLA. CCALAC will provide further updates when they become available.
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
21 Diabetes Prevention Program Established for Medi-Cal—Starting in January 2019 Effective July 10, 2017, Senate Bill 97 (Chapter 52, Statutes of 2017), requires the Department of Health Care Services (DHCS) to establish the Diabetes Prevention Program (DPP) within the Medi-Cal fee-for-service and managed care delivery systems, consistent with the guidelines provided by the Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS). The benefit will be available to eligible Medi-Cal recipients on January 1, 2019. It will include 22 peer-coaching sessions over 12 months, which will be provided regardless of weight loss.
DHCS is working with its Managed Care Plans, the Department of Public Health, Public Health Advocates and other interested stakeholders to discuss policy implications and potential collaborations. DHCS will begin drafting its policy and submit a CMS State Plan Amendment in 2018. To join the stakeholder list and to submit questions or comments, email [email protected].
DHCS is conducting a provider survey to better understand how Medi-Cal providers discuss prediabetes with their patients and to receive any comments or concerns regarding Medi-Cal’s DPP benefit. Take the 10-minute survey here.
Health Home for Patients with Complex Needs (HHPCN)—Coming to Los Angeles County July 2019 The Health Homes Program will serve eligible Medi-Cal beneficiaries with multiple chronic conditions who are frequent utilizers and may benefit from enhanced care management and coordination. Health Homes provide six core services: care management, care coordination (physical health, behavioral health, community-based long term services and supports), health promotion, transitional care, individual and family support, and referral to community and social support services.
The implementation of Health Homes will roll out in phases starting with a group of counties in July 2018. See below for the county implementation schedule. Los Angeles County will begin implementation in July 2019.
Group 1—July 1, 2018 Group 2—January 1, 2019 Group 3—July 1, 2019 • Del Norte • Imperial • Alameda • Humboldt • Lassen • Fresno • Lake • Merced • Kern • Marin • Monterey • Los Angeles • Mendocino • Orange • Sacramento • Napa • Riverside • San Diego • San Francisco • San Bernardino • Tulare • Shasta • San Mateo • Solano • Santa Clara • Sonoma • Santa Cruz • Yolo • Siskiyou
CPCA is leading effort to convene small workgroup of plans and providers to discuss how to best coordinate the execution and delivery of successful pilot.
Adult Vision Services—Pending for 2020 Beginning on January 1, 2020, adult vision services are tentatively restored for adult Medi-Cal recipients. This restoration will require a two-step process, however. The 2017-18 state budget made the statutory changes necessary to restore optometric and optical services, but the Legislature and the Governor will need to allocate funding for this purpose in the fiscal year 2019-2020 budget.
Prop 56 Supplemental Payments
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
22 Prop 56, the tobacco tax passed in November 2016, provided additional state funding earmarked for Medi-Cal and Denti-Cal providers. The state will roll out these additional dollars in the form of “supplemental” payments for a specific set of Denti-Cal codes.
FQHCs will not be eligible for any supplemental payments, including Medi-Cal and/or Denti-Cal fee-for-service or managed care supplemental payments. For more information on Prop 56 Supplemental Payment Methodologies, click here.
Impact to MHLA Dental Services Dental Roundtable members inquired if this will increase the reimbursement rate for MHLA dental services since MHLA rates are tied to Denti-Cal rates. The MHLA Program has indicated that no, because the state is structuring the increased Denti-Cal reimbursements as supplemental, MHLA dental rates will remain unchanged.
Contact Becky Lee at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
23 Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: State Initiatives (Information/Discussion)
This memo provides updates on initiatives occurring at the state level and information on how to engage.
Alternative Payment Methodology (APM) Pilot No new APM updates. The Centers for Medicare and Medicaid Services (CMS) indicated to DHCS in late summer that while the FQHC APM project can moved forward, it cannot do so in a state plan amendment (SPA), it would need to be done through an 1115 Waiver. CPCA engaged legal counsel in order to fully understand the risks and opportunities of pursuing an APM in a waiver. The analysis looked at a spectrum of waiver options and concluded that the safest, most advisable route for the APM to move forward is in a SPA. CPCA has informed the state that we cannot move forward with an APM pilot that includes a waiver at this time. CPCA is advising health centers engaged in CP3 to continue with their transformation efforts. More information is expected at CPCA’s January Board and Committee meetings.
How to Engage CPCA’s Wrap Cap Workgroup meets monthly via webinar. Email Daisy Po'oi at [email protected] to join the group. CPCA’s staff lead on the APM is Andie Patterson, [email protected].
Pay for Performance (P4P) On January 12, 2017, a county health center and hospital in San Mateo lost an appeal before DHCS relating to whether their P4P incentive payments were properly excluded from their Medi‐Cal PPS reconciliation. CPCA is closely monitoring the San Mateo appeal because elements of the San Mateo P4P structure. CPCA is encouraging health centers to “clean up” their P4P incentive contracts and will work in partnership with the regional consortia to reach health centers, health plans and IPAs to educate about the San Mateo situation and encourage “housekeeping” on P4P contracts. CPCA will also work with CAHP and LHPC to educate health plans and provide technical assistance in ensuring that their P4P quality programs pass muster per the criteria CPCA has developed. Once all CPCA member FQHCs and RHCs feel confident that their P4P incentive programs meet the standards, they will consider approaching DHCS to promulgate regulations clarifying the standards for FQHCs and A&I auditors.
How to Engage CCALAC is working with Meaghan McCamman at CPCA to develop a strategy to ensure all FQHCs, health plans and IPAs are engaged. This initiative is expected to occur over the coming year. CCALAC will work with our new Managed Care Advisory Group and our local health plans and IPAs to move this work forward in LA County. Please email Joanne Preece at [email protected] with any questions.
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
24 State Plan Amendment (SPA) Conversations DHCS is proposing changes to the Prospective Payment Reimbursement section (PPS) of the California Medicaid State Plan. For the past year, CPCA and the California Association of Public Hospitals (CAPH) have met biweekly with DHCS to review and share feedback on the components of the proposed SPA.
Timeline for Submitting SPA to CMS CPCA shared in late-December that DHCS is no longer operating on the timeline of submitting proposed language to CMS on productivity standards, 90-day requirement, MFT, and CSOSR by December 31, 2017. The new goal is to submit proposed language on all issues by March 31, 2018.
Productivity Standards, 90-day Requirement and MFTs CPCA is still waiting for DHCS to share their final proposed SPA language on these components.
Change in Scope of Service Requests (CSOSR) DHCS is working on draft proposed language on CSOSR for CPCA’s review. Per recent exchanges with DHCS, CPCA expects the draft language to include: • Clarifying definitions for type, intensity, duration, and amount of services; • Adding an additional practitioner to an existing line of service will not be considered for a Change in Scope (E.g. adding another physician to family practice or adding another pediatrician when you already have pediatricians in your PPS rate will not qualify for a CSOSR); • Adding practitioners because of a facility expansion or adding a specialist (like pediatrician) for the first time will still qualify as a CSOSR; • A full 12 months of activity before a CSOSR can be filed (CPCA was successful in getting a retro effective date, the effective date of the CSOSR will be retro to the first day of the 12 months of activity); • Productivity standards will be applied to CSOSR; • Clarifying language for implementation of EHR/EDR as a CSOSR event; and • Expanded language clarifying the 2.5% threshold for a deleted service or square footage area of a facility.
CPCA was reportedly successful in getting DHCS to remove two of their proposals that had strong opposition. DHCS’ proposed changes will not include: • A 3-year period to complete a CSOSR audit (it will stay at the current 90 days). • Adjustment to every clinic’s PPS rate based on the most recent audited home office allocations, regardless if every clinic was under audit.
Four Walls CPCA had the first discussion with DHCS on the “four walls” issue on January 4. “Four walls” is shorthand for where PPS can be billed. PPS can be billed inside the four walls of a health center, but there is ambiguity around if/when FQHCs can bill for FQHC services provided to Medi-Cal beneficiaries outside of the four-walls of an FQHC site. According to DHCS, this issue is part of the SPA negotiations because they believe the statute is being interpreted in varying ways and they wish to add clarity to ensure the rules are understood and followed appropriately by both the state and health centers. DHCS is working on draft proposed SPA language as it relates to 4-walls and will share it with CPCA once available.
How to Engage DHCS has cancelled or postponed recent meetings with CPCA and CPCA in turn has cancelled recent SPA update webinars. CPCA’s next SPA webinar is currently scheduled for January 24. Email Daisy Po'oi at [email protected] to join the distribution list and request the calendar invite. Please send comments, questions and feedback for DHCS to Ginger Smith at [email protected].
Please contact Joanne Preece at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
25 Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: Covered California Updates (Information/Discussion)
This memo provides information and updates pertaining to Covered California (Covered CA).
Deadline for February 1 Coverage Extended to January 19 Covered California informed partners and consumers on Friday that the plan selection deadline for a February 1, 2018 coverage start date has been extended to Friday, January 19. Changes made after January 19 to applications in a Pending enrollment status with a February 1 coverage start date will push the applicant’s coverage start date forward to March 1. Consumers who select plans between January 20 and January 31 will have coverage with a start date of March 1, 2018. After the close of Open Enrollment on January 31, consumers will need to experience a Qualifying Life Event (QLE) in order to apply for coverage.
The CEC/PBE Help Line schedule has been updated to reflect the service center availability, holiday closure, and extended hours of operation throughout the remainder of Open Enrollment.
Impact of Tax Reform Law Covered California emailed Community Enrollment Partners with information regarding the impact of the recently passed federal tax reform law. • Benefits related to consumers’ Covered California coverage, including financial help to reduce monthly premiums, and consumer protections, such as pre-existing conditions, have NOT changed. • The individual mandate penalty remains in effect for 2018 coverage. See tax penalty and exemptions for more information. • The only change is the tax penalty will no longer be in effect beginning in 2019.
Please contact Joanne Preece at [email protected] with any questions.
26 Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC
From: Becky Lee, Policy Analyst
Re: LA County Initiatives (Information/Discussion)
CCALAC continues to work on the following county initiatives:
Whole Person Care-Reentry As mentioned in previous meetings, organizations can contract with the Whole Person Care-Reentry program through the DHS ICMS Master Agreement process. As of right now, there is only one member clinic contracted through ICMS for the WPC-Reentry. After some delay, they are receiving clients.
In addition, CCALAC and WPC-Reentry are working together on a non-financial MOU for clinics that would like to participate in WPC-Reentry without contracting through the DHS ICMS Master Agreement process. The purpose of the non-financial MOU is for the WPC-Reentry program to serve their clients and coordinate medical appointments for them. This non-financial MOU could facilitate two types of collaboration between a clinic and WPC-Reentry program:
1. Co-locating a county community health worker (CHW) in a clinic. 2. Assigning a county CHW based in one of the eight WPC Regional Coordinating Centers to a specific clinic.
CCALAC recommended the following items to be addressed in the non-financial MOU: • Eligibility criteria for non-financial MOU • Data sharing • Care coordination definition and activities • Space • Caseload • Staffing • Supervision • Referrals and feedback loops • Access standards/ Clinic appointment slots • Trouble shooting • IT requirements • Case conferencing
Next steps In January, WPC will develop the draft non-financial MOU and CCALAC will review. CCALAC will engage members in the review process as well. 700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
27 Homelessness The next Homeless Health Advisory Committee meeting is on January 30. DHS Housing for Health Street Outreach Team will come to discuss their strategies on multidisciplinary outreach teams, which some member clinics participate in. More updates to come next month.
Prevention and Population Health Task Force The Department of Public Health is now accepting self-nominations for 2-year appointments (spring 2018 – spring 2020) to the Community Prevention and Population Health Task Force (Task Force). The Task Force functions like a County commission and is responsible for promoting health, equity and community well-being in Los Angeles County.
Now that the LA County Health Agency has launched the Center for Health Equity, the Task Force will serve as its advisory body. Task Force Members will weigh in on public health issues in the Community Health Improvement Plan. If you are interested in serving on the Task Force, instructions for applying and a self-nomination form are available at ThinkHealthLA.org. The application process includes submission of an application form, resume and three professional references, all of which are due by February 5, 2018.
If you have any questions or would like to request assistance with the application process, please contact Yeira Rodriguez at (213) 288-8023 or by email at [email protected].
Contact Becky Lee at [email protected] with any questions regarding LA County Initiatives.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
28 Member Driven. Patient Focused.
Date: January 8, 2017
To: Policy Advisory Group, CCALAC
From: Becky Lee, Policy Analyst, and Sara Watson, Event Coordinator
Re: Los Angeles Safety Net Integration Summit
As part of the Behavioral Health Task Force’s efforts to promote strengthened partnerships amongst primary care and behavioral health providers, CCALAC and LA’s Departments of Mental Health and Public Health cohosted the LA Safety Net Integration Summit on December 13, 2017. Over 100 primary care, mental health and substance use treatment providers attended.
The Summit opened with a panel discussion on unique challenges and best practices on coordinating care in the delivery of behavioral health services featuring Venice Family Clinic, Alma Family Services, and DPH Substance Abuse Prevention Control (SAPC) program. They discussed how organizations can better coordinate primary and behavioral health services internally and with external partners. Speakers also highlighted the importance of participating in local health coalitions to network, facilitate referrals, and learn about other community services.
Participants also met with other providers in their Service Planning Area (SPA) to discuss building, rekindling, and reinforcing local collaborations to serve community members. Each SPA group identified challenges, best practices and resources needed to support collaboration with external partners. Please refer to the following document for more detailed notes.
Next steps With the robust information collected from the SPA breakout sessions, CCALAC and the Behavioral Health Task Force will discuss the development of tools or resources to promote collaboration of primary care, mental health and substance use treatment services.
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
29 LA Safety Net Integration Summit SPA Break Out Sessions Group Challenges Strategies (Relationship Building) Collaboration Resources Health neighborhoods, takes active hands-on workforce support, supervision, organized intern/ SPA 1 Beacon network poor in AV Deepen relationships navigation role student placement Not enough LPHAs access, community family care Find the money engage clergy grant writing support Intake paperwork, efforts by HN, no avoiding Case conferences, 1 SUD counselor, 2 parole, 3 Focused workgroups, DM Depression, ODS, transportation, AVRC has, union station Revenue stream and carve our hoops CODC pep talks Get hospital buy-in, AV Palmdale interoperable records MFT Billing Alternative resource court Juvenile court Warm handoffs to MH (built into schedule) Veteran's court (estes)
SPA 2 -a Organizational Capacity, staffing funding Convening Prioritizing attending meetings within SPA Coalitions Using technology, different providers, different Funding to upkeep coalitions and centralized (Sara) Silos- too much focus on one's own mission networks "One Degree" SPA and Health neighborhood meetings systems Cohesive list of all providers and available No real thinking outside the box Centralized system to track progress resources , Set in existing network contacts Diversion services Expansion of VANS, SAPC, SBAT - bed availability Need to involve all organizations in meetings and Having funding follow priorities - "money where communications mouth is" Implement 1 Degree program Insurance- coverage options and treatment 1 Degree! , or something like the CASC and is up Ex. GR versus Medi-Cal and SUD treatment Health Neighborhood meetings to expand to Introduce Directors to collaborate and share SPA 2- b Staff turnover leads to decrease in collaboration other providers including medical, DMH bring in Affiliation agreements/MOUs/ SDAs referrals Communication and lack of time, distance Panel with LAUSD Average rating for collaboration: 2 (1-5 scale) Outreach Competing priorities Affiliation agreements with MH agencies Materials/Brochures Cultural considerations, access to services, perceived safety, immigration status, workforce SAPC SPA specific meetings to build relationships Health Neighborhoods and MOUs Knowing what other agencies do to make Create intro videos for families to reduce stigma referrals and help engage clients for community partners Turnover plan, institutional Knowledge Diversity of clients/ ability for agencies to serve specific populations Information sharing - consents Speaking the same language as other providers I.e. LAUSD, DMH vs SAPC vs DHS
Collaboration Ratings: STAR= 2.5 (STAR --> SPA 3 a Provider time (Case discussion) Proactive career ladders/ On boarding/ training Grandview) Need a directory Have IBHIS (DMH), required forms, call Time to build relationships Interns SPIRIT= 4.0 center/dedicated person Competing priorities Collaborate on grants Grandview= 3.0 (Grandview --> Hillsides) Community fairs/conferences Lack of MOUs Outreach resource Hillsides = 4.0 Need data systems talking Knowing who to go to (resources and contacts) MOUs and referring relationships Heritage = 4.0 (Heritage --> STAR) Need directory/profile- way to know and connect Geography Increase community clinic and MH services All Inclusive = 3.5 Advertising new programs and providers Communicate that there is Medi-Cal coverage Turnover of employees/New clinicians and access (for appts.) AltaMed = n/a 211 Los Angeles - next level Competition for grants, IP Data sharing Medi-Cal & SA - needed to get the word out Switching PC w/Medi-Cal Outreach, community, health neighborhood More funding for collaboration Housing - SHARE
30 County weighing in on best practices SPA 4- a Funding lack of or restricted, tied to funders prioritiesSystemizing relationships so not dependent on singleStart person at top to with person major systems Overloaded, so much info to digest, always moving Makingtarget priority bigger than just on person - org cultureSPA Specific meeting with CEO/CFO to prioritize prioritiesex. County providing direction on how to share records High need pt. population, resources sparse for Homeless and transitional housing SUD, SDOH Find the right partner with commitment that matchesInvite yours funders so they see funding needs LANES? MH/SUD Component, integration committee High Turnover , makes relationship building difficultInnovative tech solutions, data warehousing Identify/Share best practices, highlight successes Data- what are the priority needs? Create a shared language, develop group norms Data and info sharing across organizations with partners Learn from existing research Tech solutions for patient engagement Be as creative as your reimbursement will allow Cmn from county integration committee or other Provider Staff burnout ex. Telehealth, home visits depts. about their strategic plan, resources Shared language Data informed Central place to share Space, lack thereof, building design, segregation of services "priority of the month" Dedicated person for relationship building SPA 4-b SPA 4 is huge! Focus on needs Systematizing -face to face meetings Resource library Internal - staff challenge/ workflow Successful referrals/follow-up/ experience (trial andCommunity error) Outreach Dedicated person for follow-up relationship building Capacity/ Case management Networking/remembering conversations/ building connectionsSharing resource centers (online resource library) Internal team, additional support Exchanging information in internal meetings, streamlining process Collaboration needs to account for productivity Need for peer specialist/dedicated staff protocol, pooling contacts in a common file/drive Interdisciplinary collaboration and prioritizing it! Navigator certification/ Fellowship programs Regular meetings to check on existing providers/ outdated Huddles Funding Go to community meetings Funding and space Scope --> referrals challenges/ follow-up Data sharing Defining/Clarifying what collaboratives look like for providers and patients Data sharing Competition Burnout Big list with primary contact, 1degree.org, DMH SPA 4-C Paperwork, certifications SPA monthly BH meetings (DMH) 2nd Thursday 1:30-2:30pm)Site visit with a patient, just show up LA VANS Regular meetings , service provider meetings, Regular meetings , service provider meetings, Billing ACHSA, LGBTQ Organization meetings ACHSA, LGBTQ Organization meetings Collaboration with housing Time: coordination, meetings, streamlines, Help with paperwork for folks expanding providers Community Outreach practices, how to models or mentors Research other collaborations and invite self (DV, List of each clinic's language capacity across EHRs don’t talk to each other Victims of crimes) services Siloed systems People Connections/Networking, pass it on to othersList of each clinics services, who does what Releases List of meetings by SPA across services Access: SES, language, trans inclusive services, insurance, wait time, intersections Scopes of work and professional development
SPA 5 HIPPA Health Neighborhoods Regularly schedule case conferences Shared grant writing SAAC meetings, relationship building via phone, Follow-up client referring agency and referred agencyin-person, small group Regional training for therapists/CM, etc. Input on agenda for shared collaborative meetings Capacity, slots for clients, lack of detox beds Youth resource team/ St. Josephs Center, care coordinationShared intake and other forms MOU/Formalized agreements Strategic planning for regions to develop data Language limitations, not enough diversity Collaborating on grants together sharing (DACAR?) Regional trainings Navigating funding streams/insurance challenges Westside Anti-Violence Authority (WDVN) Request DMH to develop a centralized database of Healthclients Neighborhoods Complicated rigid criteria- which provider takes what funding Co-location (E. Eviction clinic) Co-location INN plan 2 (DMH funded) Trauma informed care
31 Inability to/Challenges of billing for preventative Awareness of openings, slots of services, services Pick up the phone centralized information Co-Location How to serve/prioritize service needs of (CHs/Clts.- clients?) with multiple diagnosis Outreach to grassroots organizations Service availability tool through SAPC, 211, DMH Centralized awareness of service openings Shared database (CHs/Clts.- clients?) data Training for therapists to better asses health and sharing SA needs, group training and cross training Share resources directory Develop centralized patient database regionally Psychiatry
Residually uninsured, need benefits counselor to Specialist referrals, have a preferred list, est good More efficient follow-up calls for specialist SPA 6 -a manage workflow relationships to get responses back referrals MOUs, transportation, appts Limited staffing, paperwork Opening up limitations on eligibility, being flexible Warm handoffs are key to connect client to Change MyHealthLA to include MH visits Understanding PH overlaps w/MH, use more CES system might be a billing barrier for providing Better movement between MH tiers, send back consistent criteria for evaluation, limit treatment coordinated care to PCP - complex system is confusing to patients episodes SPA level list servs on resource hubs (1-degree) Community Hub to share resources, timely live Rule/regs are not aligned, pot of money that Address housing, connections needed to address Pain management, participation of managed care, MSOssystem, 1Degree, 211, Health Fair follows a person social stressors Funded C management at FQHCs, target Regular meetings for collaboration, only DMH, Data sharing development of relationships good mix is needed CES lead and how to coordinate Referrals based on plan assignment/network, not Better communication to inform multi- Greater collaboration between DPH/DMH/DHS convenient / geography disciplinary teams to meet on patients (private on -EHR coordination Greater communication/collaboration with Transportation-APL benefit homeless sector, eligibility for literally homeless Funding and eligibility criteria not aligned Using garages for housing, partial solution Lots of collaboration, but still silos; not integrated with money and info sharing Cross-agency communications is needed Time WIN app- youth shelter connections/trafficking, Specialist referrals (ECW) + report backs on data Funding: More responsive funding opty, SPA 6-b No time, funding, staffing, turnover MOU, put it in writing More opportunities to convene and build relationshipswhere/what oppty out there how to write grants (rated 3) Small organizations are stretched Call to make referral and follow-up Need to align needs --> mutual benefit to collaborateFunding to help in billing limitations (i.e. same day) Recruiting correct staff money, safety, location, Need resources to bill non-clinical services like population served Engage leadership, decision makers Align shared missions/understanding of goals collaborative activities Meetings outside business hours, lunches, Philosophy/Perspectives vary Philosophy of care=crisis vs. proactivity --> align with like organizations dinners to build relationships Clear understanding of who does what, i.e. Web based communications, skype, web/ex Lack of sharing information/ resources guides service providers and capacity meetings for case conferences Collaboration based on personal relationships, Listen and understand one another, which go away with turnover communicate around complex difficult points Convene the conveners Unawareness of what other organizations do No MOUs, formal arrangements/ trust Not enough substance use treatment services Unclear expectations
SPA 7 No inpatient psych hospitals for adults Highest number of school-based collaborations 120Attend + 17 school conferences districts and meetings, serendipity Integrated funding like Riverside Outreach focus-staff "point of spear" based on strategic Lack of coordination between psych in patient and outpatient service planning and targeting More of these (Integration Summit) discussions No notification system electronic or otherwise SE LA Health Neighborhood Personal relationships, churches, Whittier Examples of best practices, case studies Outreaching is everybody's business, productivity is not No integrated funding model Alma Family Services/AltaMed integrated services atjust all billing levels Equity in resources, geographic DMC Certification, CCMHC - 8 States not CA, Same day billing limitation from Medi-Cal Adjust to culture in their home Need resources- Universal screening - PHQ/ Audit certified community MH Centers
32 SE LA Health Neighborhood, hoping PIH/ Kaiser Electronic health records, regular case present, conferencing, along with SUD providers, lack of detox - Innovations funding Systematic culture shift at systems level develop relationships, more MOUs Schools, parents, community-go beyond service providers Need more education and culture change of MOUs, formal meetings hospitals of integrated care
Having this Integration Summit, having a big SPA 8 Demand > Supply Grant seed money to initiate collaboration pause for exchange of business cards Money for space Need health plan support finding providers (mild Expand OHCA (Org HC agreement), shared elect to moderate) Money to seed development of agreements regardingrec/consult data exchange Money for care coordination/case management Expand resources, Lawyers, EHR considerations, Lack of formal systems for collaboration/referrals Single consent, single privacy notice consultants Local comm re WPC/LANES, 1 Degree Timeliness for release, consent forms Health Neighborhood meetings Money for space LB city engagement in those conbves Help with recruitment, essential for collaboration Data/Info sharing, info back from SU) Familiar with insurance networks, elegibity for enrollmentMoney for care coordination/case management to have appropriate staffing WPC - strategic approach with in existing IS --> IBHIS Co-locations, PC in MH facility, took years collaborative- if/how to engage with WPC Supply, providers all services Feeling of "lack of access" works both ways, MH Single shared EHR Centralized system to see SU access, wait lists, need to call) Gatherings, luncheons, reach out directly feels not enough PC access patient info, ?HMIS too many systems Culture and approach to care, release/ privacy Understanding of each other's systems, FQHCs, requests, policies, MH protections not same for Cold calling/visiting, how can we help your patients MH Staggered care, at different stage of rel w/diff Training across systems on who can give meds, 4 agencies/orgs Colabitition (written this way) walls, medi-cal rules, OSHPD Treatment timeliness Develop friendships/relationships Bring resources into agency, internal- 211, yelp database
OTHER Real time picture of capacity, weekly meetings HIPAA - consent Services across SPAs, housing elsewhere Availability of other services, housing Care coordination, who is on first? Filling Service gaps, complex patients, e.g. inpatientMATCH rehab and UP -->medical CATCH UP Warm handoffs not working well(external), depends on entity Facilitating transitions
33 Member Driven. Patient Focused.
Date: January 2, 2018
To: Policy Advisory Group, CCALAC
From: Sara Watson, Event Coordinator
Re: LADPH & CCALAC Members Service Planning Area (SPA) Meetings (Information/Discussion)
CCALAC continues to hold meetings in each of Los Angeles County’s Service Planning Areas (SPAs) to provide an opportunity for members and the new LADPH Director, Dr. Barbara Ferrer to get to know each other and discuss issues specific to each region. Feedback from members and LADPH staff has been overwhelmingly positive, with most expressing a desire to convene at the regional level more often.
Detailed notes and action steps are being provided to participants following each meeting. A complete summary, including next steps, will be jointly developed by LADPH and CCALAC staff at the conclusion of the series of meetings.
Upcoming Meetings:
SPA 8|South Bay Date: Wednesday, January 10, 2018 Time: 3:00 – 4:30pm Location: Century Villages at Cabrillo: 2000 San Gabriel Ave, Long Beach, CA 90810
SPA 5|West LA Date: Friday, January 26, 2018 Time: 9:30am-11:00am Location: Venice Family Clinic Simms/Mann Health and Wellness Center: 2509 Pico Blvd. Santa Monica, 90405
SPA 3|San Gabriel Valley Date: Thursday, Feb 1, 2018 Time: 3:00 – 4:30pm Location: APHCV-El Monte/Rosemead Health Center: 9960 Baldwin Place El Monte, CA 91731
SPA 2|San Fernando Valley Date: Friday, February 2, 2018 Time: 3:00-4:30pm Location: San Fernando Health Center: 1600 San Fernando Rd. San Fernando, CA 91340
Please email Sara Watson at [email protected] to RSVP.
700 South Flower Street, Suite 3150, Los Angeles, CA 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
34 Highlights from Completed Meetings:
SPA 7|East LA Date: Wednesday, December 13, 2017 Host: JWCH • Discussion of existing LADPH initiatives in SPA 7 –members expressed desire to learn more about the Health Neighborhoods and discussed SPA 7 current STI efforts. • Members raised SPA 7 specific concerns including eligibility for their large undocumented population/ DACA clients needing health care. • Discussion of improving doctor and patient relationship and training providers on culturally sensitivity.
SPA 4|Metro LA Date: Thursday, December 7, 2017 Host: Eisner Health • Discussion of existing LADPH initiatives in SPA 4 – Health Neighborhoods and STI Initiatives. • Discussion of cultural sensitivity and strategies for improving staff training, including the use of promotoras. • LADPH discussed the importance of outcomes to force accountability, especially in an environment of “initiative fatigue” or “overload” • Members raised SPA 4 specific concerns including extreme density and sometimes not being “sick enough” to draw down resources, members pointed to the need for prevention funding and alternate criteria. • Robust discussion of food insecurity and food deserts and the need for safe spaces for people to exercise and get outside. All agree on the futility of telling patients to eat well and exercise if their environment is not conducive. • Discussion on trauma informed care, different strategies and training approaches and upcoming work in this area by both health centers and LADPH.
SPA 6|South LA Date: Thursday, November 30, 2017 Host: South Central Family Health Centers • Discussion of building a culture of trust between agencies, overcoming competitiveness which arises from misaligned incentives, in order to best meet the needs of patients and the community. • Discussion of the barriers patients face that are created by provider and initiative funding streams – the way the system is set up is placing a large burden on patients. • Discussion of LADPH Trauma Informed Community pilot in Willowbrook, surrounding MLK. • Members shared issues (past and present) around lack of involvement of grass-roots providers in county initiatives and need for consideration of how resources that flow to the county are allocated. Are we best serving residents? • Discussion regarding future convenings at regional level to better get to know each other and build relationships.
SPA 1|Antelope Valley Date: Wednesday, November 29, 2017 Host: Tarzana Treatment Center • Discussion of SPA 1 specific politics and how to leverage relationships in areas that are more conservative. • Requested DPH to advocate on behalf of community-based organization when the County distributes funds. • Discussed public health and safety concerns regarding homeless shelters in SPA 1. • Expressed desire for future region-specific meetings to share information and best practices and to break down silos between organizations.
Please email Sara Watson at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
35 Member Driven. Patient Focused.
Date: January 8, 2018
To: Policy Advisory Group, CCALAC Clinical Advisory Group, CCALAC Chief Operating Officers Roundtable, CCALAC
From: Joanne Preece, Assistant Director of Policy
Re: Managed Care (Information/Discussion)
CCALAC continues to work with our members and key partners to address and understand issues related to managed care. The following is a brief update on our progress to-date and a call for members to a) raise managed care concerns with us, and b) join a new Managed Care Advisory Group, if interested.
State Level Managed Care Convening On January 16th, CCALAC Clinical Services, Member Programs and Government Affairs staff will participate in a half-day strategy convening with our statewide and regional consortia counterparts. The aim is to identify common issues and strategies to address them with: • Department of Health Care Services • Department of Managed Health Care • Health Plans • IPAs • Clinics and Health Centers We will report out to members on the results of this convening at our next PAG meeting.
CCALAC Engagement with Plans/IPAs CCALAC staff regularly meet with L.A. Care and Health Net. Our regular Managed Care Planning Roundtable meetings will begin in early February with each of the health plans. Recent discussion topics include health center funding cliff impact, SB 323 implementation, status of the APM pilot, health plan APM readiness activities, operational issues (as listed above), social determinants of health (PRAPARE), CCALAC’s homeless workgroup, Whole Person Care, and patient experience and workforce initiatives. CCALAC also engages monthly with Health Care LA IPA.
LA County Managed Care Advisory Group – Seeking Participants! To better understand member issues in managed care, CCALAC is starting a Managed Care Advisory Group. To date, we have representatives of Health Care LA IPA, Altamed IPA and members affiliated with other IPAs participating. This group will help inform our discussions with the health plans, as well as CPCA. We will meet via phone monthly or on an ad hoc basis. Members interested in participating should reach out to Joanne at [email protected].
36 Managed Care Issues Issues we are currently tracking include:
Provider Activation Ensure health plans activate credentialed providers in a timely fashion.
P4P (education) Ensure every health plan and IPA has an incentive program that works for FQHCs (excludable from reconciliation)
P4P (expansion) Maximize plan investment in provider quality incentives to improve HEDIS scores and patient satisfaction Health APM Educate plan partners to implement APM outside of waiver Plans Supervision Requirements Clarify requirements for supervision and ensure health plans uniformly enforce these requirements. increase the accuracy of encounter data and prove quality of CCHC model; increase capture (and sharing??) of data to be able to better Data capture and analysis manage assigned patients and to identify high cost and utilization patients.
Unseen patients reduce the impact of assigned but unseen patients on quality scores & capitation through improving outreach efficacy
Procurement (weighing in) Ensure plans selected in procurement are dedicated partners of CCHCs in ensuring all patients have access to high quality care Quality increase the number of plans and amount of resources dedicated to metrics/IHA/standardization participation in IHA's standardized Medi-Cal P4P program
Behavioral health Impact waiver process to ensure county MHP network adequacy/timely integration/1915(b) waiver access, ensure better coordination between MCOs and MHPs, carve in to MCOs in counties where services are being poorly managed work with other advocates and interested parties to develop a robust Provider manual/APL stakeholder process for APLs and other subregulatory changes coming process DHCS from DHCS Assignment algorithm ensure that plans are incentivized to maximize default assignments to safety-net providers Network Adequacy ensure that patients have timely access to robust networks of high Standards quality providers at a reasonable distance Reduce the delays and paperwork associated with the Medi-Cal Enrollment efficiency enrollment process. Create a process for enrollees to select a plan and PCP at point of enrollment Create a process for auto reassigning patients who seek care at a place Unseen patients (regulatory other than their assigned PCP change)
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
37 Timely Access Reporting ensure FQHCs are treated as a single PCP by site DMHC/CDI Merger Oversight ensure maximum investment of undertakings are in safety net /cchcs Network Adequacy Standards Improve monitoring, streamline for providers
Provider directory streamline for providers
Please contact Joanne Preece at [email protected] with any questions.
700 South Flower Street, Suite 3150. Los Angeles. C.A. 90017 T (213) 201-6500. F (213) 553-9324. www.ccalac.org
38 My Health LA (MHLA) Program Renewal and Reenrollment Rates Report Fiscal Year 2017 - 18
The Renewal Rate is defined by the percentage of MHLA Participants who completed a renewal before their term date and received an additional 12 months of MHLA coverage. Reenrollment Percentage is defined as the percentage of MHLA Participants who were disenrolled for failure to renew their application but re-enrolled in the subsequent 12 months. This metric is updated monthly with a 12 month “lookback” period beginning in August of each fiscal year.
MHLA Program Renewal and Reenrollment Rates Did not Renewal Rate – Reenrolled After Reenrolled MONTHLY Renewal Cohort Month / Renewal was Renewal was attempt to Percentage Disenrollment* Percentage RATE Total due to renew approved denied renew approved 7/2017 6370 2759 61 3550 43% 1167 18% 62% 8/2017 7758 3744 74 3940 48% 1196 15% 64% 9/2017 11669 6687 98 4884 57% 1593 14% 71% 10/2017 19016 11788 165 7063 62% 2192 12% 74% 11/2017 15090 8848 96 6146 59% 1140 8% 66% 12/2017 01/2018 02/2018 03/2018 04/2018 05/2018 06/2018 59,903 33,826 494 25,583 56% 7,288 12% 69% *Each month’s reenrollment number will be updated monthly to reflect new reenrollments within fiscal year 2017-18.
Notes: • “No longer eligible” means the Participant attempted to renew but was not renewed because they became eligible for Medi-Cal, moved out of County, etc. • Cohort Month = the month in which a participant must complete a renewal to continue coverage in My Health LA.
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