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DHCS Rural Managed Care Expansion Stakeholder Webinar

On August 28, 2012, the Department of Health Care Services (DHCS) held a stakeholder webinar about the Medi-Cal rural managed care expansion. The webinar began with a review of the request for application (RFA), and DHCS officials indicated that they are working to release the RFA in September. DHCS representatives also reviewed some of the stakeholder comments that they had received. Perhaps most notable was the desire of stakeholders in Del Norte, Humboldt, Lassen, Modoc, Shasta, Siskiyou, and Trinity counties to create a County Organized Health System (COHS) model operated by Partnership Health Plan. The stakeholder input that officials summarized is included in a document available for download at the end of this blog entry.

DHCS officials mentioned that plan readiness would be their chief concern in awarding contracts, and that they plan to examine the use of telehealth to better serve beneficiaries in rural areas.

Officials clarified that this managed care expansion would not affect dual eligibles unless their counties were under a COHS model of managed care. Enrollment in managed care is only mandatory for this population in the COHS model, but it is otherwise voluntary.

DHCS representatives provided a document that outlined which services would be carved out from managed care in the different models. DHCS staff also introduced a mock-up of the forthcoming website for the rural managed care expansion. (Documents containing the list of carved-out services and the mock-up of the website are available for download at the end of this post.) Staff also mentioned that dental services would not be affected by the expansion.

DHCS staff additionally clarified that Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Indian Health Centers would still be paid prospective payment system (PPS) rates as a wrap-around payment in addition to the payments they would receive from managed care plans.

Officials indicated that they would extensively analyze fee-for-service utilization data to define appropriate payment levels and network adequacy, as well as to ensure continuity of care during the transition.

Materials from the meeting are available for download below.

Revised Workgroup Charter Revised Workgroup Charter.pdf Webpage Mock-Up Webpage Mock-Up.pdf Carved Out Services Carved Out Services.pdf Stakeholder Comments Summary Stakeholder Comments Summary.pdf Rural Managed Care Workgroup Meeting Summary (8/28) Rural Managed Care Workgroup Meeting Summary (8/28).pdf

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