CCS Reform: Potential for Improvement and Potential for Pitfalls Ann-Louise Kuhns

CCS care is carved out of managed Medi-Cal. The “Carve-Out” has been extended four times since 1993 and ends in The “Carve-Out” can create confusion and lack of coordination of care How do CCS & Medi-Cal Interact? 2 CCS condition diagnosed by a provider CCS eligibility determined by county Responsibility for medical care splits Hospital/Special Care Center (FFS Reimbursement) CCS Case Manager (County employee) Specialty Physician (FFS Reimbursement) CCS Condition Medi-Cal Managed Care providers All other care Medi-Cal Managed Care Plan The “Carve-Out”

CCS Reform: The What and Why Department of Health Care Services proposes to shift responsibility for CCS from state and county CCS programs to Medi-Cal managed care plans. Medi-Cal managed care would become responsible for approving services and selecting providers that CCS children would be referred to. Having all medical care be the responsibility of a single entity (Medi- Cal managed care plan) should improve care coordination and accountability.

Why Worry? National literature review conducted in 2010 does not show that Medi-Cal managed care improves outcomes State Auditor report suggests improvements needed to State’s oversight of Medi-Cal managed care plans. 2016, UC Davis Center for Population Health Improvement concludes that there Medi-Cal managed care plan quality varies and there is little data to show outcomes have improved over time. Stanford analysis suggests that from CCS counties with a “carve-in” did worse in following up on children discharged from the hospital than counties with a CCS carve-out.

Building in Protections Will Improve Opportunities for CCS Reform Success Don't allow managed care plans to use standards that are less rigorous than CCS Proceed slowly & cautiously in shifting responsibility for CCS to managed care Require a thorough evaluation before allowing expansion statewide Require strong state oversight & an effective appeals process Engage families as advisors and community liaisons Keep funding for CCS separate to ensure it is spent on CCS care Require "continuity of care" so CCS children can keep seeing their doctors

Questions?

Ann-Louise Kuhns President & CEO California Children’s Hospital Association (916)