The Future of CCS: SB 586 and Protections for Children and Families Laurie A. Soman Lucile Packard Children’s Hospital/CRISS Family Voices of California Summit February 27, 2017

CCS Redesign: SB 586 and the Whole Child Model As DHCS Proposed to Move Responsibility for Care Management from CCS to Managed Care Plans in 21 “COHS” Counties Families and Advocates Asked….. Are There Critical Elements of CCS that Must be Preserved for Children and Families? Coalition of Advocates, Family Groups, and Providers Agreed..... Yes, There Are

CCS Redesign: SB 586 and the Whole Child Model CCS Coalition Advocates (e.g. Children Now, Western Center on Law and Poverty, SEIU, Children’s Defense Fund, Hemophilia Council, March of Dimes) Family Organizations (Family Voices of CA) Provider Groups (e.g. CA Children’s Hospital Association, Children’s Specialty Care Coalition, American Academy of Pediatrics) County CCS Programs CRISS and Other Child-Focused Organizations

SB 586 Advocates Coalition

CCS Redesign: SB 586 and the Whole Child Model Coalition Developed Principles for Implementation of Whole Child Model – April, 2016 Implementation in Limited Number of Counties that Must Meet Robust Readiness Requirements Independent Evaluation Before Expansion to Additional Counties Maintenance of CCS Standards in ALL Counties, with or without Redesign/Whole Child Model Plan Requirement to Use Staff with Appropriate Pediatric Training and Experience for Care Management Plan Accountability via CCS-Appropriate Access and Quality Standards and Benchmarks

CCS Redesign: SB 586 and the Whole Child Model Coalition Developed Principles for Implementation of Whole Child Model – April, 2016 Strong Oversight of Implementation and Plans by DHCS with Timely Release of Access and Quality Data Plans Paid Distinct, Separate CCS Rate Payment Rates Adequate to Recruit and Retain Providers with Appropriate Pediatric Expertise Requirement for Robust Youth and Family Engagement Continuity of Care for Length of Child’s Condition or 12 Months, Whichever Is Greater

CCS Redesign: SB 586 and the Whole Child Model Coalition Goal: State Legislation Coalition Sought Champion and Legislative Vehicle for Redesign Protections Based on Principles SB 586, Senator Ed Hernandez, Chair, Senate Health Committee Negotiations with DHCS by Senator Hernandez, Staff, and Coalition Advocates for Final Bill SB 586 Signed by Governor in September, 2016

CCS Redesign: SB 586 and the Whole Child Model What’s in the Bill: How Well Do Protections for Children and Families Match Advocates’ Principles? Implementation in Limited Number of Counties: 21 “COHS” Counties with Readiness Requirements  Evaluation Required Before Expansion Beyond 21 COHS Counties: Independent Evaluation Required and Current CCS Managed Care Carve-Out Now Ends 1/1/2022  Maintenance of CCS Standards: State Must Retain CCS Quality Standards and Provider Approval Process and Children Must Receive Treatment from CCS-Approved Providers– including Special Care Centers and Tertiary Hospitals-- According to State CCS Guidelines 

CCS Redesign: SB 586 and the Whole Child Model What’s in the Bill: How Well Do Protections for Children and Families Match Advocates’ Principles? Plan Requirement to Use Staff with Appropriate Pediatric Training and Experience: Plans Must Ensure Expert Case Management via Family Option for Continued Access to CCS Nurse Case Manager or Plan Staff with Clinical Experience with CCS Population or Pediatric Patients with Complex Medical Conditions.  Plan Accountability via Access and Quality Standards and Benchmarks: DHCS to Develop Pediatric Performance Standards, including Outcome Measures  Plans Must be Paid Distinct, Separate CCS Rate: DHCS to Develop and Pay Plans Rate Specific to CCS Children and Youth 

CCS Redesign: SB 586 and the Whole Child Model What’s in the Bill: How Well Do Protections for Children and Families Match Advocates’ Principles? Provider Payment Rates Adequate to Recruit/Retain Providers: Rates Must be Equal to or Greater than Current CCS Rates  Requirement for “Meaningful” Family Engagement at State and Local Levels: Participation Ensured in State CCS Advisory Group and Plan-Level Family Advisory Councils  Continuity of Care with Current Providers for Length of CCS Condition: 12 Months Continuity with Family Right to Appeal Directly to DHCS Director If Plan Denies Continuity Beyond 12 Months X Strong Oversight of Implementation and Plans by DHCS with Timely Release of Access and Quality Data: DHCS Creation of Readiness/Monitoring Requirements with Annual Reports 

CCS Redesign: SB 586 and the Whole Child Model Additional Protections for Children and Families in SB 586 Children and Youth Retain Access to CCS Maintenance and Transportation Services Children Have Continued Access to Medications Already Prescribed Even If Not in Plan Formulary Medical Therapy Program Remains with County CCS Program Plans Must Provide Families with Information on Managed Care, How to Navigate Plan Processes, and How to Contact Local Family Support Organizations Plans Must Identify and Track Children/Youth with CCS Conditions while in Whole Child Model and Track Youth Aging into Adult Medi- Cal for Three Years into Adulthood

CCS Redesign: SB 586 and the Whole Child Model What Happens Now? 12-Month Delay in Implementation Means More Time to Plan Opportunities for Family Engagement Review CCS Enrollee Materials (e.g. Notices, FAQs) for Content and Family-Friendliness Participate in Plan-Level Family Advisory Councils Assist Families Seeking Extended Continuity of Care Monitor Access to Current CCS Nurse Case Manager Participate in Evaluation (e.g. Family Experience and Satisfaction)