Cal MediConnect Martha Smith Chief Program Officer, Dual Eligible Demonstration Health Net, Inc. Paul Van Duine Senior Director of Provider Network Operations L.A. Care Health Plan USING THIS POWERPOINT TEMPLATE • Pasting text from one PowerPoint to another – 2003: Go to Edit> Paste Special> Unformatted Text – 2007: Home> Paste> Paste Special> Unformatted Text • Choose one of the three covers and delete the others • Text slide with call out box on the left is optional – Do not expand the body/bullet text box • Charts can expand across the full width of the slide • Footer text has only the Slide Number. If you wish to add a Footer Title or the Date go to: – 2003: Insert> Slide Number or Date and Time> Click check boxes – 2007: Insert> Header & Footer The menu box includes Date and Time, Slide number, and Footer (be sure to enter the name in the box below) • Color Palettes: The SHP colors are in the default palette when choosing the color CAPG Southern California Contracts Committee Meeting Annual joint meeting with HASC October 3, 2013 1

Agenda Background and General Update LA Care Network Strategy Coordinating Behavioral Health Health Net Network Strategy

California is implementing a Duals Demonstration under the Coordinated Care Initiative The passing of the Coordinated Care Initiative (CCI) is a catalyst for three key changes in California healthcare in the 8 selected counties: Mandatory enrollment into a Medi-Cal health plan California CCI Legislation Mandatory transition of Medi-Cal Long Term Services and Supports (LTSS) to Medi-Cal health plans Basic Background The passage of the Coordinated Care Initiative (CCI) in 2012 transforms California's Medi-Cal (Medicaid) care delivery system by beginning the process of integrating delivery of medical, behavioral, and long-term care services. It provides a road map to integrate Medicare and Medi-Cal for people in both programs, called “dual eligible” beneficiaries. The CCI was enacted through SB 1008 (Chapter 33, Statues of 2012) and SB 1036 (Chapter 45, Statues of 2012). Coordinated Care Initiative Cal MediConnect: A voluntary three-year demonstration program for Medicare and Medi-Cal dual eligible beneficiaries will coordinate medical, behavioral health, long-term institutional, and home-and community-based services through a single health plan. The CCI provides state authority for Cal MediConnect. The MOU executed in March 2013 with the federal Centers for Medicare & Medicaid Services (CMS) provides federal approval. Managed Medi-Cal Long-Term Supports and Services (LTSS): Nearly all Medi-Cal beneficiaries age 21 and older, including dual eligible beneficiaries, will be required to join a Medi-Cal managed care health plan to receive their Medi-Cal benefits, including LTSS and Medicare wrap-around benefits. Most Medi-Cal beneficiaries will have to join a Medi-Cal health plan for benefits like: LTSS (see following slides) Non-emergency transportation (medically necessary) Incontinence supplies Some medical equipment that Medicare doesn’t cover. Dually Eligible beneficiaries can join the Duals Demonstration and get ALL of their healthcare from one health plan (Medicare and Medi-Cal benefits). Dually Eligible beneficiaries can opt out of joining a health plan for the Medicare portion of their services. They will have to remain in a health plan for their Medi-Cal services. Voluntary transition of Dual Eligibles into a Demonstration plan (passive, with opt-out)

As a result of CCI, what changes for Medi-Cal Benes? Most Medi-Cal beneficiaries will have to join a Medi-Cal health plan for benefits like: Long Term Services and Supports (LTSS) Non-emergency transportation (medically necessary) Incontinence supplies Some medical equipment that Medicare doesn’t cover. Dually Eligible beneficiaries can join the Duals Demonstration and get ALL of their healthcare from one health plan (Medicare and Medi-Cal benefits) Dually Eligible beneficiaries can opt out of joining a health plan for the Medicare portion of their services. They will have to remain in a health plan for their Medi-Cal services

California Demonstration Sites Eight counties have been selected based on current State authority*: Los Angeles (DE pop. 374 K, eligible: 271K) Health Net LA Care San Diego (DE pop. 75 K eligible: 51K) Molina Care 1st Community Health Group Orange (DE pop. 73 K eligible: 57K): CalOptima San Bernardino (DE Pop. 54 K eligible: 36K) Inland Empire Health Plan Molina Healthcare Riverside (DE Pop. 50 K eligible: 34K) Santa Clara (DE Pop. 50 K eligible: 35K) Anthem Blue Cross Santa Clara Family Health Plan Alameda (DE Pop. 42 K eligible: 31K) Alameda Alliance for Health San Mateo (DE pop. 15 K eligible: 11K) Health Plan of San Mateo Slide 12 375 duals in LA, Slide 6 374 K. Stay with 374K. Remove double page numbers on all

What will the Program Look Like? Benefit Plan Configuration Medicare: Parts A, B, and D benefits covered Medi-Cal: All Medi-Cal services currently required in managed care services Long-Term Supports and Services Skilled Nursing Home and Community-Based programs Supplemental benefits: Vision, Transportation (optional dental) Coordination: With mental health and substance use programs Other “non-benefit” community based programs

What will the Program Look Like? Who and How? Who Will Be Included in Cal MediConnect? Beneficiaries eligible for both full benefit Medicare and Medi-Cal in the CCI counties Populations excluded from the Demo Partial-Benefit Dual Eligibles Beneficiaries with other health coverage (not including Medicare Advantage or partial coverage plans) Beneficiaries under age 21 Existing ESRDs (enrollment will be consistent with MA today) Beneficiaries with developmental disabilities receiving services through Regional Centers or a State Developmental Center Enrollees of selected waiver programs Beneficiaries living in zip codes not covered by managed care

What will the Program Look Like? Timing The Demonstration will begin no sooner than April 1, 2014 Enrollment Enrollment for the eight counties in the CCI will have different approaches Los Angeles  enrollment will phase in over 12 months with the first three months being a period of only active choice enrollment Active/elective enrollment April – June 2014 Passive enrollment by birth month beginning July 2014 – March 2015 200,000 enrollment cap San Diego  enrollment will phase in over 12 months by birth month beginning April 2014 San Mateo and Orange  commence all at once on April 2014 Passive enrollment with a voluntary opt out for the Medicare benefit only Beneficiaries can opt out of Cal MediConnect If beneficiaries don’t choose to opt out or select a health plan, they will be automatically enrolled by the State into either L.A. Care or Health Net Current D-SNP and MA enrollees are passively enrolled in January 2014 Beneficiaries can still opt out later even if they get automatically enrolled Financing: Capitated payment models with 3-way contracts between CMS, CA Department of Health Care Services (DHCS), and health plans

Coordinated Care Initiative Requirements The legislation establishing the CCI contains many projections for beneficiaries covering: Meaningful Information of Beneficiary Rights and Choices: Notices sent at least 90, 60, and 30 days prior to enrollment (coordinated with CMS) Continuity of Care People can continue to see their Medi-Cal providers for 12 months and Medicare doctors for 6 months Self-Directed Care: People will have the choice to self-direct their care, including being able to hire, fire, and manage their IHSS workers Appeals & Grievances: DHCS is working with CMS on a coordinated appeals process Strong Oversight & Monitoring: Evaluation Coordinated with DHCS and CMS