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Published byAbigayle Simpson Modified over 9 years ago
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1115 Waiver Proposals California Children’s Services Program
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Medi-Cal Managed Care Plan Fully-capitated, at risk Knox-Keene licensed plan providing services to entire population All children with all CCS eligible medical conditions Disenrollment from Healthy Families plan Mandatory enrollment
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Medi-Cal Managed Care Plan Managing and/or coordinating all of the child’s health care needs Benefits Medically necessary services to treatment the ‘whole child’ Same range of currently covered services Primary and preventive care Medically necessary services to treat the CCS condition Care coordination Outreach and Assessment
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Medi-Cal Managed Care Plan Provider network CCS approved providers Hospitals Individual providers Special care centers
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Medi-Cal Managed Care Plan Medical home and care coordination Personal physician Active family participation in decision- making Information technology Care coordinators to support physicans
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Medi-Cal Managed Care Plan Medical home and care coordination Participation in quality improvement activities Providers Patients and families
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Medi-Cal Managed Care Plan Administration 24/7 nurse advise line Member services Member education Quality monitoring and improvement
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Specialty Health Care Plan Fully capitated, at risk Knox-Keene licensed plan only providing services to children with CCS eligible medical conditions Managing and/or coordinating all of the child’s health care needs Mandatory enrollment Disenrollment from Medi-Cal managed care plan Healthy Families plan
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Specialty Health Plan Provider network CCS approved providers Hospitals Individual providers Special care centers
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Specialty Health Care Plan Benefits Medically necessary services to treat the ‘whole child’ Same range of currently covered services Primary and preventive care Medically necessary services to treat the CCS condition Care coordination
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Specialty Health Care Plan Medical home and care coordination Personal physician Active family participation in decision- making Information technology Care coordinators to support physicans
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Specialty Health Care Plan Medical home and care coordination Participation in quality improvement activities Providers Patients and families 24/7 access to care Reimbursement Quality monitoring and improvement
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Specialty Health Care Plan Administration 24/7 nurse advise line Member services Member education Member outreach and assessment
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