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1115 Waiver Proposals California Children’s Services Program.

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Presentation on theme: "1115 Waiver Proposals California Children’s Services Program."— Presentation transcript:

1 1115 Waiver Proposals California Children’s Services Program

2 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

3 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

4 Medi-Cal Managed Care Plan Provider network  CCS approved providers Hospitals Individual providers Special care centers

5 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

6 Medi-Cal Managed Care Plan Medical home and care coordination  Participation in quality improvement activities Providers Patients and families

7 Medi-Cal Managed Care Plan Administration  24/7 nurse advise line  Member services  Member education Quality monitoring and improvement

8 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

9 Specialty Health Plan Provider network  CCS approved providers Hospitals Individual providers Special care centers

10 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

11 Specialty Health Care Plan Medical home and care coordination  Personal physician  Active family participation in decision- making  Information technology  Care coordinators to support physicans

12 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

13 Specialty Health Care Plan Administration  24/7 nurse advise line  Member services  Member education  Member outreach and assessment


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