DHCS implements period of "deemed eligibility" for Cal MediConnect plans Effective September 1, 2015, Cal MediConnect will have the option to offer a one- or two-month period of “deemed eligibility,” defined as a grace period, to beneficiaries that lose Medi-Cal eligibility due to a change in circumstance. Cal MediConnect plans have the option to, but are not required to, offer this “grace period." According to the 2013 Medicare-Medicaid Plan Enrollment and Disenrollment Guidance, a Cal MediConnect plan may choose to provide a one- or two-month period of deemed continued eligibility for individuals who lose Medicaid eligibility, if the individual is reasonably expected to regain Medicaid eligibility within one or two months. Plans that choose to offer this grace period must continue to offer the full continuum of benefits. Effective with September enrollment, if the plan is offering this grace period and the beneficiary is deemed eligible, the eligibility verification through Medi-Cal’s automated eligibility verification system (AEVS) will reflect a new status under the “Eligibility Message” at the very end: SUBSCRIBER LIMITED TO SERVICES COVERED BY HEALTH PLAN: (HCP Name) (HCP Telephone): (HCP) XXX, (HCP phone number) 1-800-XXX-XXXX. If the beneficiary does not re-qualify within the plan’s period of deemed eligibility, their enrollment will be terminated. To better understand which Cal MediConnect plans are offering the grace period, the California Medical Association asked the plans about their timeframe for potential deeming of Cal MediConnect beneficiaries: Plan Name Offering Deemed Eligibility (Yes/No) Number of Months Anthem Blue Cross Yes 1 CalOptima Yes 1 Care 1st Yes 1 Community Health Group Yes 1 Health Net Yes 1 Health Plan of San Mateo Yes 2 Inland Empire Health Plan Yes 1 LA Care Yes 1 Molina Yes 1 Santa Clara Family Health Plan Yes 2 (beginning Oct. 1, 2015) If a plan opts to offer the grace period and the patient does not regain eligibility, the plan is responsible for payment for services incurred during the grace period. However, best practice is to always verify eligibility as close to, if not on, the date of service as possible and keep the AEVS confirmation in the patient’s medical record. September 8, 2015 Medi-Cal Cal MediConnect 0 0 Comment Read More »
CMA publishes duals project FAQ The 2012 California state budget authorized a three-year demonstration project that transitions dual eligibles into managed care and allows them to receive medical, behavioral, long-term supports and services and home-and-community-based services coordinated through a single health plan. The Cal MediConnect project was approved in 8 counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. No more than 456,000 individuals will be allowed to enroll into Cal MediConnect. Los Angeles’ enrollment will be capped at 200,000. To help physicians and their patients better understand the program, the California Medical Association (CMA) has published "Cal MediConnect Physician FAQ: What you need to know about keeping your patients and billing for the dual eligible population." The FAQ is available free to members in CMA's online resource library. For more details on Cal MediConnect, visit www.calduals.org and www.cmanet.org/duals. Contact: Lishaun Francis, (916) 551-2554 or lfrancis@cmanet.org. October 21, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
DHCS releases duals project toolkit The California Department of Health Care Services (DHCS) has published a physician toolkit to help providers and their patients understand the Cal MediConnect duals demonstration project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups, including the California Medical Association. The toolkit contains several documents, including an overview and several fact sheets that include information on the following: How to submit crossover claims to Medi-Cal plans Contracting with Cal MediConnect plans How crossover claims are processed for Medi-Cal managed care patients Continuity of care Sample patient letters (for contracted and non-contracted physicians) The toolkit also confirms that if a patient opts out of Medicare Advantage and remains with fee-for-service Medicare, the Medi-Cal managed care plan cannot require authorizations for physician services as the secondary payor (see the Coordinated Care Initiative Overview fact sheet for more information). It should be noted that no change has been made to the rules governing the billing of the 20 percent Medicare copay for dual eligible patients. It continues to be unlawful to bill dual eligible patients. In limited circumstances, Medi-Cal may cover Medicare coinsurance and copays. Such "crossover" claims for Medicare coinsurance and copays should be sent to the patient's Medi-Cal plan (see Payment for Medicare Physician Services Under the CCI fact sheet for more information. Physicians should also be aware that the new Cal MediConnect "Choice Form" that is now online is only a visual sample, indicating patients must use their unique forms sent to them in their "Plan Choice" booklets. Lastly, if you or your patients have questions that the plan cannot respond to, you can always contact the Cal MediConnect Ombudsman at (855) 501-3077 (TTY 1-855-847-7914), Monday through Friday, 9 a.m. to 5 p.m. For more details on Cal MediConnect, visit www.calduals.org and www.cmanet.org/duals. October 6, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
DHCS revises Cal MediConnect 'Choice Forms' After advocacy from the California Medical Association (CMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MediConnect duals demonstration project and remain in traditional Medicare fee for service. The project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that transitions a large portion of the state's dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara. The previous Choice Forms did not make it clear how a patient could opt-in or out of the program and DHCS was criticized for its lack of transparency in the documents. CMA was very vocal in requesting DHCS change the forms to clearly state the patient’s options. The state hopes the new forms provide clarity and make it easier for patients to make the choice between opting into the Cal MediConnect program or opting out of it. The Spanish language forms were also revised. The updated forms are found here and should be included in new Plan Choice books for newly enrolled members. The plan Choice Form is located in the middle of the Plan Choice Book. DHCS will also soon be finalizing a physician toolkit to help physicians and their patients understand the project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups. The various pieces of the toolkit will be released individually as they are finalized. Watch DHCS’s weekly Coordinated Care Initiative updates for more information. September 11, 2014 Medicare Department of Health Care Services, DHCS, Dual Eligible, Medicare, Cal MediConnect 0 0 Comment Read More »
Cal MediConnect lawsuit unsuccessful Last week, the Sacramento Superior Court denied a request to delay implementation of the Cal MediConnect project. In a last minute challenge to the program, the Los Angeles County Medical Association (LACMA) joined a coalition of plaintiffs, including three Los Angeles independent living centers, to file a lawsuit in Sacramento Superior Court to stop the implementation of the project. The Cal MediConnect project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that will see a large portion of the state's Medicare/Medi-Cal dual eligible beneficiaries transition to managed care plans. The project will impact approximately 456,000 dual eligible beneficiaries in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara. The lawsuit alleged that Cal MediConnect is not legally authorized because DHCS failed to obtain timely federal approval of the demonstration project as required under the state law establishing the project. Second, the lawsuit alleged that there are deep flaws with the implementation of the project thus far, including problems with the notices to beneficiaries and the enrollment form. Specifically, the lawsuit alleged the notices were not written at a 6th grade reading level as required by law and in addition, the enrollment form is too confusing to meaningfully provide an opt out choice for beneficiaries. The California Medical Association (CMA) was not a named party in the lawsuit. However, CMA believes the lawsuit raises legitimate issues about the rollout and implementation of Cal MediConnect, specifically concerning adequate notice and information to affected beneficiaries and providers. In an unrelated move, the Department of Health Care Services (DHCS) has delayed the implementation of the Cal MediConnect project for Alameda and Orange counties until July 2015. CMA will continue to work with DHCS and other stakeholder groups to identify suggestions for improvement in the Cal MediConnect implementation and rollout. To see the current timeline for implementation of Cal MediConnect program, click here. August 8, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
