COORDINATED CARE INITIATIVEQUARTERLY STAKEHOLDER MEETING

JULY 10, 2014

Pamela Mokler, Vice President, LTSS, Care 1st

Vicki Macedo, Program Specialist, HHSA AIS

Mark Sellers, Asst. Deputy Director, HHSA AIS

COUNTY OF SAN DIEGO

Health & Human Services Agency

Aging & Independence Services

Behavioral Health Services

Children’s Services

Public Health Services

Self-Sufficiency Support Divisions

AGING & INDEPENDENCE SERVICES

Area Agency on Aging/ADRC Adult Protective Services/Senior Mental Health Team In Home Supportive Services Multipurpose Senior Services Program ( & “MSSP-Like”) Long Term Care Ombudsman Call Center PA/PG/PC Veteran Services Senior Nutrition Community Services – IG, CM, RSVP, Health Promotions Community-Based Care Transitions Program

SAN DIEGO CCI HEALTH PLAN OPTIONS

AB 1040- CA Long Term Care Integration Pilot Project (LTCIP) –

Planning Committee formed 1999 with the following mission:

“Develop a comprehensive, integrated continuum of acute and long-term care (health, social, and supportive services) for the aged, blind, and disabled (ABD).”

Began with 50 participants – now over 800 members strong:Multiple Medical, Behavioral Health, Social Service Providers, Consumers, Caregivers and Advocates

LTCIP

ADRC

San Diego

Network of Care

CCI Advisory Committ

ee

Community-

based Care

Transitions

Program

www.sdltcip.org

SAN DIEGO CCI ADVISORY COMMITTEE Cal MediConnect Health Plans established to

provide them recommendations about operations, access to services, outreach & education, etc.

Communications Sub-Group: coordinated outreach to consumers, providers, physicians, pharmacists, hospitals/clinics, etc.

Coordination Guide Sub-Group: coordination between the Health Plans & IHSS/PA & MSSP

SAN DIEGO CCI ADVISORY COMMITTEE MEMBERSHIP

Cal MediConnect Health Plans

HHSA/AIS Public Authority Dual-eligible

consumers Hospital Association SD Medical Society Consumer Center HICAP

CBAS PACE Advocates Community Clinics HCBS Providers SNF Harbage Consulting

Firm Behavioral Health Disability Rights

IHSS COORDINATION GUIDE DEVELOPMENT

Workgroup: All 5 Health Plans, AIS IHSS Managers/Program Staff, Public Authority

Commitment: A single protocol

CCI Advisory Committee: review &

approval

HEALTH PLAN PERSPECTIVE

IHSS is a core service that is needed to keep members with ADL/IADL deficiencies living in the community

We need to make it easier for our members to transition from hospital to home with IHSS services, than it is to transition from a hospital to a SNF! – especially on a Friday evening! We need expedited IHSS assessments and extended hours.

All IHSS recipients’ needs are not the same! Programs need to be FLEXIBILE to meet changing needs of members/clients.

IHSS COORDINATION GUIDE KEY ELEMENTS

Application Process flow chart – especially helpful for the Health Plans at the beginning of the process

Call Center and Web Referral processes – giving them the contact information they would need and letting them know what type of information they will need to provide on referrals.

The establishment of “expedited” referral criteria and the development of an “expedited” referral process 

IHSS COORDINATION GUIDE KEY ELEMENTS

Differentiating between “expedited referrals” and situations where “urgent service referrals” are appropriate

Explaining form requirements and how the Health Plans may play a key role in assisting the member with this

Providing phone numbers to each district office, as well as a zip code list of which office handled which zip code, so that Health Plans could contact the clerical staff at each office with questions.

EXPEDITED IHSS APPLICATIONS

Expedited applications will be processed within 10 business days of receipt by the IHSS Social Worker. Health Plans will be contacted if there are problems that prevent or delay the process. Examples could include but are not limited to the following: Refusal of services by the Health Plan

Member

Failure to cooperate or provide required information

EXPEDITED CRITERIA

Someone who has critical care

needs and: No one is available to

provide in-home care

Is unsafe in his/her own home

Is at risk of hospitalization (or re-hospitalization) without additional assistance

Someone who has critical care needs:

That cannot be fully met without additional assistance from IHSS

Is unsafe in his/her own home

Is at risk of hospitalization (or re-hospitalization) without services in place

ADDITIONAL EXPEDITED INDICATORS

Other indicators for an expedited referral could include:

A diagnosis of a terminal illness.

A rapid decline in health.

Client Is transitioning out of a hospital, and no one is available to provide in-home care or the care needs can’t be fully met.

If necessary the IHSS Social Worker may conduct a needs assessment in the hospital. Once the Member transitions home, the IHSS Social Worker must complete an in-home needs assessment within 10 business days from the date of discharge.

APPROVAL/DENIAL ON EXPEDITED APPS A Notice of Action (NOA) will be issued

providing information on services and the number of hours authorized, or the reason for any denial of services

IHSS will inform the Health Plan of any ineligibility to IHSS services

The client has 90 days from the date of the Notice of Action to file an appeal

HEALTH PLAN PERSPECTIVE: IMPORTANT ACCOMPLISHMENTS

AIS was willing to be flexible AIS was willing to expedite referrals for

Plan members transitioning from hospital or SNF to home

Agreement from all 5 Health Plans, Public Authority and AIS on a single, core protocol

Shared value for the consumer-driven foundation of the IHSS program

CCI IMPLEMENTATION CHALLENGES & OPPORTUNITIES

Partnerships/relationships are everything!! Broad coordination is critical! Training, re-training…and more training! Slow beginning for IHSS – applications

(standard and expedited) and CCT’s – Why? Continuous efforts at delivering information

and resources to consumers & IP’s HICAP/Consumer Center for Health

Education & Advocacy calls – steady, but settling, burst at start of the month