ventura county medi-cal managed care commission … · committee member weckl asked about nurse...
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Meeting Agenda available at http://www.goldcoasthealthplan.org
_____________________________________________________________________________________________ ADMINISTRATIVE REPORTS RELATING TO THIS AGENDA AND MATERIALS RELATED TO AN AGENDA ITEM SUBMITTED TO THE COMMISSION AFTER DISTRIBUTION OF THE AGENDA PACKET ARE AVAILABLE FOR PUBLIC REVIEW DURING NORMAL BUSINESS HOURS AT THE OFFICE OF THE CLERK OF THE BOARD, 2220 E. GONZALES ROAD, SUITE 200, OXNARD, CA. IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT, IF YOU NEED SPECIAL ASSISTANCE TO PARTICIPATE IN THIS MEETING, PLEASE CONTACT REBEKAH AT 805/981-6691. REASONABLE ADVANCE NOTIFICATION OF THE NEED FOR ACCOMMODATION PRIOR TO THE MEETING (48 HOURS ADVANCE NOTICE IS PREFERABLE) WILL ENABLE US TO MAKE REASONABLE ARRANGEMENTS TO ENSURE ACCESSIBILITY TO THIS MEETING
Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba
Gold Coast Health Plan Provider Advisory Committee Meeting
2240 E. Gonzales, Suite 200, Oxnard, CA 93036
Tuesday, November 19, 2013 3:30 p.m.
AGENDA
CALL TO ORDER / ROLL CALL PUBLIC COMMENT 1. APPROVE MINUTES
a. Regular Meeting of February 12, 2013
2. INTRODUCTIONS
a. Provider Relations Updates b. Review and Approval of PAC Charter Policy & Procedures
i. Policies and Procedures
ii. Committee Appointment Application Form
iii. Provider Advisory Committee Application Evaluation Tool
iv. Provider Advisory Committee Charter
c. 2014 Schedule d. Health Care Reform and Medi-Cal Expansion
Rebekah EcclesTypewritten text3. APPROVAL ITEMS
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Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan November 19, 2013 Provider Advisory Committee Meeting Agenda (continued) PLACE: 2240 E. Gonzalez, Room 200, Oxnard, CA TIME: 3:30 p.m.
Meeting Agenda available at http://www.goldcoasthealthplan.org
_____________________________________________________________________________________________ ADMINISTRATIVE REPORTS RELATING TO THIS AGENDA AND MATERIALS RELATED TO AN AGENDA ITEM SUBMITTED TO THE COMMISSION AFTER DISTRIBUTION OF THE AGENDA PACKET ARE AVAILABLE FOR PUBLIC REVIEW DURING NORMAL BUSINESS HOURS AT THE OFFICE OF THE CLERK OF THE BOARD, 2220 E. GONZALES ROAD, SUITE 200, OXNARD, CA. IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT, IF YOU NEED SPECIAL ASSISTANCE TO PARTICIPATE IN THIS MEETING, PLEASE CONTACT REBEKAH AT 805/981-6691. REASONABLE ADVANCE NOTIFICATION OF THE NEED FOR ACCOMMODATION PRIOR TO THE MEETING (48 HOURS ADVANCE NOTICE IS PREFERABLE) WILL ENABLE US TO MAKE REASONABLE ARRANGEMENTS TO ENSURE ACCESSIBILITY TO THIS MEETING
4. INFORMATIONAL ITEMS a. November 2013 Town Hall Meetings b. Third Quarter 2013 Quarterly Network Report c. Geo Access Report
COMMENTS FROM COMMITTEE MEMBERS ADJOURNMENT
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Provider Advisory Committee Meeting Minutes
February 12, 2013 - Page 1 of 3
Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan (GCHP) Provider Advisory Committee Meeting Minutes
February 12, 2013 (Not official until approved)
CALL TO ORDER Provider Network Manager Sherri Bennett called the meeting to order at 3:45 p.m. in Suite 200 at the Ventura County Public Health Building located at 2240 E. Gonzales Road, Oxnard, CA 93036. ROLL CALL COMMITTEE MEMBERS PRESENT Antonio Alatorre, Clinicas del Camino Real, Inc. Kimberly Bridges, RN, BSN, Centers for Family Health, Community Memorial Health System Alger Brion, Maywood Acres SNF Mark Minnis, Livingston Memorial VNA Home Health & Hospice Clive Salmon, DPM, Podiatrist Joyce Weckl, RN, Certified Nurse Midwife EXCUSED / ABSENT COMMITTEE MEMBERS C. Albert Reeves, MD, Ventura County Health Care Plan John Roughan, Simi Valley Hospital & Health Care Services Brett Zaer, Superior Mobility Joan Araujo, VCMC Ambulatory Care Administrator STAFF IN ATTENDANCE Michael Engelhard, CEO Debbie Rieger, Interim IT Director Dr. Charles Cho, Chief Medical Officer Jenny Palm, Health Services Director Sherri Bennett, Provider Network Manager Traci R. McGinley, Clerk of the Board PUBLIC COMMENT None.
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Provider Advisory Committee Meeting Minutes
February 12, 2013 - Page 2 of 3
1. APPROVE MINUTES August 22, 2012 Committee Member Minnis moved to approve the Meeting Minutes of August 22, 2012. Committee Member Brion seconded the motion. The motion carried. Approved 6-0. 2. INTRODUCTIONS Staff and Committee Members were introduced. 3. INFORMATION ITEMS
a. Corrective Action Plan
CEO Engelhard reported that Gold Coast Health Plan (GCHP) received a Corrective Action Plan (CAP). Department of Health Care Services (DHCS) primarily concerns are regarding areas in operations that need improvement: The IBNR, claims inventory / processing, refunds, leadership / staffing, and financing. CEO Engelhard highlighted some of the areas, stating that the claims processing has been progressively attacked and the number of claims have been drastically reduced. Claims processing turn around needs to be improved. The TNE is the biggest concern, but the State also wishes the Plan to identifying additional cost savings through utilization measures. The last piece of the CAP is the submission of encounter data; as there has been formatting issues. GCHP has responded to these issues and believes the Plan is showing great progress and is becoming stable. Discussion was held regarding the Plan working with a recovery vendor and how that process will work with the Providers.
b. Ventura Transportation System Provider Network Manager Bennett advised the Committee Members on the RFP process completed by GCHP. The Plan now has a full risk contract with the vendor for transportation services. Members must contact the vendor and then the vendor is required to follow the guidelines.
c. ACA PCP Rate Increase Provider Network Manager Bennett reviewed the presentation with the Committee and noted that the Plan is waiting for additional guidance from the State on some of the items, as well as the fee schedule. It will be imperative that Providers provide encounter information as the Plan will be required to reconcile with the Providers quarterly. Committee Member Weckl asked about Nurse Practitioner services to which Provider Network Manager Bennett responded that she would research those services and provide the information to Committee Member Weckl.
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Provider Advisory Committee Meeting Minutes
February 12, 2013 - Page 3 of 3
d. Healthy Families Plan Transition Provider Network Manager Bennett advised that effective January 2013 they are individuals are no longer enrolled into Healthy Families and by the end of the year it will be fully phased in. Eligibility will be determined by Human Services and benefits will mirror Medi-Cal Services. Committee Member Alatorre raised concern that GCHP is only recognizing Ventura County Mental Health for mental health services, but it should be any Medi-Cal provider such as Clinicas. Discussion was held regarding the contracting and the phase-in period for continuity of care. Provider Network Manager Bennett advised the Committee that the Plan is setting up meetings with the Networks to discuss the issues and the contracts. GCHP will be doing 90, 60 and 30-Day notices as well as media outreach. The desire is to have minimal or no disruption in coverage. COMMENTS FROM COMMITTEE MEMBERS Committee Member Alatorre noted that VSP treats large groups differently than small groups. Interim COO Undlin was to check into the situation, but Clinicas has not heard back regarding this issue. Provider Network Manager Bennett noted that she would check into the matter. CMO Cho responded that he was not aware of the issues with VSP, but will work with Committee Member Alatorre to work through the issues. Committee Member Minnis raised concerns regarding services for home health and office visits and asked if there is written documentation. Health Services Director Palm responded that all Home Health services require authorization. Committee Member Minnis stressed that there were certain visits that were allowed. Health Services Director Palm noted that the information is on the website and she would provide the information to him. ADJOURNMENT Meeting adjourned at 4:40 p.m.
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Policies and Procedures
Title:
DRAFT- Provider Advisory Committee Charter
Policy Number: XXXXXXXXXXXX
1
Purpose:
The Ventura County Medi-Cal Managed Care Commission (VCMMCCC) enabling ordinance 4409 (April 2010) and the California Department of Health Care Services, Medi-Cal Managed Care Division, both require the establishment of a Provider Advisory Committee (PAC). The ordinance requires, at a minimum, that this committee meet quarterly and make recommendations, review policies and programs, explore issues and discuss how the plan may best fulfill its mission.
Policy: A. The PAC will consider and analyze situation of concern and bring its
recommendations to the Ventura County Medi-Cal Commission (VCMMCC) for consideration.
B. For the purpose of this policy, PAC shall also be referred to as advisory committee.
C. VCMMCC encourages provider involvement in the GCHP program.
D. Advisory committee members shall recuse themselves from voting or from decisions where a conflict of interest may exist.
E. The composition of the PAC shall reflect the diversity of the health care consumer and provider community. All advisory committee members shall have direct or indirect contact with GCHP Members.
F. In accordance with ordinance (4409, April 2011) VCMMCC established the PAC. The PAC is comprised of ten (10) voting members, each seat representing a constituency that works with GCHP and its Members.
1. One (1) of the ten (10) positions is a standing seat represented by the Ventura County Health Care Agency (VCHCA)
2. The remaining nine (9) members shall service a two year term with no limits on the number of terms a representative may serve.
a. The two year term shall coincide with GCHPs fiscal year (i.e. July 1st through June 30th).
3. PAC may include, but is not limited to, individuals representing, or that represent the interest of:
a. Allied health services providers;
b. Community Clinics;
c. Hospitals;
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Policies and Procedures
Title:
DRAFT Policy Number: XXXXXXXXXXXX
2
d. Long Term Care;
e. Home Health/Hospice;
f. Nurse
g. Physician:
h. Traditional/Safety Net;
i. VCHCA
G. PAC shall conduct a nomination process to recruit potential candidates for the impending vacant seats in accordance with this policy.
1. The advisory committee shall conduct an annual recruitment and nomination process.
a. At the end of each fiscal year, approximately half of the seats terms expire, alternating between five (5) vacancies one (1) year and five (5) vacancies the subsequent year.
2. The advisory committee shall conduct a recruitment and nomination process if a seat is vacated mid-term.
a. Candidates that fill a vacated seat med-term shall complete the term for that specific seat, which will be less than a full two (2) year term.
H. On an annual basis, PAC shall select a chairperson from its membership to coincide with the annual recruitment and nomination process. Recruitment and selection shall be conducted in accordance with Procedure D of this policy.
1. The PAC chairperson may service two (2) consecutive one (1) year terms.
2. The PAC chairperson may be removed by a majority vote from the VCMMCC.
I. To establish a nomination ad hoc subcommittee, PAC chairperson shall ask for three (3) to four (4) volunteers. PAC members who are being considered for reappointment, cannot participate in their respective nomination ad hoc subcommittee.
1. Each PAC nomination subcommittee shall:
a. Review, evaluate, and select a prospective candidate of each of the open seats, in accordance with Procedure (Section - E) of this policy.
b. Forward the prospective candidate(s) to the advisory committee for review and approval.
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Policies and Procedures
Title:
DRAFT Policy Number: XXXXXXXXXXXX
3
2. Following approval from the advisory committee, the recommended candidate(s) shall be forwarded to the VCMMCC for review and approval.
J. VCMMCC shall review and have final approval for all appointments, reappointments, and chairperson appointments to the advisory committee.
K. Advisory committee members shall attend all regularly scheduled meetings, unless they have an excused absence. An absence shall be considered excused if an advisory committee member provides notification of a absence to GCHP staff prior to the advisory committee meeting. GCHP staff shall inform the chairperson of the respective advisory committee, the Chief Executive Officer, and VCMMCC when an advisory committee member fails to attend two (2) consecutive regularly scheduled meetings upon the following:
1. Upon notification of an advisory committee members absence at two (2) consecutive regularly scheduled meetings.
2. Advisory committee members attendance shall be considered as a criterion upon reapplication.
Procedure: A. PAC composition
1. The composition of the PAC shall reflect the cultural diversity and special needs of the GCHP membership.
2. Specific agency representatives shall serve on the advisory committee as standing members.
a. VCHCA shall have one seat designated.
B. PAC meeting frequency
1. PAC shall meet at least quarterly.
2. PAC shall adopt a yearly meeting schedule at the first regularly scheduled meeting during fourth quarter for the oncoming year.
3. VCMMCC shall approve the meeting schedules, including location and time of the regular advisory committee meetings.
4. Attendance by a simple majority of appointed members shall constitute a quorum.
C. PAC recruitment process
1. GCHP shall begin recruitment of potential candidates in January of each year.
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Policies and Procedures
Title:
DRAFT Policy Number: XXXXXXXXXXXX
4
2. GCHP shall include, but not be limited to, the following notification methods for impending vacancies:
a. Outreach to Provider communities
b. Placement of vacancy on the GCHP website
c. Advertisement of vacancies in GCHP monthly Provider Operations Bulletin
3. Advisory committee chairperson shall inquire of its membership whether there are interested candidates who wish to be considered as a chairperson for the upcoming year.
D. PAC nomination evaluation process
1. Advisory committee chairperson shall request three (3) to four (4) members, who are not being considered for reappointment, to volunteer to service on the nominations ad hoc subcommittee.
2. Prior to the PAC nomination ad hoc subcommittee meetings:
a. Ad hoc subcommittee members shall individually evaluate and score the application for each of the prospective candidates using the Applicant Evaluation Tool.
b. Ad hoc subcommittee members shall individually evaluate and select a chairperson.
c. At the discretion of the ad hoc subcommittee, GCHP may contact a prospective candidates references for additional information and background information.
3. Ad hoc subcommittee shall convene to discuss and select a chairperson and a candidate for expiring seats by using the findings for the Applicant Evaluation Tool, the attendance record if relevant, and the prospective candidates references.
E. PAC selection and approval process for prospective chairpersons and advisory committee candidates
1. Upon selection of a recommendation for chairperson and a slate of candidates, each Ad hoc subcommittee shall forward its recommendation to the PAC for review and approval.
2. Following PAC approval, the proposed chairpersons and slates of candidates shall be submitted to the VCMMCC for review and final approval.
3. Following VCMMCC approval of the PACs recommendation, the new PAC members shall be effective July 1.
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Policies and Procedures
Title:
DRAFT Policy Number: XXXXXXXXXXXX
5
4. GCHP shall provide new PAC members with a new member orientation.
Attachments: References: Revision History:
Review Date Revised Date
Approved By
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VCMMCC dba Gold Coast Health Plan Committee Application Page 1 of 2
Ventura County Medi-Cal Managed Care Commission dba Gold Coast Health Plan
COMMITTEE APPOINTMENT APPLICATION FORM Name of Applicant: ______________________________________________________________
E-mail Address: _________________________________________________________________
Home Address: ___________________________________City: _______________ Zip ________
Home Phone: _______________________ Cell Phone: _______________________ Current Employer: ________________________________________________________________
Work Address: ____________________________________City: _______________ Zip: ________
Work Phone: ________________________ Name of Committee to which you are applying: _________________________________________ EXPERIENCE: What experience, training, education, or interests, specifically qualifies you as an appointee to the Committee?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________ PUBLIC SERVICE: List (past or present) public service appointments, or elected positions you (or your spouse) held (please list dates served):
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________ PUBLIC SERVICE AGENCIES: List past or present affiliations you (or your spouse) have with public service agencies:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________ AFFILIATIONS: List past or present affiliations with private and / or public health plans:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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VCMMCC dba Gold Coast Health Plan Committee Application Page 2 of 2
ORGANIZATIONS: List community organizations to which you belong:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________ CONVICTIONS AND PENALTIES: Have you ever been convicted of a felony? If yes, give date(s), location(s) and penalties. (Convictions are evaluated for each position and are not necessarily disqualifying.):
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________ REFERENCES: Provide a minimum of three references and their contact information: 1. Name: _______________________________________________________________________
Affiliation: ______________________________________________________________________
Contact Phone Number: _____________________ 2. Name: _______________________________________________________________________
Affiliation: _______________________________________________________________________
Contact Phone Number: _____________________ 3. Name: _______________________________________________________________________
Affiliation: ______________________________________________________________________
Contact Phone Number: ____________________ You are invited to include a copy of your resume or any supplemental information that you feel may assist in the evaluation of your application ______________________________________________ _____________________________ (Signature) (Date) COMPLETE FORM AND RETURN TO: Ventura County Medi-Cal Managed Care Commission dba Gold Coast Health Plan Clerk of the Board 2220 E. Gonzales Road, Suite 200 Oxnard, CA 93036
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Applicant Name: _______________________
Provider Advisory Committee Application Evaluation Tool Position Applying For: __________________ (use one per applicant)
Questions should be rated 1 through 5 based on how well the applicant satisfies the following statements: 5 = Excellent; 4 = Very Good; 3 = Average; 2 = Fair; 1 = Poor
Criteria for Nomination Consideration and Point Scale Possible Points
Awarded Points
Experience: Training, education, or interests, specifically qualifies as an appointee to the Committee?
1-5
Public Service: (past or present) public service appointments, or elected positions
1-5
Public Service Agencies: (past or present) affiliations applicant has with public service agencies:
1-5
Affiliations: (past or present) affiliations with private and / or public health plans
1-5
Organizations: Community organizations to which applicant belongs 1-5 Supportive letters of reference Yes = 5
No = 0
Total Points 30
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PROVIDER ADVISORY COMMITTEE CHARTER
Purpose The Ventura County Medi-Cal Managed Care Commission (VCMMC) enabling ordinance 4409 (April 2010) and the California Department of Health Care Services, Medi-Cal Managed Care Division, both require the establishment of a Provider Advisory Committee. The ordinance requires, at a minimum, that this committee meet quarterly and make recommendations, review policies and programs, explore issues and discuss how the plan may best fulfill its mission.
Duties and Responsibilities
The role of the Provider Advisory Committee is to consider and analyze situations of concern and bring its recommendations to the Commission for its consideration. More specific duties will be established by the committee.
PAC Composition and Qualifications
The Commission decided that the Provider Advisory Committee would consist of ten members with one dedicated seat representing the Ventura County Health Care Agency (VCHCA). Each of the appointed members, with the exception of the designated VCHCA seat position, would serve a two-year term, have no term limits and individuals could apply for re-appointment. The ten voting members would represent various professional disciplines and / or constituencies, which include: Allied Health Services, Community Clinics, Hospital, Long Term Care, Non-Physician Medical Practitioners, Nurses, Physician and Traditional / Safety Net.
Current Provider Advisory Committee
1. Allied Health Services: Brett Zaer, Superior Mobility Durable Medical Equipment 2. Community Clinics: Kimberly Bridges, RN, Centers for Family Health, CMHS 3. Hospital: John Roughan, Simi Valley Adventist Hospital 4. Long Term Care: Alger Brion, COO, Maywood Acres SNF 5. Home Health / Hospice: Mark Minnis, CFO, Livingston VNA and Hospice 6. Non-Physician Practitioner: Clive Salmon, DPM, Podiatrist 7. Nurse: Joyce Weckl, RN, Certified Nurse Midwife 8. Physician: C. Albert Reeves, MD, Ventura County Health Care Plan 9. Traditional / Safety Net: Antonio Alatorre, Clinicas del Camino Real 10. VCHCA: Terrie Stanley, RN [now vacant as of 3/30/12; new nominee pending]
Management Details of Committee Operations
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The Provider Advisory Committee is chaired by the Plans Director of Provider Relations and Provider Contracting. The Provider Relations Department prepares the agenda, collects data for consideration, creates meeting packets and takes care of all administrative details such as attendance records, minutes of the meeting, payment of honoraria for attendance, etc.
Committee Feedback
Feedback from the PAC is relayed to the appropriate GCHP committee, management principal or department for any necessary action.
PROVIDER ADVISORY COMMITTEE
MEMBER BIOS
Antonio Alatorre, COO, Clinicas del Camino Real, Inc. Mr. Alatorre has been with Clinicas for 25 years and has seen the growth from two health center sites in 1985 to providing services in 35 sites in 2010. The target population of Clinicas has always been the Farmworker population although everyone is welcomed. Mr. Alatorres passion in serving the Farmworker population started at home since he comes from a Farmworker family and he himself worked in the fields to help his family during the school summer breaks. He serves on several State PCA / NACHC committees and is very involved in advocating for the patient population that Clinicas serves at a local, State and Federal level. He earned a BS degree in Management at Cal State University Northridge and has served in his current position as COO since 2002.
Kimberly Bridges, RN, BSN, Assistant VP, Centers for Family Health an operating unit of the Community Memorial Health System in Ventura. She is a registered nurse with a Bachelors of Science degree in nursing and has been practicing as a nurse for 22 years. The Centers for Family Health where she serves as a director has eleven health centers and 2 Management Service Organizations (MSOs) that manages private medical offices owned and operated by CMHS. Kimberly has been with CMHS off and on for eleven years. Alger L. Brion, COO, Maywood Acres SNF. Mr. Brion is a Licensed Nursing Home Administrator, Licensed Hospice Administrator and previously held a RCFE Administrator license. In addition to being responsible for day-to-day operation of skilled nursing facilities he has been involved in various administrative functions involving skilled nursing facilities including purchase, acquisition and licensing of
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SNFs, setting up of Sub- Acute units in at least two skilled nursing facilities, handling corporate insurance negotiations, and budget preparation, implementation and monitoring. Mr. Brion has held administrative positions at the Sophia Lyn Convalescent Hospital, Villa Oaks Convalescent Hospital, Camellia Gardens, Country Villa East, Rosecrans Care Center, and Gladstone Care and Rehabilitation. Mark Minnis, CFO, Livingston VNA and Hospice. Mr. Minnis is a CPA by training and has led health care finance in a number of organizations in California including hospitals, skilled nursing facilities, and with Planned Parenthood just prior to joining Livingston. He has an excellent grasp on home health and hospice care and the needs of the Medi-Cal and uninsured. Mr. Minnis holds a Bachelor of Science Degree in Business Administration from California State University, Long Beach.
C. Albert Reeves, M.D., Medical Director, Ventura County Health Care Plan. Dr. Reeves has a Medical Degree from UCLA, and Family Medicine Residency from San Bernardino County Medical Center. He has been in private practice in Camarillo since 1978 and has been the Medical Director for the Ventura County Health Care Plan since 2009.
John F. Roughan, Senior Director of Managed Care and Network Development, Simi Valley Hospital. Mr. Roughan started at SVH in April 2008, after almost three years at Blue Cross of California in Woodland Hills. He worked there as director of network relations and, more recently, as senior contract manager. Mr. Roughan has 20 years experience in managed careprimarily doing network development and provider contracting for health plansand, before that, 15 years of work in hospital administration. He has an undergraduate degree from Valley State College (Cal State, Northridge) and an executive MBA from UCLA.
Clive Salmon, DPM, Practicing Podiatrist. Graduated from Long Beach State University with a Bachelors Degree in Biology in 1975. Graduated from The California College of Podiatric Medicine in 1979. He began private practice in Oxnard in 1980 and has been in practice here ever since. Dr. Salmon also worked as the staff podiatrist for Camarillo State Hospital for twelve years from 1984 until it closed in 1996.
Joyce Weckl, RN, Certified Nurse Midwife. Ms. Weckl has been a nurse-midwife/ women's nurse- practitioner in Ventura County since 1996. She is pursuing board certification as a psychiatric / mental health nurse-practitioner. Ms. Weckl provides care to Medi-Cal beneficiaries and has a deep concern about the level of care they receive. She brings a strong emphasis on care for women, infants, and their families with ideas on early infant attachment, breast feeding, and healthy families. Brett Zaer, President, Super Mobility Durable Medical Equipment. President and General Manager of superior Mobility 12 yearsservicing Ventura County since 1998 and Southern California since 1979. Two locations; one in Torrance with 30 employees and focusing on complex rehab and individuals with severe disabilities. Our
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specialty is mobility and seating and positioning products. We service all of Southern California minus San Diego County. ATPAssistive Technology Professional, oversee a team of ATPs and run the daily operations of the sales and service components of the company. BACommunications, University of California Santa Barbara. Joan R. Araujo, RN, MHSA; Deputy Director Ventura County Health Care Agency Ms. Araujo has more than 20 years of health care leadership experience, having joined the Health Care Agency in 2009. Ms. Araujo oversees operations of Ambulatory Care services, which involves more than 500,000 patient visits each year through the VCMC network of affiliated clinics and urgent care centers located in nine cities throughout Ventura County. Ms. Araujo had operational oversight of the Family Medicine Residency and Specialty Care Center construction as well as recent clinic expansions. Her role includes strategic planning of new facility development, physician recruitment, oversight during construction, fundraising, and compliance with OSHPD, Joint Commission and other regulatory bodies. She has been instrumental in the conversion of 19 clinic locations to Federally Qualified Health Centers. She had previously served VCMC as Director of Health Care Services for the VCHCP. Ms. Araujo has earned a Master of Science degree in Health Services Administration and Bachelor of Arts degree in Health Care Administration, as well as Registered Nursing and Licensed Vocational Nursing degrees.
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Leg
acy M
ed
i-C
al
Po
pu
lati
on
98,0
00
(as
of
12
/31
/2012
)
Exp
an
sio
n P
op
ula
tio
n
A
CE
MC
E
10,0
00
U
nin
su
red
*
20,0
00
H
ealt
hy F
am
ilie
s *
*
20,0
00
* E
sti
ma
ted
en
roll
me
nt
ove
r 1
2-2
4 m
on
ths
**A
pp
rox
. 6
,00
0 o
f th
es
e e
nro
lle
es
ha
ve
be
en
en
roll
ed
in
to
GC
HP
sin
ce
Ja
nu
ary
20
13
3d-7
-
8
Med
i-C
al E
xp
an
sio
n B
en
efi
ts
*Mu
st in
clu
de
10
esse
ntia
l h
ea
lth
be
ne
fits
:
1.
Am
bu
lato
ry o
utp
atie
nt se
rvic
es
2.
Em
erg
en
cy s
erv
ice
s
3.
Ho
sp
ita
liza
tio
n
4.
Mate
rnity a
nd n
ew
born
care
5.
Me
nta
l h
ea
lth
& s
ub
sta
nce
use
dis
ord
er
svcs-A
CA
re
qu
ire
me
nt
6.
Pre
scri
ptio
n d
rug
s
7.
Re
ha
bili
tative
an
d h
ab
ilita
tive
se
rvic
es
8.
La
bo
rato
ry s
erv
ice
s
9.
Pre
ventive c
are
and c
hro
nic
dis
ease m
anagem
ent
10
.P
ed
iatr
ic s
erv
ice
s, in
clu
din
g o
ral a
nd
vis
ion
ca
re
*Sourc
e:
htt
p:/
/ww
w.c
ove
red
ca
.co
m/c
ove
rag
e_
ba
sic
s.h
tml
Sta
te p
roposin
g the M
CE
benefits
mir
ror
exis
ting M
edi-
Cal benefits
, unle
ss
ma
nd
ate
d b
y A
CA
.
Lo
ng
-Term
Care
benefit pro
posed b
y D
HC
S a
s long a
s
asset
test
is a
ppro
ved b
y
CM
S.
If
not, t
hen L
TC
will
not
be a
MC
E b
enefit.
3d-8
http://www.coveredca.com/coverage_basics.html
-
De
liv
ery
Sy
ste
m C
ha
lle
ng
es
H
igh
er
need f
or
behavio
ral health s
erv
ices a
nd c
are
co
ord
ination
P
rovid
er
sta
bili
ty if th
e n
ew
ly e
ligib
le s
witch p
rovid
ers
oft
en
C
ha
llenges d
ue t
o c
hurn
betw
een E
xchange a
nd M
edi-
Cal: c
ontinuity o
f care
, afford
abili
ty,
health o
utc
om
es
9
Co
vere
d
Cali
forn
ia
Go
ld C
oast
Healt
h P
lan
Med
i-C
al
3d-9
-
S
tate
Le
gis
latu
re a
uth
ori
ze
d B
rid
ge
Pla
n p
olic
y th
rou
gh
SB
X3
1
G
ove
rno
r sig
ne
d S
BX
3 1
in
to la
w o
n J
uly
11
, 2
01
3
F
ive
-year
sunset fr
om
date
of fe
dera
l appro
val still
pendin
g
Ob
jective
s o
f th
e B
rid
ge
Pla
n:
E
sta
blis
h a
he
alth
pla
n fo
r lo
w-i
nco
me
in
div
idu
als
an
d p
are
nts
of
Me
di-
Ca
l a
nd
HF
P-e
ligib
le in
div
idu
als
mo
vin
g b
etw
ee
n M
ed
i-C
al to
Covere
d C
alif
orn
ia
P
rom
ote
s c
on
tin
uity o
f co
ve
rag
e a
nd
ca
re
R
ed
uce
th
e d
isru
ptio
ns in
co
ntin
uity o
f ca
re a
sso
cia
ted
with
ch
an
ge
s
in h
ea
lth
pla
ns
C
rea
tes a
cce
ss to
mo
re a
ffo
rda
ble
co
ve
rag
e
10
Bri
dg
e P
lan
3d-10
-
In
com
es b
etw
ee
n 1
39 %
to 2
50%
of F
PL
In
div
idu
als
pre
vio
usly
en
rolle
d in
Me
di-
Ca
l
Man
ag
ed
Care
Pla
n
M
em
bers
of a h
ou
se
ho
ld in
whic
h t
he
re is a
Me
di-
Cal or
HF
P e
nro
llee if th
ey a
re c
ou
nte
d a
s p
art
of
the
Mod
ifie
d A
dju
ste
d G
ross Incom
e h
ouseh
old
.
P
are
nt(
s)
or
care
take
r re
lative
of
a M
edi-
Cal
en
rolle
d c
hild
.
1
1
Bri
dg
e P
lan
Elig
ibilit
y L
imit
ed
To
:
3d-11
-
GC
HP
Ou
treach
Acti
vit
ies
12
C
oo
rdin
atio
n w
ith
Co
un
ty, H
ea
lth
ca
re P
art
ne
rs,
Co
mm
un
ity S
take
ho
lde
rs
R
ad
io-M
ed
ia C
am
pa
ign
an
d In
tern
et M
essa
gin
g
N
ew
Me
mb
er
Orie
nta
tio
ns
Tele
phone O
utr
each C
am
paig
n
H
ea
lth
Fa
irs &
Wo
rksh
op
s
S
ch
oo
ls a
nd
Yo
uth
Da
y C
am
ps
P
ub
lic E
ve
nts
an
d C
om
mu
nity F
estiva
ls
3d-12
-
Qu
esti
on
s ?
13
3d-13
-
Pro
vid
er
To
wn
Hal
l Me
etin
g N
ove
mb
er
20
13
4a-1
-
Age
nd
a
IC
D-1
0 In
tro
du
ctio
n
U
pd
ates
: Aff
ord
able
Car
e A
ct (
AC
A)
Incr
ease
d
Med
icai
d P
aym
ent
for
Pri
mar
y C
are
Ph
ysic
ian
s
A
CA
Exp
ansi
on
Pro
gram
In
itia
l Hea
lth
Ass
essm
ent
(IH
A)
Req
uir
emen
ts
4a-2
-
ICD
10
In
tro
du
cti
on
4a-3
-
ICD
Ove
rvie
w
Inte
rna
tio
nal C
lassific
atio
n o
f D
ise
ase (
ICD
) co
des, de
velo
ped b
y
the
Worl
d H
ea
lth
Org
an
ization (
WH
O),
are
a c
orn
ers
ton
e o
f h
ealth
info
rmation
.
D
efine p
atient health s
tatu
s
P
rovid
e s
urg
ica
l o
r d
iag
no
stic p
roce
du
re c
od
es
A
lre
ad
y u
se
d in
se
ve
ral o
the
r in
du
str
ializ
ed
na
tio
ns s
uch
as U
nite
d
Kin
gd
om
e, N
ord
ic C
ou
ntr
ies, F
ran
ce
, A
ustr
alia
, B
elg
ium
, G
erm
an
y
an
d C
an
ad
a
ICD
-9 I
ssu
es:
M
ore
th
an
35
ye
ars
old
; h
as o
utliv
ed
its
use
fuln
ess
U
.S. is
th
e la
st in
du
str
ializ
ed
na
tio
n u
sin
g IC
D-9
Ru
nn
ing
ou
t o
f co
de
s to
assig
n, e
sp
ecia
lly fo
r n
ew
pro
ce
du
res
4a-4
-
ICD
-10
Co
de
Imp
lem
en
tati
on
D
iagn
ose
s ar
e u
sed
fo
r co
din
g o
f d
ise
ase
s an
d s
ign
s,
sym
pto
ms,
ab
no
rmal
fin
din
gs, c
om
pla
ints
, so
cial
ci
rcu
mst
ance
s an
d e
xte
rnal
cau
ses
of
inju
ry o
r d
ise
ase
s.
IC
D-1
0-C
M (
Clin
ical
Mo
dif
icat
ion
= d
iagn
osi
s co
de
s)
U
sed
by
all p
rovi
der
s in
eve
ry h
ealt
h c
are
sett
ing
Ex
pan
sio
n t
o m
eet
rep
ort
ing
nee
ds
IC
D-1
0-P
CS
(Pro
ced
ure
Co
des
)
R
epla
ces
ICD
-9-C
M P
roce
du
res
U
sed
on
ly f
or
inp
atie
nt
inst
itu
tio
nal
pro
ced
ure
co
din
g
N
ot
use
d o
n p
hys
icia
n c
laim
s, e
ven
th
ose
fo
r in
pat
ien
t vi
sits
C
PT/
HC
PC
S w
ill c
on
tin
ue
to
be
use
d f
or
pay
me
nt
of
ph
ysic
ian
cla
ims
4a-5
-
ICD
-10
Val
ue
He
alth
an
d H
um
an S
erv
ice
s (H
HS)
man
dat
es
that
al
l co
vere
d e
nti
tie
s, (
incl
ud
ing
pro
vid
ers
, cle
arin
g h
ou
ses,
he
alth
pla
ns)
mu
st t
ran
siti
on
to
th
is n
ew
cod
e se
t.
4a-6
-
ICD
-10
Val
ue
co
nt
.
ICD
-10
maj
or
ob
ject
ive
s:
In
crea
sed
co
din
g ac
cura
cy, s
tan
dar
diz
atio
n, a
nd
exp
and
abili
ty
B
ette
r id
enti
fica
tio
n o
f m
emb
ers
for
care
man
agem
ent
Po
ten
tial
fo
r d
eep
er p
op
ula
tio
n-l
evel
an
alyt
ics
for
pu
blic
hea
lth
Imp
rove
d q
ual
ity
and
ou
tco
mes
dat
a
Imp
rove
s co
mm
un
icat
ion
bet
wee
n p
hys
icia
ns
ICD
-10
re
pre
sen
ts a
maj
or
chan
ge in
th
e m
ed
ical
co
din
g sy
ste
m
N
ew c
od
e st
ruct
ure
an
d c
od
ing
rule
s
New
ter
min
olo
gy t
o d
efin
e m
edic
al p
roce
du
re (
CP
T/H
CP
C n
ot
imp
acte
d)
M
uch
gre
ater
sp
ecif
icit
y in
ICD
-10
Gre
ates
t im
pac
t is
in C
ard
iolo
gy, O
bst
etri
cs, a
nd
Ort
ho
ped
ics
4a-7
-
Beg
inn
ing
Oct
ob
er 1
, 20
14
P
hys
icia
n
IC
D-1
0 C
M
C
PT
/ H
CP
CS
Ho
spit
al
In
pat
ien
t: IC
D-1
0 C
M &
PC
S
O
utp
atie
nt:
ICD
-10
CM
&
CP
T /
HC
PC
S
Beh
avio
ral H
ealt
h
IC
D-1
0 C
M
C
PT
/ H
CP
CS
D
SM-I
V
Lab
ora
tory
IC
D-1
0 C
M
C
PT
/ H
CP
CS
Lon
g Te
rm H
ealt
hca
re
IC
D-1
0 C
M
C
PT
/ H
CP
CS
All
Oth
er
IC
D-1
0 C
M
C
PT
/ H
CP
CS
4a-8
-
Wh
en
An
imal
s A
ttac
k! IC
D-1
0-C
M:
St
ruck
by
pig
: W5
5.4
2X
St
ruck
by
racc
oo
n:
W5
5.5
2X
St
ruck
by
turt
le:
W5
9.2
2X
St
ruck
by
par
rot:
W6
1.0
2X
St
ruck
by
mac
aw: W
61
.12
X
St
ruck
by
oth
er
mam
mal
: W
55
.81
XA
4a-9
-
Edit
ing
for
Co
mp
lian
ce
CM
S G
uid
elin
es
stat
e t
hat
a C
laim
or
Enco
un
ter,
e
lect
ron
ic o
r p
ape
r, c
ann
ot
con
tain
bo
th IC
D-9
an
d IC
D-
10
co
de
s. G
CH
P w
ill r
eje
ct n
on
-co
mp
lian
t c
laim
s an
d
en
cou
nte
rs.
IC
D-9
co
des
will
no
lon
ger
be
acce
pte
d o
n c
laim
s w
ith
DO
S af
ter
9/3
0/1
4
IC
D-1
0 c
od
es w
ill n
ot
be
acce
pte
d o
n c
laim
s w
ith
D
OS
bef
ore
10
/1/1
4
4a-10
-
ICD
-9 v
s. IC
D-1
0:
Co
din
g
4a-11
-
EDI 5
01
0 a
nd
CM
S 1
50
0 F
orm
Imp
act
ED
I Fo
rmat
5
01
0
A
lrea
dy
incl
ud
es q
ual
ifie
r to
iden
tify
ver
sio
n o
f IC
D c
od
es r
epo
rted
Qu
alif
ier
in p
lace
for
ICD
-9 t
od
ay
IC
D1
0 q
ual
ifie
r lo
gic
will
be
bas
ed o
n 1
0/1
/14
co
mp
lian
ce d
ate
C
MS
15
00
Pap
er
Cla
im F
orm
Ch
ange
s:
Ex
pan
din
g n
um
ber
of
Dia
gno
sis
Co
des
fro
m 4
to
12
Form
acc
om
mo
dat
es a
max
imu
m o
f 7
ch
arac
ters
in le
ngt
h
In
dic
ato
r ad
ded
to
iden
tify
ver
sio
n o
f IC
D c
od
es r
epo
rted
ICD
-9 =
9 a
nd
ICD
-10
= 0
Fo
rm h
as b
een
ap
pro
ved
by
the
OM
B (
Off
ice
of
Man
agem
ent
an
d
Bu
dge
t)
B
oth
ICD
9 &
ICD
10
co
de
s ca
n n
ot
be
on
th
e s
ame
cla
im
4a-12
-
Ne
w C
MS-
15
00
Fo
rm
The n
ew
CM
S-1
500 f
orm
has
expanded d
iagnosis
fie
ld a
rea t
o
allo
w f
or
12 I
CD
-10-C
M c
odes a
nd a
n
ICD
-9 v
s.
ICD
-10 indic
ato
r (B
ox 2
1)
4a-13
-
Clin
ical
Do
cum
en
tati
on
ICD
-10
Sp
eci
fici
ty N
ece
ssit
ate
s:
P
rovi
der
: m
ore
det
ail i
n c
linic
al d
ocu
men
tati
on
Staf
f: le
arn
new
co
din
g m
eth
od
olo
gy
Po
ssib
le Im
pac
ts:
Ti
mel
ines
s o
f su
bm
issi
on
s
Incr
ease
in r
ejec
ted
cla
ims
du
e to
inva
lid s
ub
mis
sio
ns
R
even
ue
imp
act
du
e to
del
ayed
or
inac
cura
te s
ub
mis
sio
ns
Cla
im q
ual
ity
and
acc
ura
cy c
ou
ld a
lso
imp
act:
Qu
alit
y o
f C
are
(pay
fo
r p
erfo
rman
ce,
HED
IS, c
on
sum
eris
m r
epo
rtin
g)
Pa
tien
t m
ix s
tati
stic
s
Car
e m
anag
emen
t
D
ata
Cap
ture
fo
r o
ther
sta
tist
ical
rep
ort
ing
and
dis
ease
man
agem
ent
4a-14
-
Are
as o
f G
reat
est
Imp
act:
ICD
-10
CM
O
rth
op
ed
ics
Car
dio
logy
Ob
stet
rics
4a-15
-
Som
e c
od
es
are
val
id in
bo
th IC
D-9
an
d IC
D-1
0
Th
e b
elo
w e
xam
ple
s s
how
how
sig
nific
ant
the d
iffe
rence in t
he m
eanin
g c
an b
e
4a-16
-
ICD
-10
We
bsi
tes
4a-17
-
Pri
mary
Care
Paym
en
t
Incre
ase -
UP
DA
TE
S
AC
A S
ec
tio
n 1
20
2 Im
ple
me
nta
tio
n
4a-18
-
AC
A P
CP
Rate
In
cre
ase
Up
date
s
G
CH
P is s
till
wa
itin
g fo
r fu
nd
ing
fro
m D
HC
S (
exp
ecte
d in
No
ve
mb
er)
To
re
ce
ive
pa
ym
en
t, p
hysic
ian
s m
ust s
elf-a
tte
st
th
eir e
ligib
ility
:
htt
p:/
/file
s.m
edi-
cal.c
a.go
v/p
ub
sdo
co/a
ca/a
ca_f
orm
_lan
din
g.as
p
Q
ualif
ied p
rovid
ers
who s
elf-a
ttest during the e
sta
blis
hed tim
efr
am
e
will
re
ce
ive
pa
ym
en
ts r
etr
o-a
ctive
to
Ja
nu
ary
1, 2
01
3.
P
hysic
ian
s c
an
no
t re
ce
ive
ad
ditio
na
l p
aym
en
ts u
ntil th
ey s
elf-a
tte
st
an
d p
rovid
e G
CH
P w
ith
W9
an
d c
om
ple
te th
e G
CH
P In
form
atio
n
Form
(fo
rm w
ill b
e s
ent out via
em
ail
com
munic
ation a
nd w
ill b
e
loca
ted
on
th
e G
CH
P w
eb
site
on
ce
ava
ilab
le)
4a-19
http://files.medi-cal.ca.gov/pubsdoco/aca/aca_form_landing.asphttp://files.medi-cal.ca.gov/pubsdoco/aca/aca_form_landing.asphttp://files.medi-cal.ca.gov/pubsdoco/aca/aca_form_landing.asp
-
Eli
gib
le P
rov
ide
rs
Board
ce
rtific
ation in fa
mily
medic
ine, in
tern
al m
ed
icin
e
an
d/o
r p
ed
iatr
ic m
ed
icin
e.
(OB
/GY
N a
nd
Em
erg
en
cy
physic
ians a
re n
ot
cate
gori
cally
elig
ible
), o
r
B
oard
ce
rtifie
d in
subspecia
lty r
ela
ted to
on
e o
f th
e lis
ted
sp
ecia
ltie
s, o
r
A
t le
ast 60 p
erc
ent o
f bill
ed s
erv
ice
s t
o M
ed
i-C
al m
ust
fall
with
in the
E&
M o
r vaccin
e a
dm
inis
trative c
odes c
overe
d b
y
the
reg
ula
tion
N
urs
e P
ractitio
ners
and o
ther
physic
ian e
xte
nders
are
e
ligib
le if
the
y w
ork
un
de
r th
e d
ire
ct
su
pe
rvis
ion
of
a
qua
lifie
d p
hysic
ian.
4a-20
-
Eli
gib
le P
rov
ide
rs
P
rovid
ers
mu
st
be
en
rolle
d in M
ed
i-C
al
T
he incre
ase
must be p
assed o
n to the r
endering
pro
vid
er
and c
annot
be r
eta
ined b
y t
he c
linic
.
F
QH
Cs, R
HC
s,
an
d C
BR
Cs r
eceiv
e w
rap
-aro
und
paym
ents
thro
ugh f
ee
-for-
serv
ice, so they a
re n
ot
elig
ible
.
4a-21
-
Co
ver
Lett
er
4a-22
-
Exp
lan
atio
n o
f P
aym
en
t
4a-23
-
Pay
me
nt
Sum
mar
y an
d D
etai
l
4a-24
-
AC
A E
xp
an
sio
n P
rog
ram
4a-25
-
Ob
jec
tiv
es
:
P
rovid
e C
urr
en
t P
rog
ram
Sta
tus
L
IHP
O
ption
al E
xp
an
sio
n
A
B 8
5
M
en
tal H
ealth E
xp
ansio
n
oM
BH
O I
mp
lem
en
tatio
n
4a-26
-
LIH
P S
tatu
s
T
ran
sitio
n P
CP
Assig
nm
en
t/L
inka
ge
C
urr
ent M
em
bers
hip
Dis
trib
ution:
o7
5%
VC
MC
& 2
5%
Clin
ica
s
oA
nticip
ate
100%
lin
kag
e
D
HC
S to
share
Mem
ber
info
rmation t
he
firs
t part
of D
ecem
ber
B
AA
bein
g e
xe
cu
ted
with
VC
HC
A-
To fa
cili
tate
excha
nge
of d
ata
for
ca
re c
oord
ination
4a-27
-
LIH
P S
tatu
s
M
em
be
r O
utr
ea
ch
& N
otifica
tio
n
D
HC
S N
otifications-
o9
0 D
ay (
10
/4/1
3)
L
IHP
o60 D
ay (
11/1
/13)
D
HC
S
o3
0 D
ay (
12
/1/1
3)
D
HC
S
M
em
be
r o
utr
each (
post card
s/fly
ers
)
Colla
bo
ration w
ith
VC
HC
A t
o d
istr
ibute
G
CH
P L
IHP
We
lco
me
le
tte
r su
bm
itte
d to
D
HC
S fo
r a
ppro
val
4a-28
-
AC
A E
xp
an
sio
n O
utr
ea
ch
C
om
munic
ations T
eam
pla
n to d
evelo
p
R
adio
Ads
F
lye
rs
N
otification
s
Jo
int C
om
mu
nic
atio
ns w
ith
VC
HC
A
P
igg
yb
ack o
n C
ou
nty
Outr
ea
ch
Gra
nts
C
om
mun
ity E
ven
ts
4a-29
-
LIH
P S
tatu
s
P
art
ne
rsh
ip E
ffo
rts
C
ase
Man
ag
em
en
t t
ask fo
rce
Jo
int C
om
mu
nic
atio
ns W
ork
gro
up
P
roje
ct M
an
ag
em
en
t m
ee
tin
gs
4a-30
-
LIH
P T
imelin
e
11
/1/2
01
33
/15
/20
14
12
/20
13
1/2
01
42
/20
14
3/2
01
4
12
/1
30
Day
No
tice
-DH
CS
12
/28
83
4 &
Su
pp
lem
enta
l File1
/7
Wel
com
e P
acke
ts S
hip
An
tici
pat
ed
Re
gula
tory
De
live
rab
les
(12
/1-1
2/3
1):
Co
ntr
act
Am
end
men
t-p
end
ing
Co
nti
nu
ity
of
care
-Req
uir
emen
ts &
Rep
ort
ing-
Pen
din
g
Po
licie
s &
Pro
ced
ure
s-p
end
ing
Up
dat
ed E
OC
-pen
din
g D
HC
S te
mp
late
lan
guag
e
Rat
es &
Rat
e C
ateg
ori
es-p
end
ing
11
/8/1
3 -
1/1
7/1
4
Cas
e M
anag
emen
t Tr
ansi
tio
n
Tech
nic
al W
ork
Eff
ort
(1
2/1
-12
/31
):
Aid
Co
de
Map
pin
g (t
o in
clu
de
new
MA
GI C
od
es
Up
dat
e/co
nfi
gure
ika
(co
des
, rat
es, e
tc)-
Pen
din
g
Dat
a M
app
ing
(83
4/s
up
ple
men
tal)
Pro
vid
er li
nki
ng/
assi
gnm
ent
Up
dat
e /
Test
fu
lfill
men
t p
roce
ss (
Wel
com
e Le
tter
, EO
C &
ID C
ard
)
11
/7 -
12
/31
Reg
ula
tory
Del
iver
able
s
12
/28
PC
P A
ssig
nm
ent
Pro
cess
Beg
ins
3/2
01
4
Pro
ject
Clo
se
11
/7/1
3 -
1/1
/14
Pro
vid
er C
on
trac
t N
ego
tiat
ion
s-A
s N
eed
ed
1/1
- 3
/15
Cas
e M
anag
emen
t Tr
ansi
tio
n
4a-31
-
LIH
P-B
en
efi
t C
om
pa
ris
on
D
HC
S t
o p
rovid
e B
en
efit
Cro
ssw
alk
fo
r
man
da
ted
be
ne
fits
A
dditio
na
l se
rvic
es p
rovid
ed
by th
e c
ou
nty
for
AC
E M
em
be
rs
G
CH
P t
o id
en
tify
vari
ances a
nd d
evelo
p
messa
gin
g f
or
mem
bers
an
d p
rovid
ers
4a-32
-
Be
hav
iora
l He
alth
Be
ne
fits
Ja
nu
ary
1, 2
01
4 a
ll h
ealt
h p
lan
s m
ust
pro
vid
e
beh
avio
ral b
enef
its.
B
ehav
iora
l hea
lth
ben
efit
will
be
cove
red
by
Med
i-C
al
Man
aged
Car
e -
GC
HP
P
rovi
des
exp
and
ed b
enef
its
for
mild
to
mo
der
ate
beh
avio
ral h
ealt
h c
on
dit
ion
s
Ex
pan
ded
su
bst
ance
ab
use
tre
atm
ent
ben
efit
.
4a-33
-
Man
age
d B
eh
avio
ral H
eal
th O
rgan
izat
ion
G
CH
P h
as e
nte
red
into
an
agr
eem
ent
wit
h a
man
aged
b
ehav
iora
l hea
lth
org
aniz
atio
n v
end
or,
Bea
con
, to
im
ple
men
t an
d a
dm
inis
ter
the
beh
avio
ral h
ealt
h
ben
efit
s.
GC
HP/
Bea
con
is c
oo
rdin
atin
g d
iscu
ssio
ns
to d
evel
op
a
net
wo
rk s
trat
egy.
D
HC
S h
as a
lrea
dy
no
tifi
ed t
he
enro
llees
of
the
ben
efit
an
d p
lan
s to
pro
vid
e th
e p
lan
s so
on
.
4a-34
-
Wh
at d
oe
s th
is m
ean
fo
r p
rovi
de
rs?
P
rovi
der
s w
ill b
e ex
pec
ted
to
use
a d
epre
ssio
n r
atin
g to
ol t
o d
eter
min
e w
hen
to m
ake
a b
ehav
iora
l hea
lth
ref
erra
l.
P
rovi
der
s w
ill a
lso
be
exp
ecte
d t
o b
e ab
le t
o u
se s
ub
stan
ce u
se d
iso
rder
trig
ger
qu
esti
on
s in
th
e St
ayin
g H
ealt
h A
sses
smen
t (S
HA
or
IHEB
A)
to
det
erm
ine
wh
ich
mem
ber
s w
ill b
enef
it f
rom
SB
IRT
(scr
een
ing,
bri
ef
inte
rven
tio
n, a
nd
ref
erra
l fo
r tr
eatm
ent)
.
Th
e St
ate
is s
till
clar
ifyi
ng
the
role
of
the
pri
mar
y ca
re p
rovi
der
in
imp
lem
enti
ng
thes
e n
ew A
CA
ben
efit
s. W
e w
ill s
har
e in
form
atio
n a
s so
on
as
it b
eco
mes
ava
ilab
le f
rom
th
e St
ate
as w
ell a
s tr
ain
ing
reso
urc
es in
th
e u
se o
f
dep
ress
ion
ass
essm
ent
too
ls a
nd
SB
IRT.
4a-35
-
LIH
P-M
em
be
r Id
en
tifi
ca
tio
n
T
ransitio
nin
g m
em
bers
will
have a
n L
1 a
id
co
de
T
hey m
ay m
ain
tain
this
cod
e t
hro
ugh
20
15
R
ed
ete
rmin
atio
n o
r o
the
r ch
an
ge
in
cir
cum
sta
nce
will
tri
gge
r a
id c
od
e c
ha
ng
e.
4a-36
-
LIH
P-P
rov
ide
rs
P
rovid
er
Reim
burs
em
ent
F
FS
un
til an
ap
pro
pria
te c
apitatio
n r
ate
ca
n
be
de
ve
lope
d
P
ossib
ly C
AP
& F
FS
re
imb
urs
em
en
t-D
epe
nd
ing o
n A
id C
ode
(sim
ilar
to a
dm
in
mem
bers
)
P
rovid
er
Co
ntr
acting
W
ill b
e r
equ
ire
d if con
tra
cte
d r
ate
ch
an
ge
4a-37
-
Op
tio
na
l E
xp
an
sio
n
N
ew
ly E
ligib
le Incom
e R
ange
1
00
-13
3%
+ 5
% b
on
us =
13
8%
Fed
era
l
Pove
rty L
eve
l (F
PL)
N
ew
Modifie
d A
dju
ste
d G
ross Incom
e
(MA
GI)
Aid
Co
de
s
B
ene
fits
will
mirro
r w
ha
t is
cu
rre
ntly
pro
vid
ed in
Fe
e-F
or-
Se
rvic
e M
ed
i-C
al
4a-38
-
Op
tio
na
l E
xp
an
sio
n
C
halle
nges-
U
nkno
wn h
ealth s
tatu
s o
f th
e 1
33
-13
8%
FP
L
po
pu
latio
n
N
o P
re-A
uth
ori
za
tio
n o
r C
laim
s h
isto
ry w
ill b
e
availa
ble
4a-39
-
Ne
xt S
teps
C
ontr
act A
mendm
ents
R
ep
ort
ing
S
taffin
g
C
om
mu
nic
ation
s &
Ou
trea
ch
4a-40
-
IH
A
Pro
vid
er
In-S
erv
ice
Tra
inin
g
4a-41
-
He
alth
Ass
ess
me
nts
IHA
In
itia
l Hea
lth
Ass
essm
ent
IH
EBA
In
div
idu
al H
eal
th E
du
cati
on
Beh
avio
ral
Ass
essm
ent
U
pco
min
g Tr
ain
ing
TB
A
New
IHEB
A a
sses
smen
t to
ol &
res
ou
rce
guid
e
DH
CS
Web
site
IH
EBA
alr
ead
y tr
ansl
ated
h
ttp
://w
ww
.dh
cs.c
a.go
v/fo
rmsa
nd
pu
bs/
form
s/Pa
ges/
Stay
ingH
ealt
hy
Ass
essm
entQ
ues
tio
nn
aire
s.as
px#
Span
ish
4a-42
http://www.dhcs.ca.gov/formsandpubs/forms/Pages/StayingHealthyAssessmentQuestionnaires.aspx#Spanishhttp://www.dhcs.ca.gov/formsandpubs/forms/Pages/StayingHealthyAssessmentQuestionnaires.aspx#Spanishhttp://www.dhcs.ca.gov/formsandpubs/forms/Pages/StayingHealthyAssessmentQuestionnaires.aspx#Spanish
-
Wh
at is
th
e IH
A?
IH
A
is a
co
mp
reh
ensi
ve a
sses
smen
t th
at is
co
mp
lete
d
du
rin
g th
e m
emb
ers
init
ial e
nco
un
ter(
s) w
ith
th
eir
pri
mar
y ca
re p
hys
icia
n (
PC
P).
IH
A-
enab
les
the
mem
ber
s P
CP
to
ass
ess
and
man
ge t
he
acu
te, c
hro
nic
an
d p
reve
nti
ve h
ealt
h n
eed
s o
f th
e m
emb
er.
4a-43
-
IHA
F
ou
r (4
) C
om
po
ne
nts
Th
e IH
A in
clu
des
a C
om
pre
hen
sive
His
tory
f
ou
r el
emen
ts t
o b
e as
sess
ed
1. H
isto
ry o
f P
rese
nt
Illn
ess
2
. Pas
t M
ed
ical
His
tory
a.
Pri
or
maj
or
illn
esse
s an
d in
juri
es
b. P
rio
r o
per
atio
ns
c. P
rio
r h
osp
ital
izat
ion
s d
. Cu
rren
t m
edic
atio
ns
e. A
llerg
ies
f. A
ge a
pp
rop
riat
e im
mu
niz
atio
ns
stat
us
g. A
ge a
pp
rop
riat
e fe
edin
g an
d d
ieta
ry s
tatu
s
4a-44
-
IHA
F
ou
r (4
) C
om
po
ne
nts
c
on
t
3. S
oci
al H
isto
ry
a.
Mar
ital
Sta
tus
and
livi
ng
arra
nge
men
ts
b
. Cu
rren
t em
plo
ymen
t
c. O
ccu
pat
ion
al h
isto
ry
d
. Use
of
alco
ho
l, d
rugs
, an
d t
ob
acco
e. L
evel
of
edu
cati
on
f. S
exu
al h
isto
ry
g.
An
y o
ther
rel
evan
t so
cial
fac
tors
4
. Rev
iew
of
Org
an S
yste
ms
4a-45
-
IHA
T
ime
fram
e
Ea
ch P
CP
is r
equ
ired
to
sch
edu
le a
nd
per
form
th
e IH
A
Co
mp
lete
d w
ith
in 1
20
day
s o
f en
rollm
ent
Pro
vid
ers
can
do
wn
load
nam
es o
f n
ew m
emb
ers
via
the
Pro
vid
er P
ort
al
Co
ntr
acte
d P
rovi
der
s ca
n c
on
tact
mem
ber
s an
d s
ched
ule
ap
po
intm
ents
4a-46
-
IHA
M
isse
d o
r B
roke
n A
pp
oin
tme
nts
M
isse
d/b
roke
n a
pp
oin
tmen
t is
to
be
do
cum
ente
d in
th
e p
rovi
der
s m
edic
al r
eco
rd.
Rep
eate
d a
ttem
pts
will
be
mad
e to
rea
ch t
he
mem
ber
to
d
eter
min
e an
d d
ocu
men
t th
e re
aso
n f
or
a m
isse
d
app
oin
tmen
t.
GC
HP
Pro
vid
ers
are
exp
ecte
d t
o m
ake
at le
ast
thre
e d
ocu
men
ted
att
emp
ts t
hat
dem
on
stra
te C
on
trac
ts
un
succ
essf
ul e
ffo
rts
to c
on
tact
mem
ber
an
d s
ched
ule
th
e IH
A.
4a-47
-
IHA
M
isse
d o
r b
roke
n A
pp
oin
tme
nts
If t
hes
e ef
fort
s p
rove
to
be
un
succ
essf
ul,
the
do
cum
enta
tio
n m
ust
incl
ud
e at
leas
t th
e fo
llow
ing:
On
e at
tem
pt
to c
on
tact
mem
ber
by
ph
on
e
O
ne
atte
mp
t to
co
nta
ct m
emb
er b
y le
tter
or
po
stca
rd
The
con
tra
cto
r m
ust
do
cum
ent
all
att
emp
ts t
o p
erfo
rm
the
IHA
at
sub
seq
uen
t o
ffic
e vi
sits
un
til a
ll co
mp
on
ents
o
f th
e IH
A a
re c
om
ple
ted
.
4a-48
-
2220 E. Gonzales Rd, Suite 200 Oxnard, California 93036
Phone: 805-981-5320 Fax: 805-981-5314
Gold Coast Health Plan DHCS Contract No. 10-87128 Page 1 of 6
Reporting Period: July 1 September 30 2013
October 30, 2013 Sunita Kapoor, RN, BSN Contract Manager County Organized Health Systems Unit Medi-Cal Managed Care Division 1501 Capitol Ave. Ste. 71.4008 MS-4407 Sacramento, CA 95814-5005 RE: Report of Changes in Provider Network, 3rd Quarter 2013 (July 1 September 30, 2013) This information is provided to comply with Exhibit A Attachment 6, Provision 10 of our contract (Provider Network Report) to deliver services to Medi-Cal beneficiaries in Ventura County. There were (12) primary care provider(s) added to Gold Coast Health Plan Medi-Cal provider network during the Third Quarter of this year (July 1 September 30, 2013). There were (5) primary care provider terminations.
Primary Care Provider Additions for Ventura County
Provider Location Specialty Languages
*Gonzales, Isabel Ventura Family Medicine Spanish
*Kang, Seong Thousand Oaks Family Medicine Korean
Larsen, Fran Ventura Family Medicine
*Morris, Carolyn Santa Paula Family Medicine
*Raheel, Seema Ventura Internal Medicine
Persian, Bugarian, Pashto
Lauzon, Vanessa Ventura Family Medicine
Sanders, Catherine Ventura Family Medicine
*Adigopula, Sunitha Oxnard, Moorpark Pediatrics
*Ngu, Rosalind Moorpark Family Nurse Practitioner
Spanish, Tagalog
Borden, Teresa Oxnard, Ventura Family Medicine
Rodriguez, Joseph Oxnard Family Medicine
Aline, Peter Oxnard Internal Medicine
4b-1
-
2220 E. Gonzales Rd, Suite 200 Oxnard, California 93036
Phone: 805-981-5320 Fax: 805-981-5314
Gold Coast Health Plan DHCS Contract No. 10-87128 Page 2 of 6
Reporting Period: July 1 September 30 2013
*Safety Net Provider
Primary Care Provider Terminations for Ventura County
Provider Location Specialty Languages Reason
*Li, Connie Moorpark, Oxnard Pediatrics Cantonese Mandarin
Resigned
*Vicente, Joan Santa Paula Family Medicine Tagalog, Spanish
Resigned
Saucedo, Mario Oxnard, Santa
Paula Family Medicine Leaving Group
*Malinoff, Frances Ventura Pediatrics Spanish Resigned
Norlander, Amanda Ventura Family Medicine Spanish Resigned
*Safety Net Provider
There were (28) specialty care providers added to Gold Coast Health Plan Medi-Cal provider network during the Third Quarter of this year (July 1 September 30, 2013). There were (8) specialty providers terminations from Gold Coast Health Plan Medi-Cal provider network.
Specialty Care Provider Additions for Ventura County
Provider Location Specialty Languages Spoken (Other than English)
Harake,Bilal Ventura Pediatric Cardiology Spanish
Singh,Karandeep Oxnard Cardiovascular Disease Hindu, Punjabi
Cole,Terry Ventura OB/GYN Spanish
Alves,Carlos Thousand Oaks
Cardiac Electrophysiology Spanish, Italian
Nazemi,Pehzman Thousand Oaks Opthalmology Spanish
Dexter,John Ventura
Wound Care and Hyperbaric Medicine
Patel,Rishi Camarillo Cardiovascular Disease Hebrew
Sarafzadeh,Yasmin
Newbury Park, Santa Paula, Simi Valley OB/GYN
Shu,Tiffany Ventura OB/GYN Mandarin
Parsa,Miriam Ventura Pediatrics
Albay,Diana Oxnard Endocrinology
Kokorowski,Paul Oxnard Pediatric Urology
Hartshorn,Timothy Ventura Orthopaedic Surgery
Gholami,Parviz Simi Valley Gastroenterology
4b-2
-
2220 E. Gonzales Rd, Suite 200 Oxnard, California 93036
Phone: 805-981-5320 Fax: 805-981-5314
Gold Coast Health Plan DHCS Contract No. 10-87128 Page 3 of 6
Reporting Period: July 1 September 30 2013
Rosenberg,Joshua Ventura
Oncology, Hematology, & Radiology Farsi
Walkowsky,Tihele Fillmore, Ojai OB/GYN
Casarez,Timonthy Thousand Oaks Pediatric Cardiology
Ferry,David Thousand Oaks Pediatric Cardiology
John-Kelly,Helen Ventura
Pediatric Gastroenterology
Kim, Nancy Thousand Oaks Pediatric Cardiology
Lakhani, Mohan Simi Valley
Cardiovascular Disease Hindi, Sindhi
Rishi,Patel Oxnard
Cardiovascular Disease
Singh,Harpreet Oxnard Internal Medicine Hindu, Punjabi
Singh,Karandeep Oxnard Internal Medicine Hindu, Punjabi
Sukpreet,Walia Oxnard Gastroenterology Spanish, Pujabi, Hindi
Wong, Jeffrey Thousand Oaks Pediatric Cardiology
Arfaei,Ashgar
Ventura Pulmonary Medicine Bernstein,Robert
Ventura Pulmonary Medicine Spanish
Specialty Care Provider Terminations for Ventura County
Provider Location Specialty Languages Reason
Allins, Alexander Ventura General Surgery Spanish Leaving Delegated Group
Zimmerman, Andre Santa Paula,
Fillmore Orthopaedic Surgery Spanish Leaving Delegated Group
Sugasawara, Roy Oxnard Urology Leaving Delegated
Group.
Allins, Alexander Ventura General Surgery Spanish Resigned
Kaminski, Stephen Ventura General Surgery Spanish Leaving Delegated Group
Kessey, Kofi Ventura Neurosurgery Spanish Leaving Delegated Group
Skaist, Leonard Oxnard Urology Spanish Leaving Delegated Group
Bove, Ale