GOOD AFTERNOON
WELCOME TO THE ASSEMBLY HEALTH
AN ASSEMBLY BUDGET SUB
COMMITTEE NUMBER ONE HEARING ON
THE PROPOSED CAL AIMED MEDICARE
BENEFIT CHANGES. DUE TO THE
CONTINUED STAY HOME ORDER WE
ARE PRACTICING PHYSICAL
DISTANCE SEEN HERE IN THE
HEARING ROOM AND THROUGHOUT THE
CAPITOL BUILDING. SO WE'RE ONLY
ABLE TO HAVE A LIMITED NUMBER
OF PEOPLE WATCH AND PARTICIPATE
IN THE HEARING IN PERSON. WAS
REQUIRED THAT MASS BE WORN AND
PHYSICAL DISTANCE THEME BE
MAINTAINED BY ALL MEMBERS OF
THE PUBLIC TESTIFYING WEATHER
HERE IN THE ROOM OR AT ONE OF
OUR VIDEO CONFERENCING SITES.
IF YOU DO NOT HAVE A MASK WE
CAN PROVIDE ONE FOR YOU- WHEN
WE REACH- THE PUBLIC COMMENT
PORTION OF THE AGENDA I WOULD
ASK THAT ANY MEMBERS OF THE
PUBLIC TO TEST. THE MEMBERS OF
PUBLIC TO TESTIFY EITHER IN THE
STATE CAPITAL. WHERE THE
WITNESS VIDEO ROOM. AND PLEASEMAINTAIN SOCIAL DISTANCING AS
YOU MOVE AROUND THE ROOM. IN
ADDITION WE HAVE PANELISTS AND
OTHER MEMBERS OF THE PUBLIC
MAKING USE OF OUR WITNESS VIDEO
CONFERENCING ROOMS HERE IN THE
CAPITAL AND ANOTHER. A FEW
OTHER LOCATIONS THROUGHOUT THE
STATE. THESE WITNESSES WILL
APPEAR ON THE SCREEN SO MEMBERS
CAN WATCH THEIR TESTIMONY LIVE.
FROM OUTSIDE OF THE HEARING
ROOM AND ALSO ASK THEM
QUESTIONS- FOR MEMBERS OF THE
PUBLIC WILL BE CALLING IN WE
WILL BE USING A MODERATED
TELEPHONE SERVICE THROUGH WHICH
ANY MEMBER OF THE PUBLIC CAN
PROVIDE COMMENTARY. WE GET TO
THAT POINT IN THE AGENDA.
PALACE OF ALREADY BEEN PROVIDED
A CALLING NUMBER PRIOR TO THIS
HEARING. THE CALL IN NUMBER FOR
PUBLIC COMMENT FOR THIS HEARING
IS EIGHT SEVEN SEVEN. SIX NINE
TWO. EIGHT NINE FIVE SEVEN AND
THE ACCESS TO CODE IS TWO FOUR
TWO. SIX TWO THREE SEVEN READ
THAT AGAIN. THE NUMBER IS.
EIGHT SEVEN SEVEN SIX NINE TWO
EIGHT NINE FIVE SEVEN. AND THE
ACCESS CODE IS TWO FOUR TWO SIX
TWO THREE SEVEN. YOU CAN ALSO
FIND THIS NUMBER ON THE
ASSEMBLY WEBSITE HEALTH
COMMITTEE'S WEBSITE. AS WELL AS
ON YOUR TV SCREEN. THE OPERATOR
ON THE LINE WILL GIVE YOU
INSTRUCTIONS ON HOW TO BE
PLACED IN THE QUEUE. A TO
PROVIDE YOUR COG PUBLIC
COMMENT. YOU'RE CALLING IN
PLEASE LIMITED ALL BACKGROUND
NOISE THIS INCLUDES MUTING YOUR
LIVESTREAM BROADCAST. AND YOUR
SMART DEVICES TO REDUCE THE
SOUND DISTORTION. WHAT'S YOUR
PLACE IN THE QUEUE YOU ALSO
NEED TO MUTE YOURSELF UNTIL
YOU'RE CALLED UPON TO SPEAK.
YOU HAVE ANY PROBLEMS WITH THE
MODERATED- PHONE SERVICE YOU
CAN CALL THE COMMITTEE AT NINE
ONE SIX. THREE ONE NINE TWO
ZERO NINE SEVEN AND MY STAFF
WILL BE THERE TO HELP YOU. I
ALSO WANT TO NOTE THAT WE ARE
ACCEPTING WRITTEN PUBLIC
COMMENT THROUGH THE HEALTH
COMMITTEES PUBLIC EMAIL. AND
THAT IS A H. E. A. DOT
COMMITTEE. DOT C. A. DOT G. O.
V. WHICH CAN BE FOUND ON OUR
WEBSITE WE MAY NEED TO LIMIT
HOW LONG EACH PERSON HAS TO
PROVIDE PUBLIC COMMENT- THANK
YOU FOR YOUR PATIENCE- THANK
YOU TO ALL OF OUR SPEAKERS FOR
A COMPANY I REQUEST TO- PRESENT
AT THIS HEARING DURING THE
PANDEMIC. THIS IS THE SECOND
WHAT WE HOPE WILL BE THREE
INFORMATIONAL HEARINGS ON
CALAMP. TODAY'S HEARINGS
FOCUSED ON THE PROPOSED MEDIC
CAL MANAGED CARE BENEFIT
CHANGES A LOT TO DISCUSS AND WE
HAVE A VERY FULL AGENDA SO TO
SAY I LOOK FORWARD TO HEARING
TESTIMONY. I'D LIKE TO INVITE
MY CO CHAIR DR REGULAR TO MAKE
OPEN OPENING REMARKS. WE HAVE A
FULL AGENDA SIX PANELS TO
DISCUSS. THE PROPOSED CHANGES
TODAY ALL THE PANELISTS ARE
USING WEBEX SO WE CAN SEE YOU
CAN WE CAN SEE THEM AS THEY
SPEAK. THE HEARING PAPERS
POSTED ON THE ASSEMBLY- HEALTH
COMMITTEE WEBSITE UNDER THE
HEARINGS AND THEN INFER INFO
HEARINGS TAB. AND DOCTOR
ARAMBULA AND I WILL ALTERNATE
THE CHAIRING EACH PANEL. AT THE
END OF THE HEARING WILL MAKE
WILL TAKE PUBLIC COMMENT AND
WITH THIS SO LET'S TO- AND BY
DOCTOR AND REALLY MAKE OPEN
REMARKS. THANK YOU DOCTOR
WOULDN'T- WHAT A PLEASURE IT IS
TO BE JOINING YOU AGAIN TODAY
FOR THIS JOINT HEARING BETWEEN
ASSEMBLY HEALTH AND ASSEMBLY.
BUDGET SUB COMMITTEE NUMBER
ONE. NOW I'M PLEASED TODAY TO
TALK ABOUT CAL HM AND I HOPE
THAT TODAY'S FOCUS WILL BE ON
BOTH EQUITY AND HOW WE CAN
DIRECTLY AFFECT THE SOCIAL
DETERMINANTS OF HEALTH. AND
WHEN I SPEAK ABOUT EQUITY I'M
REALLY TALKING ABOUT
GEOGRAPHICAL EQUITY RIGHT NOW.
CURRENTLY UNDER THE WHOLE
PERSON CARES PILOT AS WELL AS
THE HEALTHY HOMES PROGRAMS THAT
ARE BEING RUN BY THE STATE.
THOSE ARE BEING ADMINISTERED IN
TWENTY FOUR COUNTIES OF THE
FIFTY EIGHT COUNTIES IN OUR
STATE. REPRESENTING ONE OF
THOSE COUNTIES THAT IS NOT
COVERED UNDER A WHOLE PERSON
CARES OR HEALTHY HOMES. I KNOW
THAT THERE IS A REAL BENEFIT TO
THOSE PILOT PROGRAMS AS THEY'VE
HELPSTO PROVIDE- REAL.
RESOURCES FOR US ADDRESSING THE
SOCIAL DETERMINANTS OF HEALTH.
SO I LOOK FORWARD TO TODAY'S
DISCUSSION ABOUT HOW WE CAN
HELP TO EXPAND THOSE SERVICES
STATEWIDE WITH THE WHOLE
PERSON- PERSON CARES APPROACH
IN MIND AS POWER LINES. SO THAT
WE CAN MAKE SURE THAT WE CAN
PROVIDE BETTER SERVICES TO
CALIFORNIANS WITHOUT I LOOK
FORWARD TO THAT FACE
DISCUSSION. GREAT THANK YOU
VERY MUCH ANY OTHER COMMITTEE
MEMBERS ANY COMMENTS AT THIS
POINT. CNN WILL GO AHEAD AND
START- OUR FIRST PANELIST ON
THE VARIOUS PROPOSED CHANGES
INVOLVING THE NEW. QUOTE IN
LIEU OF SERVICES OPTION AND
QUOTE- THE PANELISTS ARE- WILL
LIGHT BORN DIRECOR DEPARTMENT
OF HEALTH CARE SERVICES J. C.
COOPER THE CHIEF DEPUTY
DIRECTOR OF HEALTH CARE
PROGRAMS AND THE STATE MEDICAID
DIRECTOR. DIRECTOR ALSO- WHICH
IS WITH THE DEPARTMENT OF
HEALTH CARE SERVICES. NED
RUSTIC OFF FISCAL AND POLICY
ANALYST AT THE LEGISLATIVE
ANALYST'S OFFICE. KAREN HANS
BERGER- DR HANS BERGER CHIEF
MEDICAL OFFICER OF THE INLAND
EMPIRE HEALTH PLAN. AND LINDA
WAY THE POLICY ADVOCATE FOR THE
WESTERN CENTER ON LAW AND
POVERTY. WE'LL HAVE THE- OUR
FOR SPEAKERS GO AHEAD. WELL
GOOD AFTERNOON ALL DOCTOR
AROUND THE WORLD IT WILL- A
REAL LIFELONG HOME DEPARTMENT
HEALTH CARE SERVICES JUST A FEW
OPENING COMMENTS ALONG MORE J.
C. COOPER DAHLE HOME WALK
THROUGH RESPONSES TO THE
QUESTIONS ON THE AGENDA- I JUST
WANT TO SAY THAT I THINK OF THE
ITEMS BEING COVERED IN TODAY'S
AGENDA. OR REALLY THE MOST
IMPORTANT REFORMS LIKE IMAGINE
IN OUR HEALTH DELIVERY SYSTEM-
THROUGH HEALTH CARE MANAGEMENT
AND LITTLE OF SUBSTANCE WE CAN
START TO ADDRESS THE UNDERLYING
CIRCUMSTANCES WHICH DOCTOR
RANDALL SAID SOCIAL
DETERMINANTS OF HEALTH. ABOUT
CONTRIBUTORS MUCH TO HEALTH
OUTCOMES AS. ON DOES. DOES
MANAGEMENT AND- ALL IT ALSO THE
BODIES WERE US TOOLS ARE ADD TO
ALMOST ACT. BULLS OF GEOGRAPHIC
EQUITY STOCK PROGRAM. TOOK
BECAUSE IT WILL CLOSER
STATEWIDE FROM ALSO RACIAL
EQUITY. BECAUSE IT WILL. MAKE
THE MOST. PEOPLE AND THEIR
NEEDS ARM AND- RELATED TO THAT
IS THE FACT THAT WE WILL OFFER
A REAL RESPONSE TO MANY OF THE
PEOPLE. WHO WERE ADDED TO THE
MEDICAL COVERAGE THROUGH THE
EXPANSION WILL PERFORM THE
PROGRAM REALLY WAS DESIGNED AS
A HEALTH DELIVERY SYSTEM WELL
TO MEET THEIR NEEDS AND I
THINK. WITH WHAT WE ARE
PROPOSING HERE TODAY. WE START
NOW ROAD MEETING- NEEDS SO
REQUIRE ON TRADE TO COLLEAGUE.
GOOD AFTERNOON EVERYONE. I'M SO
STARTING WITH IN LIEU OF
SERVICES AND YOU KNOW ONE THING
THAT WE ARE STILL CONSIDERING
IS AN ADDITIONAL NAME FOR THIS
BUT ESSENTIALLY. ADDITIONAL
ROCK SERVICES THAT CAN BE MADE
TO INDIVIDUALS- WITHIN MEDICARE
MANAGED CARE- THE DEPARTMENT IS
PROPOSING FOURTEEN DISTINCT
SERVICES- WHICH ARE MEDICALLY
APPROPRIATE COST EFFECTIVE
ALTERNATIVES TO SERVICES
OTHERWISE AVAILABLE IN THE
STATE PLAN- ONE THING WE DO I
TRY TO MAKE SURE IT'S CLEAR IS
THAT MEDICARE MANAGED CARE
PLANS WILL HAVE THE- OPTION TO
OFFER. ON THE IN LIEU OF
SERVICES UNDER FEDERAL
REGULATIONS IT DOES HAVE TO BE.
AT THE OPTION OF THE MANAGED
CARE PLANS AS WELL AS THE
BENEFICIARY WILL HAVE THE
OPTION TO ACCEPT THE IN LIEU OF
SERVICE OR TO RECEIVE THE STATE
PLANS SERVICE INSTEAD- SO WE DO
TRY TO CLARIFY THAT. THE
FOURTEEN IN LIEU OF SERVICES-
INCLUDE A- A RARE KIND OF
HOUSING SERVICES ARE SUITES
WHICH INCLUDE TRANSITION
SERVICES HOUSING DEPOSITS
TENDENCY IN THE STATE-
SUSTAINING SERVICES. I'M AND
THEN WHAT WE'RE TURNING AS
SHORT TERM POST HOSPITALIZATION
HOUSING ESSENTIALLY SIX UP TO
SIX MONTHS OF- TEMPORARY
HOUSING- AS SOMEONE TRANSITIONS
FROM. AN INPATIENT STAY
INSTITUTIONAL LEVEL CARE-
INCLUDING- YOU KNOW A JAIL
SETTING OUT TO TRANSITION TO
YOU. ARE WE'RE ALSO INCLUDING
RECUPERATIVE CARE WHAT'S ALSO
BEEN KNOWN AS MEDICAL RESPITE
AS WELL AS OTHER RESPITE
SERVICES I'M TO GIVE CARE
GIVERS ARE OTHERS AT A-
REPRIEVE- AND THEY HAVE
DILATATION PROGRAMS THAT CAN BE
SET UP ACROSS LARGER URBAN
AREAS- TO MAKE SURE THAT
SERVICES ARE BEING PROVIDED IN
A CENTRAL LOCATION- IN. FOR
EXAMPLE IN LOS ANGELES YOU CAN
SET UP A DAY HABILITATION
PROGRAM- IN THE MIDDLE OF THE
CITY TO PROVIDE ADDITIONAL
SERVICES TO HOMELESS POPULATION
JUST AS AN EXAMPLE THERE. WERE
ALSO HAVE A VARIETY OF- HOME
COMMUNITY BASED SERVICES. OFTEN
PROVIDED IN OUR NINETEEN FIFTY
IN C. WAIVERS WANTING X. THAT
THROUGH THE LIEU OF. ON THESE
INCLUDE A NURSING FACILITY
TRANSITIONS TO BOTH ASSISTED
LIVING FACILITIES- SUCH AS
RESIDENTIAL CARE FACILITIES FOR
THE ELDERLY AND ADULT
RESIDENTIAL FACILITIES AS WELL
AS A COMMUNITY TRANSITIONS FROM
A NURSING FACILITY. TO
SOMEONE'S HOME ARMS OF THE
FLEXIBILITY THERE HE SERVICES
WOULD COVER ON NOT ONLY THE
TRANSITION FROM THOSE-
LOCATIONS- TO THE HOME IT WOULD
ALSO COVER FOR EXAMPLE ANY RAP
SERVICES NECESSARY IN AN RCMP
OR IN OUR FOR- AVAILABLE TO
THAT BENEFITS YOUR ONCE THEY'RE
PLACED IN THAT ASSISTED LIVING
FACILITY. IT ALSO PERSONAL CARE
IN HOMEMAKER SERVICES- HOME
MODIFICATIONS AS NECESSARY TO
KEEP SOMEONE SAFELY IN THE HOME
A MEDICALLY TAILORED MEALS
SOBERING CENTERS AND ADDS ABOUT
REMEDIATION. ARE YOU CAN SEE ON
MANY OF THE IN LIEU OF SERVICES
BEING OFFERED REALLY FOCUSED ON
THE HOMELESS JUSTICE INVOLVED
AGING POPULATION- AS WELL AS
COMING COMMUNITY BASED SERVICES
FOR SOME OF OUR MOST VULNERABLE
BENEFICIARIES. THE EXAMPLE HERE
OF RESPITE SERVICES FOR
CHILDREN WITH COMPLEX MEDICAL
CONDITIONS OR SOMEONE WITH
DEMENTIA OR ALZHEIMER'S REALLY
CHANGING IN REGARDS TO THE
TYPES OF SERVICES THAT WE ARE
PROVIDING OUR MEDICARE
BENEFICIARIES SO THEY CAN
RESIDE SAFELY IN THE COMMUNITY
WITH OUR FAMILY- WHEN THAT IS
THEIR CHOICE. ADDITIONALLY WE
HAVE BUILT THIS INFRASTRUCTURE-
OVER TIME WE HAVE DEVELOPED
SOME OF THE INFRASTRUCTURE
THROUGH BOTH THE HELP HOMES IN
PARTS OF THE WHOLE PERSON CARE
PILOTS. ON THE MEDICARE MANAGED
CARE PLANS IN COUNTIES WITH
THESE PROGRAMS WILL BE REQUIRED
TO SUBMIT A TRANSITION PLAN. TO
THE DEPARTMENT- THAT WOULD
START ON JANUARY FIRST OF
TWENTY TWENTY TWO- THOSE ARE
THE TRANSITION PLAN IS DUE JULY
ONE OF TWENTY TWENTY ONE- WITH
THE HELP OF THOSE AT
TRANSITIONING IN LIEU OF
SERVICES TO START IN JANUARY
ONE OF TWENTY TWENTY TWO- AND
THEY WOULD HAVE TO DEMONSTRATE
TO US THROUGH THAT TRANSITION
PLAN. HOW THEY ARE- WHICH
INCLUDES SERVICES THEY'RE GOING
TO BE PROVIDING AND HOW THEY
WILL TRANSITION THOSE OUR HOPE.
IS THAT THEY WILL CONTINUE TO
PARTNER UP WITH THE EXISTING
PROVIDERS IN THE COMMUNITY WHO
ARE PROVIDING THESE SERVICES
TODAY. I FOR EXAMPLE PUBLIC
HOSPITAL SYSTEMS WHO ARE-
PROVIDING MANY OF THESE
SERVICES- THROUGH THE WHOLE
PERSON CARE PILOTS AND IN
PARTNERSHIP WITH MANY OF THEIR
COUNTY COLLEAGUES- OR I WITH
OUR COUNTY COLLEAGUES FOR
EXAMPLE BEHAVIORAL HEALTH.
PROVIDERS WITHIN THE COUNTY MAY
BE REALLY GOOD CANDIDATES TO
PROVIDE SOME OF THESE IN LIEU
OF SERVICES. AS WELL AS SOME OF
OUR EACH CBS PROVIDERS TO DO
THIS TODAY OF FOR EXAMPLE R. C.
C. T. PROVIDERS TO DO
TRANSITIONS TODAY ACROSS THE
STATE OF CALIFORNIA. IN VARIOUS
LOCATIONS UNDER MONEY FOLLOWS
THE PERSON PROGRAM WHERE WE
HAVE SEEN GREAT SUCCESS IN
TRANSITIONING INDIVIDUALS TO
ASSISTED LIVING ENVIRONMENTS
FOR TO THEIR HOMES IN
MAXIMIZING THEIR EXPERIENCE
THERE. TO REALLY ENSURE THAT
MANAGED CARE PLANS ARE NOT.
REINVENTING THE WHEEL FOR LACK
OF BETTER SCRIPT IN BUT REALLY
PARTNERING WITH THOSE WHO KNOW
HOW TO DO THIS WELL AND HAVE
THE EXPERIENCE AND EXPERTISE TO
DO YOU ARE THESE VERY UNIQUE
SERVICES- EVENTUALLY IT WHAT
WOULD HELP IS STATEWIDE BUT
STARTING. THROUGH THE INDO OF
SERVICES TO BEGIN. AS WE ABOUT
HOW WE WERE. MONITOR MEDICARE
MANAGED CARE PLANS- WE'RE
LOOKING. AT END OF COPPER.
APPROACH TO ALL OF THAT I'M
WITH EVERY LARGE TRANSITION WE
USUALLY LOOK AT A NUMBER OF
DOMAINS WE LOOK AT ACCESS TO
SERVICES WE WILL LOOK AT
SERVICE PROVISION- PROVIDER
CAPACITY GRIEVANCE APPEALS- AS
WELL AS OUTCOMES THIS WILL PLY
TO IMPROVE SERVICES ALSO EVEN
THOUGH IT IS OPTIONAL ONCE A
MANAGED CARE PLAN A LACKS TO
PROVIDE THE IN LIEU OF SERVICE.
THEY WOULD BE REQUIRED TO STILL
MEET LL THE REQUIREMENTS OF
THE DEPARTMENT IN REGARDS TO
ACCESS COMMUNICATION- APPEALS
EXCEPT ROB- I WHICH IS ALSO
MENTIONED WE HAVE SOME
EXPERIENCE WHERE WE HAVE USED A
VARIOUS OUTCOME MEASURES- LIKE
IN OUR WHOLE PERSON CARE PILOTS.
TO ASSESS THESE TYPES OF
SERVICES DIFFERENT SERVICES
THAT ARE ALWAYS PROVIDED
TYPICALLY BY AGE I MANAGED CARE
PLAN- AND IN THE WHOLE PERSON
HERE FOR EXAMPLE SOME OF THE
OUTCOMES THAT WE WERE LOOKING
AT ARE FOCUSED ON THINGS LIKE
INLET TORY CHAIR EDIE VISITS
WHICH IS THAT HE DOES MEASURE.
INITIATION ENGAGEMENT OF
ALCOHOL AND OTHER DRUG
DEPENDENCE TREATMENT AS WELL AS
FOLLOW UP AFTER HOSPITALIZATION
FOR MENTAL ILLNESS ALL THREE HE
DOES MEASURES OF WELL BEDDED
MEASURES THAT REALLY ALLOW US
TO TEST SOME OF THE
EFFECTIVENESS OF SOME OF THESE
TYPES OF SERVICES. BUT WE ALSO
LOOK AT THINGS LIKE JUMPER
CITIZENS THEM AS WELL AS THE
PERCENT OF HOMELESS WHO ARE
CURRENTLY HOUSE FOR GREATER
THAN SIX MONTHS WE WILL HAVE TO
FIND THE BALANCE OF WHAT WE CAN
EXPECT OUR MEDICARE MANAGED
CARE PLANS TO REPORT DAY ONE.
BUT PUTTING A PIN THIS FOR
LATER REALLY LOOKING AT OTHER
MEASURES WHERE THROUGH THE
INCENTIVE DOLLARS AVAILABLE
THROUGH CALLING HOPING THAT WE
CAN THINK ABOUT MEASURES THAT
CUT ACROSS DELIVERY SYSTEMS TO
SHOW HOW WE'RE INTEGRATING AS
WELL AS BRINGING IN SOCIAL
ASPECTS OF THESE. OUTCOMES AND
INCENTIVIZING SOME MAY BE
HARDER TO REPORT OUTCOMES SO
THAT WE CAN BUILD THAT
INFRASTRUCTURE FROM A DATA. I'M
SHARING POINT OF VIEW. THE
DEPARTMENT PLAN ON A SURE BEST.
FOR BOTH OUR PERSON AND HOMES-
WITH OUR MANAGE CARE PLANS AND
AS WE LEARN. FROM THE GROWTH OF
THESE AND GO UP SERVICES A PLAN
TO GO BEFORE OTHERS A REALLY
PROVIDING TECHNICAL ASSISTANCE
AND LESSONS LEARNED ACROSS THE
STATE OF CALIFORNIA. I'M I
WOULD NOTE THAT THERE ARE A FEW
ITEMS WITHIN THE IN LIEU OF
SERVICES THAT DO HAVE LIMITS.
ON THE ONCE IN A AN
INDIVIDUAL'S LIFETIME LIMIT
THAT YOU SAW- IN PARTICULAR
AROUND SOME OF THE HOUSING
RELATED IN LIEU OF SERVICES.
ARE INTENDED TO BE SAFEGUARDS
AGAINST IN LIEU OF SERVICES
THAT ARE USED TO PROVIDE A
BROADER HOUSING BENEFIT WHICH
IS NOT PERMISSIBLE UNDER THE
MEDICAID PROGRAM- ALSO I WOULD
NOTED THAT WHILE WE DID HAVE
THE ONCE IN A LIFETIME LIMIT
FOR SOME OF THOSE HOUSING
OPTIONS. WE DID ADD BASED ON
EXTENSIVE STAKEHOLDER FEEDBACK.
OPTION TO APPROVE AN ADDITIONAL
TIME WITH DOCUMENTATION AS TO
WHAT CONDITIONS HAVE CHANGED TO
DEMONSTRATE THAT WHILE
PROVIDING THE ADDITIONAL
HOUSING SERVICES. WOULD BE
SUCCESSFUL IN THAT SECOND
ATTEMPT TO TRYING TO FIND THAT
BALANCE WITHIN THOSE. OTHER
LIMITS THAT YOU SAW LISTED
WITHIN THE IN LIEU OF SERVICES
ARE VERY CONSISTENTWITH OUR
EXISTING NINETEEN FIFTEEN C.
AND HOME AND COMMUNITY BASED
WAIVERS. ARE WHERE WE
OFTENTIMES YOU HAVE TO SET
VARIOUS LIMITS- REALLY USED TO
ENSURE THAT. THEY ARE COST
EFFECTIVE FOR EACH SERVICE THAT
APPROPRIATE PRICING GUIDELINES
AS WELL AS TO PROVIDE STRUCTURE
FOR THE MANAGED CARE PLANS AS
THEY DEVELOP THEIR UNIQUE
OFFERINGS AT THESE IN THE WEB
SERVICE AS- AND THAT COMES OFF
OF A LOT OF EXPERIENCE THAT
WE'VE HAD IN THAT SPACE. UP FOR
MANY YEARS- WITHIN THE
DEPARTMENT. THE LIMITS ARE
REALLY INTENDED TO MITIGATE
POTENTIAL ABUSE OR MISUSE OF IN
LIEU OF SERVICES SUCH AS
INSTANCES WHERE THEY'RE
PROVIDING DELUDE SERVICE CAN
MAYBE. NOT BE AS COST EFFECTIVE
RELATIVE TO OTHER STATE PLANS
SERVICES SOMETHING THAT THE
MANAGED CARE PLANS WHAT OFTEN
HAVE TO CONSIDER WHEN THEY'RE
MAKING DETERMINATIONS TO OFFER
THESE IN THE WEB SERVICES. OR
TO AUTHORIZE THEM FOR
SOMEBODY'S USE. ADDITIONALLY
WOULD JUST SAY THE PROPOSED
UTILIZATION LIMITS WERE REALLY
DEVELOPED WITH CONSIDERATION OF
MEMBERS NEEDS AND REFINED
THROUGH A LOT OF STAKEHOLDER
ENGAGEMENT. DCS IS NOT BELIEVE
THAT THEY RESTRICT THE ABILITY
OF PLANS TO CONNECT PEOPLE TO
NON MEDICAL SERVICES TO ADDRESS
SOCIAL DETERMINANTS OF. HEALTH
OR FOR THEM TO RESIDE SAFE WE
THE HOME- WE'VE IT'S ACTUALLY
THE COUNTRY. YEAH OF THESE THE
WORKS. IN WITH THE ENHANCED
CARE MANAGEMENT BENEFIT REALLY
ARE DESIGNED TO ENABLE THESE
LINAGES- AND PROVIDE THE BEST
CARE FOR SOMEONE OFTENTIMES
LESS COSTLY. ON THAN WHAT IS
BEING PROVIDED OTHERWISE. WHEN
IT COMES TO RATES ON A FEW
THINGS TO POINT OUT AND WE'VE
GOTTEN THIS QUESTION- RECENTLY
SO WANTED TO MAKE SURE PEOPLE
ARE UNDERSTANDING- THERE ARE
SOME IN LIEU OF SERVICES THAT
WOULD BE BUILT INTO THE RATE
FROM DAY ONE FOR EXAMPLE. WHERE
WE HAVE A WHOLE PERSON CARE
PILOTS THAT ARE PROVIDING IN
LIEU OF SERVICES- FOR SOME OF
THE HELP HOMES HOUSING
COORDINATION SERVICES. THOSE
WOULD BE INCLUDED AND WE HAVE
USED TO BE ON ENCOUNTER DATA-
AND EXPERIENCE FROM BOTH OF
THOSE TO INFORM WHAT'S IN THE
BUDGET IN REGARDS TO THE IN
LIEU OF SERVICES. THEN DO YOU
SEE AS WELL ALSO COLLECT IN
LIEU OF SERVICES COSTS
SEPARATELY FROM STATE PLAN
SERVICES. ADMINISTRATOR PLANS
BUILD UP THAT EXPERIENCE OVER
TIME IT WILL EVENTUALLY BE
BUILT INTO THEIR RATE- BUT
SENSE IN LIEU OF SERVICES ARE
OPTIONAL. AND WE DO NOT HAVE
THE SCHEDULE OF THOSE BEING
IMPLEMENTED THAT WILL BE DONE
OVER TIME IN BUILT INTO THE
RATE AS THEY BUILD THAT
EXPERIENCE- IN IN THEIR KIND OF
MANAGED CARE PLAN. THE OTHER
THING I'D POINT OUT IS THAT- IF
WE NEED THAT EXPERIENCE TO BE
IN THE RATES FOR A WHILE SO FOR
EXAMPLE- THEY WOULD BE
PROVIDING THE SERVICES FIRST
THEN WE WOULD BUILD THAT
THROUGH COUNTER DATA AND THEN
THEY WOULD. IT WOULD BE SHOWN
IN THEIR FUTURE YOUR RATES SO
THE ONLY THING BEING BUILT IN
JANUARY ONE TWENTY TWENTY TWO
IS REALLY WHAT WE'RE SEEING
TRANSITION FROM WHOLE PERSON
CARE. AND THEN AS PLANS ELECT
AND PROVIDE THOSE SERVICES IT
WOULD BE BUILT IN INTO THE
LATER YEARS. I'M I THINK THE
DECISION WE JUST WANNA MAKE
SURE THAT PEOPLE UNDERSTAND
MANAGED CARE PLANS WILL HAVE TO
COMMUNICATE. WHAT IN LIEU OF
SERVICES ARE GOING TO BE
OFFERED TO MEMBERS THROUGH
THEIR EVIDENCE OF COVERAGE-
WHICH IS PROVIDED TO YOU ALL-
THE BENEFICIARIES IN A MANAGED
CARE PLAN. WE ALSO WILL HAVE A
TAILORED NOTICES AND
COMMUNICATION THAT WILL HAVE TO
GO OUT TO MEMBERSHIP- WE KNEW
IN LIEU OF SERVICES. ARE ARE
OFFERED. WE ARE GOING TO ALLOW
MANAGED CARE PLANS DO YOU BRING
UP IN LIEU OF SERVICES EVERY
SIX MONTHS. ARE WE CURRENTLY
JUST CLOSE THE COMMENT PERIOD
ON OUR MODEL OF CARE DOCUMENT
WE OUTLINED. MANY OF THOSE
REQUIREMENTS IN DETAIL PIECES
FOR HOW THE MANAGED CARE PLAN
WILL FILE THAT WITH THE
DEPARTMENT. OF HEALTH CARE
SERVICES. AND THEN. LASTLY
WOULD JUST NOTE THAT. WE REMAIN
OPEN TO MANAGED CARE PLANS
ADDING FUTURE IN LIEU OF
SERVICES BEYOND THE FOURTEEN.
HOWEVER DCS WILL NOT RECOGNIZE.
THEY RECOGNIZE ANY OF THE
UNLISTED IN LIEU OF SERVICES
UNLESS THEY BECOME ADOPTED. AND
ARE INCORPORATED INTO A PART OF
THE FULL IN LIEU OF SERVICE
STRUCTURE WITHIN THE MANAGED
CARE PLANS CONTRACT. SO WE
WOULD DEFINITELY HAVE TO ENGAGE
IN CONVERSATIONS WITH THEIR
PLANS AS THEY EXPLORE THOSE.
OPTIONS AND THIS. IS THE END OF
OUR COMMENTS AT THIS TIME.
GREAT THANK YOU VERY MUCH WILL
MOVE ON I DO WANT TO NOTE THAT
WE DO HAVE ANOTHER PANELIS
THERE WAS LEFT OFF AN ADVERT IN
THE AND THAT WOULD BE- M. J.
DIAZ. WHO IS REPRESENTING SEIU
SO SHE'LL BE SPEAKING. AT THE
END OF THE PANEL SO WE'LL MOVE
ON TO OUR NEXT OUR NEXT
PANELIST. HEY GOOD AFTERNOON
THIS IS NET REZNIKOV. LA I JUST
HAVE A- A FEW BRIEF COMMENTS TO
MAKE ABOUT INCLUDE SERVICES-
FIRST OFF I'D I'D LIKE TO
MENTION THAT. WE NOW HAVE FOR
ANALYSES OF CALAMP POSTED ON
OUR WEBSITE- SO THE FIRST ONE
WAS ABOUT. THE OVERARCHING
ISSUES WITH IN CALAIS AND THEN
WE HAD ONE ON. THE FINANCING OF
CALAIS M. AND THEN MOST
RECENTLY- AT THE END OF LAST
WEEK AT THE BEGINNING OF THIS
WEEK. WE POSTED AT ANALYSIS. OF
EQUITY CONSIDERATIONS. IN
CALAIS MAINE ALSO CALLEBS
PROJECTED IMPACT ON SENIORS AND
PERSONS WITH DISABILITIES AND-
WE DO EXPLORE IOS IT IN SOME
DETAIL IN. BOTH OF THOSE TWO
LATTER POSTS. THE BOTTOM LINE.
FOR US WHEN IT COMES TO IOS IS
THAT WE DO. SEE SOME BENEFITS
TO THIS PROPOSAL. HOWEVER WE DO
ALSO HAVE SOME. QUESTIONS ABOUT
THEIR PROPOSAL STILL AN AD.
FORESEE SOME POTENTIAL ISSUES.
THE BIGGEST OF THOSE ISSUES IS
THAT. BECAUSE IT WILL BE
LARGELY AT THE DISCRETION OF
PLANS WHAT IN LIEU OF SERVICES
THEY WILL OFFER. THE TYPES OF
PLANS THAT THE TYPES OF
BENEFITS THAT ARE. OFFERED.
MIGHT VARY ACROSS THE STATE.
ADDITION IT'S- IF THE- CHIU IN.
CERTAIN OF THESE SERVICES. IN
EVERY COUNTY SO FOR EXAMPLE-
THE HOUSING NAVIGATION SERVICES-WHETHER- THERE ARE PROVIDERS IN
EVERY COUNTY THAT CAN ADD UP
PARTNER WITH PLANTS PROVIDE
THOSE SERVICES WHETHER. THE
HOUSING EXISTS TO. NAVIGATE
NAVIGATE MEDIC HOW ENROLLEES
TO- THINGS LIKE THAT. BUT
MOVING ON TO SOME OF THE
POTENTIAL BENEFITS- THE ONE OF
THE BIG ONES IS THAT- BY MAKING
THESE INTO MEDICAL SERVICES IT
IT UNLOCKS A CONSIDERABLE
FEDERAL FUNDING TO PROVIDE
CERTAIN BENEFITS THAT AT. THE
STATE MIGHT NOT BE ABLE TO
ACCESS FEDERAL FUNDING OR
OTHERWISE- WE ALSO THINK THAT
IT COULD AS A RESULT OF THESE
SERVICES LEAD TO BENEFICIAL
HEALTH OUTCOMES FOR A MEDIC CAL
ENROLLEES AND- AFTER THAT- IT
COULD POSSIBLY PREVENT THE NEED
FOR COSTLY- MORE INTENSIVE.
MEDICAL INTERVENTIONS FURTHER
DOWN THE ROAD- ADDITIONALLY TO
THE EXTENT THAT THIS PROGRAM
WOULD REPRESENT A CONSOLIDATION
OF. HEALTH HOMES AND A WHOLE
PERSON CARE. THESE ARE BECAUSE
THESE ARE TO- PRETTY SIMILAR
PROGRAM SURVEYING OVERLAPPING
POPULATIONS ARE WE DO FEEL THAT
IT MAKES SENSE FROM A MINISTRY
OF PERSPECTIVE AND FROM THE
PERSPECTIVE OF REDUCING
FRAGMENTATION. TO CONSOLIDATE
SOME OF THE SERVICES UNDER THE
HELLO WEST. I WAS BANNER. IN A
TO THE CONCERNS I MENTIONED UP
FRONT THAT WE DO WE DO HAVE A
COUPLE OF OTHER ONES I WON IS
JUST A QUESTION FOR THE
LEGISLATURE TO POSSIBLY
CONSIDER ABOUT THE- UTILIZATION
LIMITS THAT WERE MENTIONED
WHICH IS- DO ALL OF THESE
UTILIZATION LIMITS FOR THE
RESPECTIVE SERVICES STRIKE THE
RIGHT BALANCE BETWEEN FISCAL
PRUDENCE AND ALLOWING THE BUTTE
BENEFITS TO BE EFFECTIVE FOR
VERY HIGH NEED BENEFICIARIES.
ANOTHER ANOTHER QUESTION- TO
POTENTIALLY CONSIDER IS HOW
COST EFFECTIVENESS WILL BE
OVERSEEN BY THE STATE. WITHOUT
SUFFICIENT OVERSIGHT AND
ASSURANCE IT IS IT IS AT LEAST
POSSIBLE THAT IOS COULD LEAD TO
INCREASING RATHER THAN
DECREASING COSTS. ADDITIONALLY
WITH REGARDS TO THE- THE
POPULATION CURRENTLY ENROLLED
IN HEALTH HOMES- THE QUESTION
OF WHETHER THERE WILL BE
ADEQUATE CONTINUITY OF CARE
PROTECTIONS TO MAKE SURE THAT
EXISTING BENEFICIARIES ARE ARE
TRANSFERRED INTO SERVICES THAT
CONTINUE TO MEET THEIR NEEDS.
AND THEN JUST A ALASKA GENERAL
POINT WHICH IS THAT- OVERALL
CALIFORNIA HAS HAS TYPICALLY
DONE A PRETTY GOOD JOB WE FEEL
OF THAT ALLOWING SERVICES TO
VERY ACROSS THE STATE TO
CONFORM WITH LOCAL NEEDS SAID
EACH INDIVIDUAL COUNTY- BUT BUT
IT'S BEEN MORE CHALLENGING TO
BRING IN LESSONS LEARNED FROM.
HOW PROGRAMS HAVE BEEN APPLIED
DIFFERENTLY IN DIFFERENT PARTS
OF THE STATE AND SO WITH THIS
THIS BRINGS UP THE QUESTION OF
HOW TO HOW TO EVALUATE- I LOS
AND DOES. TAKE SOME SOME
LESSONS LEARNED FROM HOW IT IS
IMPLEMENTED IN DIFFERENT PARTS
OF THE STATE THANK YOU VERY
MUCH AND HAPPY TO ANSWER ANY
QUESTIONS. THANK YOU AND JUST
SERVICIOS WILL BE TAKING
QUESTIONS AT THE END OF EACH
PANEL SO THANK YOU VERY MUCH.
OUR NEXT. PANELIST DR- KAREN
HANS BERGER. YEAH SURE WOULD
CHANGE YOUR ARAMBULA AND THE
MEMBERS OF THE COMMITTEE- I'M
HERE ENHANCE BURGER I AM THE
CHIEF MEDICAL OFFICER AT THE
INLAND EMPIRE HEALTH PLAN. WE
SERVE OVER ONE POINT THREE
MILLION MEMBERS MEDIC CAL
MEMBERS- IN RIVERSIDE AND SAN
BERNARDINO COUNTY WE HAVE SEVEN
THOUSAND PROVIDERS SAID OUR
PRIMARY CARE AS WELL AS.
SPECIALISTS AND WE ALSO HAVE
PARTNERS WITH MOST COMMUNITY
BASED OR- THROUGHOUT THE IN THE
EMPIRE. I APPRECIATE YOUR- TO
TALK TO YOU TODAY THE FOR.
PROPOSAL I'D LIKE TO START BY
THAT I ATE P. APPRECIATE AND
APPLAUD C. H. THE- FOR THEIR
EFFORTS DURING INTO CAL. WE
SPEAK HOW LAME THE NET. LEVEL
OF THE MEDICARE PROGRAM. IS
WELL WORTH THE PROGRAMS PROVIDE
PERSON CENTRED CARE ADDRESS ALL
AT OF HEALTH. WE HAVE ALL
LEARNED THE WAY WITHOUT QUALITY
FOOD OR ROOF OVER YOUR HEAD.
YOU SIMPLY CANNOT MAINTAIN GOOD
HEALTH. THE COUNTY. UNIFIES THE
CLINICAL AND NONCLINICAL
SERVICES. AS A MEDIC CAL
BENEFICIARIES UNDER THE
RESPONSIBILITY OF THE MANAGED
CARE PLAN LIKE I H. P. AND THAT
HELP US TO SERVE THE MOST
VULNERABLE IN OUR COMMUNITY
ADDRESSING ALL ASPECTS OF
HEALTH THAT MAY BE IMPAIRING
THEIR ABILITY TO REACH THEIR
FULL POTENTIAL. HISTORICALLY I
THINK LEADERSHIP HAS INVESTED
IN WHAT IS NOW CALLED IN WITH
SERVICES. WE HAVE DONE THIS IN
A LIMITED FASHION- BECAUSE OF
THE COST THAT HAS BEEN TO THE
PLAN AS WELL AS THE
AVAILABILITY AND ARGUE COUNTY.
WE'VE INVESTED IN RESIDENTIAL
CARE FACILITIES FOR THE ELDERLY
AND CONGREGATE LILY LIVING
FACILITIES. WHICH PROVIDE
MEMBER CLINICALLY APPROPRIATE
CARE IN A COST EFFECTIVE MANNER
AND ALLOW THEM TO STAY IN THEIR
COMMUNITY. WE ARE PLEASED TO
SEE THAT MANY OF THE SERVICES
THAT WE HAVE BEEN DOING ARE
INCLUDED IN THE LOWEST SERVICE
OFFERING. WHICH INCLUDE HOUSING
ACCESS TO FOOD TRANSITIONING
ELIGIBLE MEMBERS FROM SKILLED
NURSING FACILITIES BACK INTO
THE COMMUNITY SETTING. I SEE
GOAL IS GOAL IS TO UNDERSTAND
HOW WE CAN ADOPT AS MANY OF THE
STATE'S PROPOSED ISLAND
OFFERING AS POSSIBLE. AND WE
APPRECIATE THE ONGOING FORMS
YOU ENGAGE WITH THE DEPARTMENT
AND THE LEGISLATURE TODAY TO
ENSURE THE PROGRAM'S SUCCESS.
FROM WHAT WE HAVE LEARNED NEEDS
THERE ARE SENATE EUROPE SOME OF
OUR CONCERNS. THE FIRST IN
ORDER FOR I. SPEAKER THEN
SURELY OFFER ALL THE ILO OUT
ALL L. O. S. SERVICES IT IS
CRITICAL THAT YOU H. C. AT THE
QUALITIES AND STANDARDS FOR POT
FOR PROVIDER NETWORKS THE
FLEXIBLE TO ACCOUNT FOR THE
DIVERSE GEOGRAPHIES AND BASS
FOR THIS AN EXISTING
INFRASTRUCTURE. IT WILL TAKE
TIME TO DEVELOP THE NATIVE WORK
FORCE AND PHYSICAL
INFRASTRUCTURES TO PROVIDE
THESE SERVICES. AS YOU MAY KNOW
I H. Q. Q. COUNTY FAILED OVER
TWENTY SEVEN THOUSAND SQUARE
MILES FROM BERGEN TO EXTREMELY
RURAL AREA. THESE RURAL AREAS
IN PARTICULAR THERE IS A
SHORTAGE OF CLINICAL PROVIDERS.
AND COMMUNITY BASED
ORGANIZATIONS OFFERING I LOS
SERVICES. THIS WILL BECOME EVEN
MORE ACUTE WHEN WE ADD
ADDITIONAL EXTREMELY ROLE THAT
GOES TO OUR SERVICE AREA UNDER
CALTRAIN. WILL BE ESSENTIAL IN
BUILDING THE PHYSICAL AND WORK
FOR INFRASTRUCTURE NEEDED TO
BETTER SERVE THE POPULATION.
NETWORK EXPANSION INVESTMENT
WILL BE KEY TO OUR SUCCESS. AND
THIS WILL SIMPLY TAKE TIME.
NETWORK UNDER THE PROPOSED I
WILL WITH SERVICES MUST BE
OFFERED THROUGHOUT THE COUNTY
AND THE QUESTION I WOULD
PROPOSE IS SHOULD I A L. S.
SERVICES THE HELP FROM SOME
BENEFICIARIES BECAUSE THE
INFRASTRUCTURE HAS NOT YET BEEN
BUILT THROUGHOUT THE FULL
SERVICE AREA. SECOND CONCERN IS
WHERE WORKFORCE IS AVAILABLE
MANY COMMUNITY BASED
ORGANIZATIONS WILL NEED
SIGNIFICANT HELP. IN OUR
EXPERIENCE THE CBO'S ARE FULL
OF PASSIONATE HEART LET PEOPLE
DOING AMAZING WORK ON A
SHOESTRING. BUT THE REALITY IS
THAT MANY DO NOT CURRENTLY
POSSESS THE SOPHISTICATION
REQUIRED TO COMPLY WITH THE
GOVERNMENT CONTRACT UNDER
CAROLINE KITCHENETTE ENCOUNTER
DATA WORKING HAVE THE
SOPHISTICATED DATA SYSTEMS
REQUIRED FOR INFORMATION
SHARING AND HIPAA COMPLIANCE.
ONE CANNOT UNDER ESTIMATE THE
HEAVY LIFT REQUIRED BY THESE
ORGANIZATIONS. IT NEVER GET
TECHNICAL ASSISTANCE AND
FINANCIAL SUPPORT WILL BE
REQUIRED TO HELP THEM BUILD THE
CONNECTIVITY NEEDED EXTENDING
WELL BEYOND A FEW WHETHER DARK.
AND LASTLY AS PLANS WORK MEET
THE JULY FIRST DEADLINE. WE'RE
CERTAIN DELIVERABLES REGARDING
THE IPLEMENTATION OF PROGRAM
DESIGN IT WILL BE IMPORTANT
THAT THE STATE PROVIDE US WITH%
FULL FINANCIAL DETAILS AS SOON
AS POSSIBLE. WE ARE REQUESTING
AT LEAST NINETY DAYS BEFORE
PROGRAM DESIGN DOCUMENTS ARGUE.
AS YOU CAN IMAGINE IT IS
DIFFICULT TO BUILD A HOUSE IF
YOU DO NOT KNOW HOW MANY BRICKS
THAT YOU COULD ACTUALLY BUY.
THIS IS CRITICAL TO OUR
PLANNING PROCESS. AND WILL
ALLOW IT ACCURATELY DETERMINE
WHERE WE WILL OR WILL NOT BE
ABLE TO DELIVER. ECM AND IOWA.
IN CLOSING I COMMEND DH CS
WE'RE BRINGING FORWARD SUCH A
BOLD AND INNOVATIVE PROGRAM.
ACCEPTING SO MANY OF OUR
RECOMMENDATIONS AND FURTHER
DESIGNING THE PROGRAM
COMPONENTS AND FOR THEIR
TIRELESS WORK IMPLEMENT. IT
IMPLEMENT IN LEWISBURG AT THIS
I THANK YOU FOR YOUR TIME AND
WELCOME YOUR QUESTIONS ON THE
PANEL. THANK YOU VERY MUCH
DOCTOR HANS BERGER- WE WILL GO
AHEAD AND MOVE ON NEXT TO OUR
NEXT PANELIST LINDA WAY. GOOD
AFTERNOON CHAIR MEMBERS LINDA
WAY WITH WESTERN CENTER ON LAW
AND POVERTY STATEWIDE ANTI
POVERTY ADVOCATES.
ORGANIZATIONAL LEADERS ASK NO
FEEDBACK IT SERVES AS- WANTED
TO SUPPORT CENTERS FOR THE
HEALTH CONSUMER LINE AND
NETWORKS CONSUMER ASSISTANCE
PROGRAM OPERATED BY LEGAL AID
PROGRAMS THROUGHOUT THE STATE.
FIRST I WANT TO THANK THE
ASSEMBLY COMMITTEES FOR HOLDING
THIS IMPORTANT STORY. AND IT
KNOWLEDGE THE DEPARTMENT TO
WORK ON THIS AMBITIOUS
PROPOSAL. HOMELESSNESS
DRAMATICALLY IMPACT HEALTH
OUTCOMES AND ACCESS TO CARE ON
AVERAGE PEOPLE EXPERIENCING
HOMELESSNESS IN KERR TWICE THE
MEDICAL COSTS IN OTHER MEMBERS
YET GUY OVER TWENTY FIVE YEARS
YOUNGER THAN HEALTH PEOPLE WITH
SIMILAR HEALTH COMMISSION. DATA
SHOWS BENEFICIARIES
EXPERIENCING HOMELESSNESS NEED
HOUSING SUPPORT SERVICES
SERVICES THAT HELP PEOPLE
ACCESS AND SAVE A LIFE IN
HOUSING BEFORE THEY CAN IMPROVE
THEIR HEALTH OUTCOMES OR LOWER
THEIR COSTS. THE DEPARTMENT
CREATED A WHOLE PERSON CARE
PILOT AND THEN MEDICARE
BENEFITS TO HELP HOMES PROGRAM
WHICH IS AN ENTITLEMENT WE CO
SPONSORED DEFINED HOUSING
SUPPORT SERVICES. ALTHOUGH THE
DEPARTMENT ACKNOWLEDGES
BENEFICIARIES EXPERIENCING
HOMELESSNESS NEED HOUSING
SUPPORT SERVICES CAL AIM WILL
ELIMINATE THESE PROGRAMS AND
INSTEAD PROVIDE HOUSING SUPPORT
SERVICES AT THE PLAN OPTIONS TO
INFLUENCE SERVICES. DESPITE
INTENSE CALLIN WOULD HALT THE
PROGRESS THAT THE PROPOSAL
INCLUDES. NO HOUSING SUPPORT
BENEFIT. THE END CARE MANAGED
BENEFIT ALL OFFER CARE.
EVIDENCE OVER THIRTY SHOW CARE.
NO HOW INTENSE THAT WILL NOT
PRODUCE THE INTO OUT. IS IF
PEOPLE STILL LET CANNOT GET
FIRST HEALTHY AND THEY CAN.
THEIR THAT THIS HELP THEM GET
HAVE. DON'T IN PROPOSES CAN
THIRTY AT THE OPTION TO IN
THEIR- THE PROPOSAL A LITTLE
FOR. SERVICES IN CENTER PAYMENT
PROPOSED WILL RESULT IN
TARGETING THOSE WITH THEM CUTE
MEDICAL CONDITIONS AND OLD
SCHOOL MANY MA'AM. WHO'S TAKING
MAY NOT BE REALIZED IMMEDIATELY
OR WHO MAY NOT HAVE BEEN
GETTING NEEDED SERVICES AT ALL.
IN FACT A NUMBER OF PLANTS THAT
HAVE TOLD MY COLLEAGUE THAT
THEY KIND OF TARGET ONLY THE
TOP 1% OF PEOPLE EXPERIENCING
HOMELESSNESS. BUT THE HOUSING
SUPPORT. IN LIEU OF SERVICES.
THE PROPOSAL DID NOT. THE BIG
CHALLENGES MET CAL PLAN BASED
AND I DON'T THEM EXPERIENCING.
AND PROVIDING CULTURALLY
RESPONSE- ALTHOUGH ARE. BY THE
SPANNED THAT PLAN ATTEMPT. WITH
PERSON CARE AND HOW HOME
PROGRAM FROM. YOU REMAIN
CONCERNED THAT WITHOUT.
INCENTIVES TO DO SO CONTOUR TO
KNOW PRACTICES IN CONTRACT WITH
MEDI CAL PROGRAM. WITH MEDICAL
PROVIDERS AND CLINICS THAT THEY
HAVE AN EXISTING RELATIONSHIP
WITH. THEREFORE WE RECOMMEND
HOUSING SUPPORT SERVICES YES
STATEWIDE BENEFIT THEY CAN BE
FACED INTO ALLOW PLANTS TO
BUILD CAPACITY. WE BELIEVE THIS
IS BEST DONE THROUGH A
SUPPLEMENTAL PER MEMBER PER
MONTH RATE AND THE MINISTER TO
ASK THAT A STANDARDIZED
GUIDELINES IN CONTRACTING
PRACTICES. THAT WOULD ATTRACT
PROVIDERS WITH THE EXPERTISE
WHILE ALSO BEING ELIGIBLE FOR
UP 2890% FEDERAL. MATCH THANK
YOU. THANK THANK YOU VERY. I GO
AHEAD AND MOVE ON TO A J. D. DR
I WOULD END UP ARAMBULA AND GDS
HERE ON BEHALF OF SEIU
CALIFORNIA AND ARE SEVEN
HUNDRED THOUSAND PRIVATE AND
PUBLIC SECTOR WORKERS. TO SHARE
PERSPECTIVES SPECIFICALLY ON
THIS MANAGED CARE PLANS
VOLUNTARY PROVISION OF I LOS
WITHIN CAL AIMED. AS YOU KNOW
SEIU MEMBERS ARE STRONG
PARTNERS AND PROVIDERS REALLY
LEADING THE WAY IN HEALTHY
COMMUNITIES AND SUSTAIN
WELLNESS AND PRODUCTIVITY OF
OUR MEDICAID ENROLLEES. I WILL
SPECIFICALLY SPEAK FROM THE
PERSPECTIVE OF OUR PROVIDERS
THAT ARE ALREADY PROVIDING THE
SERVICES LIKE THOSE PROPOSED TO
BE OFFERED AS I LOS SUCH AS
HOUSING TRANSITION NAVIGATION
SERVICES. HUSBAND PAT AND
DEACONS ENGLISH FROM THIS SHORT
TERM POST STABILISATION HOUSING
NURSING FACILITIES AND ASSISTED
LIVING FACILITIES. OUR PUBLIC
SECTOR WORKERS HAVE THE SKILL
SET AND TRAINING AS WELL AS
SUBJECT MATTER EXPERTISE OF
LOCALLY AVAILABLE RESOURCES TO
MAKE TIMELY AND DIRECT
REFERRALS CONNECTING PEOPLE TO
CRITICAL SERVICES LIKE HOUSING.
ADDITIONALLY OUR LONG TERM CARE
PROVIDERS LIKE OUR HOME CARE
AND NURSING HOME WORKERS HAVE
SPECIALIZED SKILLS AND TRAINING
TO HANDLE THE NEEDS OF THOSE IN
THEIR CARE PRIMARILY THE
ELDERLY AND MEET STANDARDS TO
RETAIN AND ATTRACT THE
NECESSARY LONG TERM CARE
GIVERS. TO MEET OUR GROWING
DEMAND FOR SUCH SERVICES. R. S.
YEAH YOU PROVIDERS CONTINUE TO
PERFORM THEIR DUTIES WITH THE
HIGHEST QUALITY AND HAVE
DEMONSTRATED POSITIVE IN STATE
OUTCOMES ON THE DELIVERY OF
CARE OF PATIENTS AS WELL AS
COST SAVINGS FOR THE ENTIRE
HEALTH CARE SYSTEM. WE BELIEVE
IN LIEU OF SERVICES PROPOSAL
SHIPS MEDIKAL PROGRAM IN THE
WRONG DIRECTION IF MANAGED CARE
PLANS HAVE. FASHIONED GRANT
SUCH SERVICES TO ELIGIBLE
ENROLLEES AND WHAT TYPES OF
PROVIDERS THEY WILL CONTRACT TO
FOR SUCH SERVICES. WE BELIEVE
MOST MANAGED CARE PLANS DO NOT
HAVE THE APPROPRIATELY TRAINED
AND KNOWLEDGEABLE STAFF. TO
APPROVE ELIGIBILITY FOR AYE LOS
MANY OF THESE ISLANDS SHOULD BE
PROVIDED BY LOCAL COUNTIES
BECAUSE THEY KNOW EXISTING
LOCAL RESOURCES- AS WELL AS
CERTIFIED LONG TERM CARE
PROVIDERS BECAUSE THEY HAVE THE
SPECIALIZED SKILL SET. THERE
ARE FOURTEEN DEFINE OPTIONS FOR
I LOS- THAT MANAGED CARE PLANS
CAN OFFER- AND WE KNOW THAT THE
BENEFICIARY AS STATED BY- MISS
COOPER HAVE TO ACCEPT THESE AS
IN LIEU OF. ANOTHER DESIGNATED
MEDICAL BENEFIT. BUT MANAGED
CARE PLANS ARE NOT LIMITED TO
THESE- ADDITIONALLY- I LOS MUST
BE MEDICALLY APPROPRIATE AND
COST EFFECTIVE FOR IT TO BE
OFFERED. AND MUST BE EXPLICITLY
CONTAINED WITHIN THE MANAGED
CARE PLANS CONTRACT WITH THE
GATES YES. IF THIS OCCURRED
THERE WOULD NEED TO BE A STRONG
DETAILED OVERSIGHT OF HOW
MANAGED CARE PLANS. USER
PROPOSED DISCRETION ON WHETHER
TO OFFER THESE SERVICES AND HOW
TO BUNDLE THESE. SERVICES ARE
WE BELIEVE THE HDS MUST HAVE
STRONG OVERSIGHT OVER THESE
TRANSITION AND THE PROPOSAL
SHOULD INCLUDE MORE DETAILS
REGARDING CONSEQUENCES OF NOT
BEING ABLE TO COME TO
CONTRACTING AGREEMENT. I
SPECIFICALLY ELEVATING OUR
PERSPECTIVE ON THE ISLANDS FOR
NURSING FACILITY TRANSITION AND
DIVERSE IT DIVERSION TO
ASSISTED LIVING FACILITIES- DHS
WILL ALLOW MANAGED CARE PLANS
TO CONTRACT WITH PROVIDERS.
OTHER DAY IN CASE MANAGEMENT
AGENCIES HOME HEALTH- AND ARSC
ARE AT THE OPERATING OPERATORS
AS LONG AS THEY APPLY MINIMUM
STANDARDS TO ENSURE ADEQUATE
EXPERIENCE. BUT IN. ORDER TO
ENSURE THE STANDARDS ARKANSAS
AND THE STATE AND BETWEEN PLANS
WE BELIEVE THE H. YET THE AGE
THAT SHOULD SET SOME. STANFORD
I CAN'T MONITOR APPLY TO
ALTERNATIVE PROVIDERS WE NEED
TO GUARANTEE THAT ALTERNATIVE
PROVIDERS ARE REQUIRED TO MEET
QUALITY STANDARDS FOR THE
PATIENT AND THE PATIENT'S- AND
LASTLY WE DO ENCOURAGE DH CS TO
DEFINE THE PARAMETERS. OF
MANAGED CARE PLANS DISCRETION
AND AUTHORITY IN DETERMINING
THE COR PORTFOLIO OF SERVICES
WITHIN I LOS AND THE
APPROPRIATE CERTIFIED SKILLED
PROVIDERS- ELIGIBLE FOR THESE
IN LIEU OF SERVICES. THANK YOU.
THANK YOU VERY MUCH- WILL BRING
IT BACK TO THE COMMITTEE FOR
QUESTIONS OR COMMENTS. DR RAMYA.
THANK YOU MR CHAIRMAN MY FIRST
QUESTIONS CAN BE PICKING UP-
WHERE MG DEALS WITH S. YEAH YOU
JUST PASSED SO THE QUESTION IS
FOR THE DEPARTMENT AND IT'S
REGARDING THE DISCRETION OF THE
MANAGED CARE PLANS. WHAT WHAT
DOES HAPPEN IF- THE PLANS DON'T
WANT TO MAKE THE IDEAL L. O. S.
SERVICES EXCEPT ACCESSIBLE AS
POSSIBLE AS WE ARE IMAGINING IN
IMPLEMENTATION. JESSICA BERMAN
DEPARTMENT HEALTH CARE SERVICES
SO I THINK ONE OF THE THINGS I
WOULD JUST MAKE SURE IT'S CLEAR
AND IT'S IN OUR PROPOSAL IS
THAT- WE ARE ACTUALLY REQUIRING
THAT MEDICAID MANAGED CARE
PLANS- CONTRACT WITH
INDIVIDUALS WHO PROVIDE BOTH
WHOLE PERSON CARE AND HEALTH
PROBLEMS IT'S ONLY IF IN WHICH
THEY CANNOT COME TO AGREEMENT
AND WE GIVE A- A VERY SHORT
LIST OF REASONS OF WHICH WE
WOULD FIND OUT REASONABLE- ONE
INCLUDES THAT THE- INDIVIDUAL
PROVIDING THOSE. IN LOVE
SERVICES THROUGH WHOLE PERSON
CARE TODAY NO LONGER WANT TO
PROVIDE THOSE SERVICES- AS BE
PROVIDED THROUGH THAT
TRANSITION PLAN THAT I
MENTIONED EARLIER SO WE ARE
DOING OUR BEST TO ENSURE. THAT
WE CAN HAVE THOSE WHOLE PERSON
CARE- IN LIEU OF SERVICES THAT
ARE BEING OFFERED BY COUNTIES
AND PUBLIC HEALTH HEALTH
SYSTEMS TODAY TRANSITION OVER
SUCCESSFULLY TO THE MANAGED
CARE PLANS WITH DIRECT CONTRAST
BETWEEN PLANS AND PROVIDERS.
THAT BEING SAID- UNDER FEDERAL
REGULATIONS IT- THAT MANAGED
CARE PLAN DOES HAVE THE OPTION-
TO PROVIDE THOSE IN LIEU OF
SERVICES I THINK ONE OF THE
OTHER WAYS IN WHICH WE ARE
TRYING TO ENSURE THAT MANAGED
CARE PLANS BUILD UP THE
CAPACITY IN THESE IN LIEU OF
SERVICES- STATEWIDE- IS THROUGH
THE INCENTIVE DOLLARS PROPOSED
IN CALAIS WHERE WE WOULD HAVE.
DOLLARS THAT COULD HELP BUILD
CAPACITY FARTHER THAN WHAT WE
HAVE TODAY I'M IN BOTH WHOLE
PERSON CARE AND HEALTH I'M JUST
NOTATING THAT HELP COMES IS
ALSO NOT STATEWIDE TODAY- AND
SO- THE IDEA BEHIND THE
INCENTIVES IS WHERE THERE
AREN'T IN THE WEB SERVICES
AVAILABLE ARE WHERE THERE'S NOT
THE CAPACITY THAT WE CAN PAY
FOR THAT WORKFORCE PAY FOR THAT
CAPACITY THAT INFRASTRUCTURE-
BUT JUST EMPATHIZING WITH
PROVIDERS WHO HAVE EXPERIENCE
WITH THAT TYPE. OF SERVICE AS
INDICATED IN OUR AYE KELLY
PROPOSAL AND LISTED UNDER
ALLOWABLE PROVIDERS ESPECIALLY
FOR MANY OF THE SERVICES JUST
MENTIONED- WE OFTEN ARE LISTING
SERVICES LIKE COUNTY PROVIDERS-
THE HOUSING EXPERTS. ARE NOT
MANAGED CARE PLAN AS JUST BE
CLEAR. AND I DO WANNA FOLLOW UP
AND ECHO WILL BE HER FROM-
DOCTOR HAND BERGER WHO SAID
THAT SHE SEES THIS AS A
NECESSARY EVOLUTION OF MEDIKAL
WHAT WE ARE DISCUSSING HERE AND
CAL IMINT AND I WOULD AGREE
WITH THAT ASSESSMENT OVERALL. I
THINK WHAT I'M TRYING TO MAKE
SURE THOUGH IS THAT WE HAVE THE
PARTNERSHIPS THAT ARE NECESSARY
THAT WE'RE NOT DUPLICATING
SERVICES AND SO I WAS HOPING
YOU COULD COMMENT ABOUT- OF
FULL SERVICE PARTNERSHIPS AND
OVERLAP HERE WITH I. O. L. O.
S. SERVICES AND IF WE ARE
COORDINATING SERVICES WITH
THOSE AND IF NOT. WHY NOT. SO
WHAT I WOULD SAY THERE IS- THAT
NGUYEN IN LIEU OF SERVICES
BEING PROVIDED. THERE WILL HAVE
TO BE COORDINATION WITH A
VARIETY OF PEOPLE FOR EXAMPLE
WE'RE CURRENTLY USING- A
VARIETY OF BRAIDED FUNDING TO
COVER THESE TYPES OF SERVICES
TODAY. ONCE WE ALLOW FOR IT TO
BE A MEDICAID SERVICE WHETHER
THAT ENHANCE YOUR MANAGEMENT AS
A BENEFIT. OR THE IN LIEU OF
SERVICES THEY WERE ABLE TO DRAW
DOWN FEDERAL FUNDS FOR THOSE
SERVICES- AND WE SHOULD BE
MAXIMIZING THAT ABILITY TO DRAW
DOWN FEDERAL FUNDS AND PROVIDED
STATEWIDE WHEN POSSIBLE. ON TO
MEDICARE BENEFICIARIES- IN
WHICH CASE THERE MAY BE SOME
FUNDS THAT ARE LOCALLY BEING
PROVIDED THROUGH AN HSA OR
OTHER MEANS WHICH WOULD THEN BE
FREED UP TO BE. A REALLOCATED
TO OTHER PRIORITIES- AND OR
THERE MAY NEED TO BE UPGRADING
OF FUNDING OF SERVICES- IT'S
ONE OF THE REASONS WHY WE THINK
COUNTY PARTNERS WILL BE
CRITICAL PARTNERS AS PROVIDERS
IN BUT WE ARE. A BUILDING IN
CALLING- AND SO I WOULD SAY
JUST A LEVERAGES A LOT OF OUR
LESSONS LEARNED FROM ACROSS THE
STATE WHERE WE HAVE SEEN-
WHETHER ITS PILOTS OR SMALLER
PROGRAMS- AND ELEVATING THAT AT
A LARGER LEVEL- RELYING ON
THOSE WHO ARE EXPERTS TO BE THE
PROVIDER- IN DRY DOWN FEDERAL
FUNDS TO BE ABLE TO HAVE IT BE
SUSTAINABLE. OVER A LONGER
PERIOD OF TIME AND NOT SUBJECT
TO LOCAL BUDGETS AND-
ALLOCATIONS- BUT- SUSTAINABLE
ACROSS THE ENTIRE STATE. AND
WHILE I WITH- DIRECTOR LIGHT
BORN THAT THIS IS- QUITE
EXCITING. AND INNOVATIVE AND
FORWARD THINKING I- WILL
CONTINUE TO- PROCESS FORWARD
FOR PROGRESS. AND WANTED TO
HIGHLIGHT ONE OF THE PILOT
PROGRAMS THAT HAS SHOWN GREAT
SUCCESS. IN BOTH BEING COST
EFFECTIVE AS WELL AS- BEING
HELPFUL FOR PATIENTS IN THE
MEDICALLY TAILORED MEAL
PROGRAMS. TO WALLETS IDENTIFIED
AS ONE OF THE AYE A LITTLE LESS
BENEFITS. IT'S CURRENTLY NOT A
COVERED BENEFIT UNDER MEDICARE
ALLEN WOULD JUST ENCOURAGE THE
DEPARTMENT TO CONTINUE LOOKING
TOWARDS THIS PILOT AS- A
BENEFIT THAT WE CAN- PROVIDE
STATEWIDE. THANK YOU VERY MUCH.
THANK YOU VERY MUCH- QUESTION
FOR DOCTOR COUPLE QUESTIONS FOR
DR HANS BERGER. YES SIR SO ARE
THERE ARE THERE ANY ARE ANY OF
THE PROPOSED UTILIZATION
CONTROLS GOING TO LIMIT THE
EFFECTIVENESS OF THE I. O. S.
I. L. O. S. IN OPTIONS. I
WOULD- I THINK THAT BECAUSE YOU
KNOW I THE IOWA SERVICES AT
LEAST I CAN SPEAK FOR MY COUNTY
IT MAY BE VERY DIFFERENT FOR A
PLACE LIKE SAN FRANCISCO OR
PLACES IN THE BAY AREA WHERE
THE SERVICE AREA IS VERY TIGHT
AND FAIRLY UNIFORM BUT IN OUR
AREA WE HAVE QUICK BASKET
PRINCES IN- AND EVEN ABILITY TO
DELIVER IT SERVICES AND IT'S
GOING TO TAKE TIME TO DELIVER
THEM. AND I THINK THAT SOME OF
THE CONTROLS THAT THEY WOULD
HAVE TO BE THROUGHOUT THE
COUNTY ARE GOING TO BE A ARE
SIGNIFICANTLY DELIVER OUR
LEMONADE ARE BILITY TO DELIVER
AND WHERE THEY ARE AVAILABLE
NOW AND WITH THE IDEA THAT WE
WOULD BE BUILDING THEM OVER
TIME I ALSO THINK THAT THEY'RE
GOING THROUGH BECAUSE THEY WILL
THEY ARE NOT LIKELY TO BE
UNIFORM THROUGHOUT THE ENTIRE
SERVICE AREA ON THAT HAVING TO
GO THROUGH THE NORMAL-
EDUCATION PROCESS WITH PRE
AUTHORIZATION AND- APPEAL
RIGHTS AND ALL THAT GOES ALONG
WITH THAT ARE GOING TO MAKE IT
VERY DIFFICULT. FOR US TO BE
ABLE TO TAKE THE POPULATION TO
BE ABLE TO DO OUR BEST WITH THE
LOWEST SERVICES AS WE CONTINUE.
TO BUILD THE PLANE AS WE FLY IT.
WELCOME THAT WOULD BE CHALLENGE
A LOT OF- BECAUSE OF THE
DIVERSE NATURE I MEAN RIVERSIDE
COUNTY SAN BENITO COUNTY ARE
HUGE COUNTY SO THE IDEA THAT
YOU COULD HAVE. THESE SERVICES
DISPERSED AND EVENLY CROP THAT
THROUGHOUT THE COUNTY IS. GOING
TO WOULD BE A TOUGH TO ATTAIN
SO- APPRECIATE THAT SO WHAT IS
IT WHAT WHAT IN THOSE SERVICES
IS AYE AJP CONSIDERING. WELL I
CAN TELL YOU WHAT WE ALREADY
DO- WE HAVE AS SMALL HOUSING
PROGRAM WHERE WE HAVE HOUSES
OVER TWO HUNDRED OF OUR HIGH
UTILIZED THEIR- HIGH COST TO
LOOK MEMBERS. THAT IS- WE
PARTNERED WITH RANDY AND- ARE
LOOKING AT OUR OUTCOMES. AND
HEALTHY IN THAT IT HAS BEEN A
COST EFFECTIVE PROGRAMS THAT
HAS IMPROVED THE QUALITY OF
CARE. FOR THE MEMBERS IN THAT
PROGRAM- SO WE WOULD OBVIOUSLY
TO CONTINUE ON THAT PROGRAM SO
LOW INCOME HOUSING IS NOT.
AVAILABLE EVERYWHERE. AND SO
EVEN JUST THE RESOURCE TO BE
ABLE TO PUT. OUR MEMBERS INTO
SUPPORTED HOUSING IS LIMITED-
WE CURRENTLY HAVE A VERY
ROBUST- PROGRAMS AROUND THAT
NUMBER IF YOU ARE IN- JUST-
YOU'LL CARE IN DOWN SKILLED
NURSING FACILITIES. FOR THOSE
THAT QUALIFY WE WORK TO MOVE
THEM OUT INTO A COMMUNITY
SETTING. LIKE YOU KNOW SIXTEEN
YOUR SUPPORT OF HOUSING OR BACK
INTO ITS FAMILY- DEPENDING ON
WHAT THEIR NEEDS ARE AND
WHETHER THEY ARE ELIGIBLE FOR
THAT. WE ARE- STARTING A PILOT
FOR MEDICALLY TAILORED MEALS
THAT- WILL BE STARTING IN THE
NEXT COUPLE. OF MONTHS. AND WE
HAVE- WE HAVE ALWAYS DONE AS
THE- EVERYBODY HAS HARPER
MEDIATION WE'VE ALWAYS THAT OUT
NEED REMEDIATION. AND IN A
SMALL WAY OBVIOUSLY YOU KNOW
THESE ARE NOT BEEN-
REIMBURSABLE SERVICES AND SO WE
HAD TO CHOOSE MEMBERS THAT WE
REALLY FEEL WERE USING
EMERGENCY ROOM ON A REGULAR
BASIS BECAUSE OF- THAT HIT HOME
CONDITIONS THAT THEY WERE
LIVING IN AND THAT HAS ALSO
BEEN VERY SUCCESSFUL. AND SO
DOES THE SOME OF THE ONES THAT
WOULD KIND OF COMES. TO MIND AT
THE TOP OF MY HEAD. THANK YOU
THANK YOU VERY. I'M GOING TO GO
BACK TO THE ADMINISTRATION- AND
THANK OF THANK YOU FOR THE
PRESENTATION- I THINK THE
PROPOSAL HAS A LOT OF PROMISE
OF MY STAFF WE'VE BEEN TALKING
ABOUT THIS OPTION FOR PER FOR
YEARS NOW. THE ONE THING I
WANNA MAKE SURE IS THAT WE
INTEGRATE THE SERVICES THAT
PLAN PROVIDE WHICH- AND THE
SERVICES OF SOCIAL SERVICES
PROVIDE. I'M NOT SURE THOSE
RELATIONSHIPS REALLY EXIST-
MATT AND NOW AT LEAST AT LEAST
IS NOT IS A PARENT IS IT IS IT
MIGHT BE. BUT HAVING A HEALTH
PLAN INVOLVED IN HOUSING
HOMELESS IS POTENTIALLY A BIG
CHANGE IN WHAT THEY DO- AS WE
SEE FROM I. H. P. THEY'RE DOING
THAT- THEY'RE DOING THAT NOW
SO. HOW DO WE MAKE SURE IT'S
GOING WELL THAT THE CONNECTIONS
ARE HAPPENING LOCALLY THAT
PLANS ARE NOT REINVENTING THE
WHEEL. AND THAT THIS OPTION IS
BEING IMPLEMENTED EFFECTIVELY.
THIS IS A QUESTION FOR J. C.
THANK YOU SO ANYTIME WE
IMPLEMENT LARGE CHANGES
ESPECIALLY SOMETHING AS LARGE
AND COMPLEX HAS A CALENDAR OUT
WE DO HAVE- REPORTING
REQUIREMENTS SO WE CAN
CONSTANTLY KIND OF GAUGE HOW
THINGS ARE GOING UP WE WOULD
HAVE A SIMILAR TRANSITION
REPORTING REQUIRED HERE SO WE
WOULD BE ABLE TO KNOW- HOW MANY
INDIVIDUALS ARE RECEIVING THE
ON THE WEB SERVICES- AS WELL AS
IF THEIR GRIEVANCES OR APPEALS
BEING FILED WITH THE PLAN IN
REGARDS TO THE AVAILABILITY OF
THESE TYPES OF SERVICES. THAT
REALLY ALLOWS AS WITH ANY NEW
BENEFIT OUR TRANSITION TO
REALLY KEEP AN EYE ON WHAT'S
HAPPENING- WHETHER IT'S
HAPPENING ACROSS THE ENTIRE
SEASON WE CAN BUILD UP AND
GATHER PEOPLE TO DISCUSS HOW WE
NEED TO ADDRESS THE SITUATION-
OR WHETHER WE'RE JUST HAVING A
LOCAL ISSUE MAY BE A PROBLEM
WITHIN A CERTAIN GEOGRAPHICAL
AREA THAT NEEDS TO BE
ADDRESSED- AND SO WE WILL WE
WILL DO THAT THROUGH THIS
TRANSITION TO KEEP AN EYE IN
REGARDS TO IT WILL ALSO- BE
ENCOURAGING OUR MANAGED CARE
PLANS TO IMPLEMENT AS MANY OF
THE IN LIEU OF SERVICES AS THEY
CAN YOU KNOW THAT MANY MAY NOT
BE ABLE TO DO THEM ALL AT. ONCE
THAT'S A HUGE LIFT WE
UNDERSTAND THAT- BUT- MAKING
SURE THAT WE'RE SEEING PROGRESS
IN REGARDS TO THOSE BEING
AVAILABLE ON AND THEN IN
REGARDS TO YOUR COMMENT IN
REGARDS TO PARTNERSHIP WITH
SISTER DEPARTMENTS ESPECIALLY
AT THE DEPARTMENT OF SOCIAL
SERVICES UP WE HAVE ENGAGED
EARLY AND OFTEN OF WHAT THE
DEPARTMENT OF SOCIAL SERVICES
REGARDING OUR IN- IN LIEU OF
SERVICES IN PARTICULAR-
PROPOSAL ESPECIALLY AROUND. OUR
HOUSING COMPONENTS THAT WE'VE
ASKED FOR THE REVIEW COMMENTS
FEEDBACK- WE'VE INVITED THEM TO
VARIOUS TABLES AND WE PARTNER
ON OFTEN- END AS WE BEGIN TO
EXPLORE THE TECHNICAL
ASSISTANCE THAT WE WILL BE
PROVIDING TO OUR MEDICARE
MANAGED CARE PLANS AND
PROVIDERS OVER THE NEXT FEW
YEARS ESPECIALLY AROUND IN LIEU
OF SERVICES I THINK THAT WE
WILL ONLY CONTINUE TO PARTNER
WITH OUR COLLEAGUES AT THE
DEPARTMENT OF SOCIAL SERVICES A
PUBLIC HEALTH- AND OTHERS. I
HAD TO REALLY ENSURE THAT WE
ARE I BRING IN ALL THE RIGHT
PEOPLE THE TABLE LEVERAGES THE
X. THAT I. THERE AND- ONLY TO
YOU IMPROVE THE SERVICES TO
MAKE SURE. AS MANY MEDICARE
BENEFICIARIES CAN RECEIVE
ACCESS TO THE SERVICES AS
POSSIBLE. GREAT THANK YOU VERY
MUCH- NOTHING WITH THAT WE'LL
GO AHEAD AND MOVE ON TO OUR
SECOND- I'M SORRY. DID YOU HAVE
A QUESTION MISTER ROBERTS.
WHAT'S YOUR ADDRESS THANK YOU
AND I JST WANNA THANK YOU FOR-
ACKNOWLEDGING THE SEMINOLE
COUNTY HAS A LARGE SQUARE
MILES- WITHIN THAT AREA TO GET
THE DISTRIBUTION. OF THESE
THESE- MUCH NEEDED RESOURCES
BUT I ALSO WANT TO CHIME BACK.
ON THE REQUEST AS FAR AS-
GIVING GETTING SOME LEAD TIME
AS FAR AS THE INFRASTRUCTURE IN
THE BUILD OUT. OF WHAT'S NEEDED
AT THE LOCAL LEVEL I KNOW ON
THE SPEAKER THING WAS DR HANS
BERGER THAT BROUGHT IT UP AS
FAR AS A- A NINETY DAY LEAD
WAY- AS FAR AS SOME OF THESE
IMPLEMENTATIONS AND BUILDING
OUT THAT INFRASTRUCTURE. I
WONDER IF WE CAN GET SOME MORE-
FEEDBACK ON THAT OR SOME.
COMMENTS ON THAT FROM FROM OUR
STAFF. YES THANK THANK YOU
THANK MISRABA SO THIS COOPER
COMMENTS ON. YES SO ON THE
DEPARTMENT OF HEALTH CARE
SERVICES ACTUALLY- RELEASED
ABOUT. A FEW WEEKS AGO A VERY
DETAILED INFORMATION REGARDING
THE CONTRACT LANGUAGE BETWEEN
THE MANAGED CARE PLAN AND- THE
DEPARTMENT AS WELL AS BETWEEN
MANAGED CARE PLANS AND
PROVIDERS. WE ALSO RELEASED THE
MODEL OF CARE DOCUMENT. AS WELL
AS- A CODING GUIDANCE FOR A
COMMENT- I APPLAUD THOSE THINGS
BECAUSE THOSE ARE KIND OF SOME
OF THE INFRASTRUCTURE PIECES.
YOU ARE GOING TO NEED TO BE
AWARE OF IN REGARDS TO THE
TRANSITION- SO THAT THEY COULD
HAVE COME AND WE CAN GET THOSE
OUT. WE'RE ALSO COMMITTING TO
GETTING RATES OUT. FAR SOONER
THAN WE EVER DO JUST TO BE
CLEAR ON ANY TRANSITIONS THAT
WE DO WITHIN MANAGED CARE. UP
AND WE KNOW THAT IS BECAUSE-
OUR MANAGED CARE PLANS NEED TO
HAVE THAT INFORMATION. I'M AS
SOON AS POSSIBLE SO WE ARE VERY
COMMITTED TO GETTING THE RIGHT
INFORMATION OUT- TO YOU ARE
MEDICARE MANAGED CARE PLANS AS
SOON AS WE- CAN- AND THEN WE
ALSO ARE WORKING. ON IN IN LIEU
OF SERVICES FEE SCHEDULE- THAT
WOULD ALLOW FOR GEOGRAPHICAL
DIFFERENCES ACROSS THE STATE OF
CALIFORNIA REGARDS TO RATE.
LEVERAGE NATIONAL PRICING OF
OTHER STATES THERE'S A- AREAS
WHERE WE HAVE VERY SOME
COMMUNITY BASED SERVICES IN
REGARDS TO WHAT'S BEING
PROVIDED. I'M IN THAT IS ALSO
SCHEDULED TO COME OUT. EARLY-
SUMMER. I ALSO THAT MANAGED
CARE PLANS PROVIDERS. HAVE THAT
INFORMATION AS THEY'RE HAVING
CONVERSATIONS- AND SO WHAT I
WOULD SAY THE DEPARTMENT'S VERY
COMMITTED TO GETTING ALL-
INFORMATION OUT TO MANAGED CARE
PLANS AND PROVIDERS THAT THEY
HAVE THE INFORMATION THEY NEED
TO MAKE THE DECISIONS- TO
CONTRACT- INFORM THEIR NETWORKS
AND FILE ALL OF THEIR MODEL OF
CARE DOCUMENTS WITH THE
DEPARTMENT. OF BASED ON THE
TIMELINE SCHEDULE WHICH WE HAVE
RELEASED- AND THEN LASTLY WE
ARE WORKING ON THE INCENTIVE
DOLLARS. IN HAVING THAT
PROPOSAL WHICH WILL GO OUT FOR
ROBUST STAKEHOLDER ENGAGEMENT-
ALLOWING US TO ALSO GET. ON
ADDITIONAL CAPACITY AND
INFRASTRUCTURE DOLLARS OUT SO
THAT I COUNTIES AND PLANS CAN.
CONTINUE TO DO THAT. ADDITIONAL
BUILDING UP AND SERVICES. OKAY
OKAY WITHIN YOU THANK YOU VERY
MUCH. WITH THAT GO AHEAD MOVE
ON FOR A SECOND PANEL. WE WILL
NOW MOVE ON THE PANEL TO ON THE
PROPOSED ENHANCED CARE
MANAGEMENT BENEFIT WE HAVE
SEVEN PRESENTERS ON THIS PANEL
FROM JC COOPER TO RECOMMEND
REZNIKOV. MEMORIES OF ALLAH
LINDA WAY JULIE WALLACE PARA
MAKE DETAINING AND PAULA WILL
HELP. LET'S BEGIN WITH JC
COOPER. THANK YOU- IT SO ONE OF
THE THINGS IN REGARDS TO
ENHANCE CARE MANAGEMENT ON WHAT
YOU THINK IS IMPORTANT TO MAKE
SURE THAT WE ARE HIGHLIGHTING
IS CURRENTLY ARE MANAGED CARE
PLANS HAVE TWO DIFFERENT TYPES
OF- CARE MANAGEMENT OR CASE
MANAGEMENT IN THEIR CONTRACTS
THE FIRST IS- BASIC CASE
MANAGEMENT IN THE SECOND IS
COMPLEX CASE MANAGEMENT- AND
OFTEN TIMES MANY OF OUR MANAGED
CARE PLANS ARE NCQA ACCREDITED
AND THEY'RE LINING THEIR
COMPLEX CASE MANAGEMENT
PROTOCOLS A WITH THE NCQA
REQUIREMENTS HERE WHAT WE'RE
PROPOSING IS TO ADD AN
ADDITIONAL CARE MANAGEMENT
COMPONENT WITHIN THEIR
CONTRACT- CALLED ENHANCE CARE
MANAGEMENT. IN REALLY THERE MAY
BE SOME OVERLAP WITH THE
COMPLEX CASE MANAGEMENT
CATEGORY BUT HERE WE'RE TALKING
ABOUT THE HIGHEST NEED
BENEFICIARY WITHIN ON THE
MEDICARE MANAGED CARE PLANS
RESPONSIBILITY- IT IS THOSE
INDIVIDUALS WHO HAVE VERY HIGH
BOTH- YOU KNOW PHYSICAL HEALTH
NEEDS OUR HELP STATUS ARE
COMPLEXITY MAYBE OUR ADDITIONAL
BEHAVIORAL HEALTH SERVICES OR
REALLY IMPACTED NEGATIVELY BY
SOCIAL DETERMINANTS OF HEALTH
OR SOCIAL DRIVERS OF HELP-
WHERE SOMEONE IS NAVIGATING
ACROSS MULTIPLE DELIVERY
SYSTEMS AS WELL AS HAVING MANY
OF THE SOCIAL FACTORS IMPACTING
THEIR ABILITY TO YOU- HAVE
BETTER HEALTH OUTCOMES. SO IT'S
YOUR MOST COMPLEX
BENEFICIARIES- ACROSS OUR
DELIVERY SYSTEM I THINK THAT'S
JUST AN IMPORTANT PIECE TOUCH
TO REMEMBER THAT THIS IS THE
TOP OF THE ICEBERG IN REGARDS
TO THE TYPES OF SERVICES THAT
WOULD BE PROVIDED IT REALLY IS
ABOUT ADDRESSING BOTH THE
CLINICAL AND NON CLINICAL NEEDS
OF OUR BENEFICIARIES. AS WELL
AS GOING OUT IN THE COMMUNITY
SO ONE OF THE FUNDAMENTAL
DIFFERENCES AROUND ENHANCE CARE
MANAGEMENT IS IT'S NOT MEANT TO
BE- A CARE MANAGEMENT OR CASE
MANAGEMENT PROGRAM PROVIDED
WHERE SOMEONE IS JUST REACHING
OUT TO SOMEONE ON THE PHONE IT
IS REALLY MEANT AND DESIGNED TO
BE OUTSIDE OF THE FOUR WALLS TO
BE COMMUNITY BASED ON IF YOU
LOOK AT THE TYPES OF ENHANCE
CARE MANAGEMENT- TARGET
POPULATIONS IT'S NOT ONE THAT
IS CONDUCIVE TO YOU. ARE REALLY
JUST A PHONE BASED PIECE I'M
REALLY TRYING EMPHASIZE. THAT
CAN. OF IN HERE CARE MAN IT
DOESN'T MEAN THAT A CARE
MANAGER WILL CALL THE
BENEFICIARY BUT IT'S REALLY
MEANT TO BE ON THE GROUND. FOR
EXAMPLE SOMEONE EXPERIENCING
HOMELESSNESS IT'S NOT GOING TO
BE EFFECTIVE IF SOMEONE IS JUST
DOING OUT REACH WERE HOPING
THAT THEY CAN GET THEM ON THE
PHONE. IT REALLY NEEDS TO BE A
STREET BASED TEAM WHO'S OUT
THERE ENGAGING WITH THE
INDIVIDUAL BUILDING THAT TRUST
OVER TIME. IN ORDER TO BE ABLE
TO GET THEM HOPEFULLY INTO YOU-
AND PROVIDED WITH SOME OF THE
IN LIEU OF SERVICES AS WELL AS
INTO YOU ANY NEEDED CARE- THAT
THEY'RE NEEDING- OR MAY HAVE
BEEN NOT PROVIDED. THE OTHER
THING THAT'S UNIQUE AROUND
ENHANCE CARE MANAGEMENT YOU'LL
SEE IT IN OUR THE POST A
CONTRACT LANGUAGE IF YOU ARE
TAKING ON THE RESPONSIBILITY OF
BEING THE SINGLE. CARE MANAGER
FOR THAT INDIVIDUAL OFTENTIMES
INDIVIDUALS WHO WILL BE
ELIGIBLE FOR ENHANCED CARE
MANAGEMENT ARE SEEKING SERVICES
ACROSS. MULTIPLE DELIVERY
SYSTEMS A MEDIC CAL IS VERY
COMPLEX- WE HAVE. A LOT OF
THINGS CARP OUT OF OUR MANAGED
CARE PLANS THEY CAN MAKE IT
CHALLENGING FOR SOMEONE TO
NAVIGATE THESE VARIOUS A
DELIVERY SYSTEMS. AND BY BEING
ENHANCE CARE MANAGEMENT
PROVIDER YOU ARE TAKING ON THE
RESPONSIBILITY OF DOING THAT
COORDINATION ACROSS ALL
DELIVERY SYSTEMS FOR THAT
BENEFICIARY. ON ONE THING
THAT'S REALLY IMPORTANT PIECE
FOR PEOPLE TO CONSIDER. SO FOR
IN HIS CARE MANAGEMENT- WE ARE
AS HAS BEEN NOTED BY OTHERS IN
PREVIOUS COMMENTS IN THIS
HEARING PROPOSING TO REPLACE
OUR CURRENT HEALTH HOMES
PROGRAM. AS WELL AS
TRANSITIONING ON THE WHOLE
PERSON CARE- PILOTS- INTO THE
ENHANCED CARE MANAGEMENT.
BENEFITS WE ALSO THINK THAT IT
IS VERY COMPLEMENTARY RATHER
THAN DUPLICATIVE OF WHAT IS
BEING PROVIDED TO HELP KIND OF
BRIDGE SILOS FOR SOME OF OUR
MOST. MEDICALLY COMPLEX.
INDIVIDUALS THAT ARE ALSO
HAVING THOSE SOCIAL FACTORS
IMPACTING THEIR ABILITY- SHE
RECEIVED SERVICES. THE OTHER
THING WE WOULD ON THAT NOTE
TAKE HERE. IS THAT WE WILL BE
ISSUING GUIDANCE AND WE'RE- TO
WHERE THEY'RE IS OVERLAP BEING-
AT. OF COORDINATION I SOME OF
THE PIECES I WOULD FLAG FOR YOU
INCLUDE THAT TARGETED CASE
MANAGEMENT PROVIDED BY PUBLIC
HEALTH DEPARTMENT. WE ALSO KNOW
THAT WE NEED TO GET ADDITIONAL
GUIDANCE OUT REGARDS HOW THIS
WILL INTERACT WITH THE
BEHAVIORAL HEALTH. PROVIDED BY.
TARGETED CASE MANAGEMENT
PROVIDED BY OUR COUNTY
COLLEAGUES AS THERE'S A LOT OF
COMPLEXITIES THAT THINKS RUBIO
ON HOW THAT WORKS GIVEN THE
BENEFIT THERE. AND THEN ANOTHER
EXAMPLE IS- CASE MANAGEMENT FOR
OUR CCS OF BENEFICIARIES ARE
CHILDREN. I THINK ONE OF THE
THINGS THAT I WOULD HIGHLIGHT
THOUGH IS. GIVEN THAT WE HAVE
SOME OF THOSE SILOS PIECES IT
JUST HIGHLIGHTS THE NEED FOR
THE POPULATIONS THAT ARE
CURRENTLY LISTED IN IN
HEALTHCARE MANAGEMENT. EGGMAN
NEED FOR THIS HIGHER LEVEL
BENEFIT OF BEING AVAILABLE FOR
THEM. SO ANOTHER THING JUST TO
MAKE SURE IT'S CLEAR ALL SEVEN
ENHANCE YOUR ENJOYMENT TARGET
POPULATIONS ARE MANDATORY
POPULATIONS. THE MANAGED CARE
PLANS WILL BE RESPONSIBLE FOR
PROVIDING. TAILORED ECM
PROGRAMS FOR ALL TARGET
POPULATIONS WORKING WITH
PROVIDERS WHO HAVE EXPERTISE IN
THOSE PARTICULAR POPULATIONS.
FOR EXAMPLE- EIGHT AND A HALF
CARE MANAGEMENT PROVIDER
PROBABLY WON'T BE THE SAME ONE
WORKING ON- INDIVIDUALS
TRANSITIONING FROM
INCARCERATION INTO THE
COMMUNITY- AS YOU WOULD BE
HAVING SOMEONE CONTRACTED FOR.
CHILDREN AND YOUTH WITH HIGH
COMPLEX MEDICAL CONDITIONS ARE
TWO DIFFERENT TYPES OF
PROVIDERS AND THAT WILL BE
EXPECTED ON THERE WILL NOT BE A
LONG LIST OF PROVIDERS WHO CAN
MEET ALL OF THE VARIOUS TARGET
POPULATIONS. WITH THE EXCEPTION
OF A FEW KEY PARTNERS LIKE
PUBLIC HOSPITAL SYSTEMS WHO
REALLY ARE TO PROVIDE A REALLY
DIVERSE AMOUNT OF THESE
SERVICES TODAY THROUGH A WHOLE
PERSON CARE- HI LET'S. SO
MANAGED CARE PLANS WILL BE
REQUIRED TO CONTRACT WITH
COMMUNITY BASED PROVIDERS TO
PROVIDE ECM SERVICES ON
INDIVIDUALS LIKE PUBLIC
HOSPITAL SYSTEMS OF THE
MENTIONED ARE COUNTY PARTNERS
ESPECIALLY FOR. THE ENHANCED
CARE MANAGEMENT- THE TARGET
POPULATION AROUND THE
INDIVIDUALS. WITH SERIOUS
MENTAL ILLNESS. WE EVEN PUT IN
OUR UP TO GUIDE WE WILL IT'S
MANAGED PLAN TO CONTRACT WITH
COUNTIES WE ALSO EXPECT THAT IF
THAT INDIVIDUAL I'M IS ALREADY
RECEIVING SERVICES THAT THEY
BEAT AND THERE ARE A CONTRACTED
ENHANCE YOUR MANAGEMENT
PROVIDER. THE BIG IT DEFAULTED
AUTOMATICALLY ASSIGNED TO THAT
COUNTY ENHANCE CARE MANAGEMENT
PROVIDER WE ALSO KNOW THAT
COMMUNITY BASED ORGANIZATIONS
WILL PLAY A HUGE ROLE IN THE
SPACE A REP ESPECIALLY AROUND.
ON SOME OF THE HOMELESS
POPULATIONS WHO ARE OUT DOING
MANY OF THIS SOMETIMES
THROUGHOUT THE LAND TO BE
FUNDING SOMETIMES TO OTHER
SOURCES- AND HOPEFULLY THEY'LL
BE ABLE TO CONTRACTING PROVIDE
THE ENHANCED CARE MANAGEMENT UM
SERVICES. REALLY WE'RE TRYING
TO LEVERAGE AND BUILD THE
EXISTING INFRASTRUCTURE
RELATIONSHIPS AND PROVIDER
EXPERIENCE TO PROVIDE THIS TO
OUR BENEFICIARIES. ACROSS THE
ENTIRE STATE OF CALIFORNIA. I'M
WE HAD SOME QUESTIONS IN
REGARDS TO YOU- THE PERCENTAGES
OUT THERE ARE WE GET THIS
QUESTION A LOT. TO HELP HOMES
CURRENTLY TARGET SOME OF THE
HIGHEST RISK IN REGARDS TO
ABOUT THREE TO FIVE PERCENT-
BUT THAT'S WHO THEY'RE
TARGETING THAT DOESN'T MEAN
THAT'S HOW MANY PEOPLE. ARE
ACTUALLY BEING ENGAGED IN THE
PROGRAM- WHOLE PERSON CARE HAD
SIMILARKIND OF TARGETS FOR OUR
REGION ENROLLMENT. UNDER DCS
EXPECTS THOUGH WITH THAT TYPE
OF PERCENT OF WHO YOU'RE
ENGAGING WHO MAY BE ELIGIBLE.
ON THAT ABOUT 1% OF THE
MEDICARE MANAGED CARE
POPULATION- THAT WOULD BE
RECEIVING ACTUALLY GIVING BEING
GIVEN ENHANCE CARE MANAGEMENT
SERVICES- STONE. THERE'S A
DIFFERENCE BETWEEN THOSE WHO
ARE ELIGIBLE ARE THOSE WHO
WOULD ENGAGE IN OUTRAGE AND
THOSE WHO ACTUALLY PARTICIPATE.
ON THESE BENEFICIARIES ARE
REALLY COMPLEX- AND MANY OF
THEM MAY NOT BE. WILLING OR
ABLE. TO ENGAGE AND ENHANCE
CARE MANAGEMENT AND WE HAVE
LEARNED THAT THROUGH BOTH A
WHOLE PRSON CARE PILOTS AND
OUR HEALTH HOME PROGRAM. IN
REGARDS TO HOW HARD IT CAN BE
TO REALLY WORK WITH SOME OF
THESE OUR POPULATIONS. AS WE
TOOK A LOT OF THOSE LESSONS
LEARNED TO INFORM ON THE THAT
THE PERCENTAGES FOR THIS
HIGHEST NEED OUR POPULATION-
SOMETIME MY PIECES TO MAKE SURE
PEOPLE ARE TRACKING SO- WE ARE
PROPOSING THAT BY JANUARY ONE
OF TWENTY TWO YOU ALL MANAGED
CARE PLANS IN COUNTIES WITH
WHOLE PERSON CARE PILOTS- AND-
OR HELP THOSE PROGRAMS. WOULD
BEGIN TO IMPLEMENT THE ENHANCED
CARE MANAGEMENT BENEFIT FOR
POPULATIONS THAT ARE ENROLLED
IN WHOLE PERSON CARE OR HELP
HOMES- BY JULY ONE OF TWENTY
TWENTY THREE MANAGED CARE PLANS
AND COUNTIES WITH OUT WHOLE
PERSON CARE PILOTS- INDOOR
HELTON'S PROGRAMS WOULD BEGIN
TO IMPLEMENT- ENHANCE YOUR
MANAGEMENT BENEFITS FOR THE-
SELECT POPULATIONS WHICH WOULD
HAVE TO BE PROVIDED TO THE
DEPARTMENT IN ADVANCE BASED ON
OUR MODEL OF CARE- GUIDANCE
THAT HAS BEEN RELEASED. IT
WOULDN'T PRECLUDE H. COUNTY OR
I'M SORRY A MANAGED CARE PLAN-
WHO. DOES NOT HAVE A WHOLE
PERSON CARE PILOT OUR HELP
COMES. TO NOT GO LIVE IN
JANUARY ONE OF TWENTY DO YOU
THINK. THE- THE LARGE. IN LIEU
HERE OF ARE INSISTING MAJOR
WOULD GO WITH THAT JOE. TWO
THREE TWO PERIOD- AND THEN FINE-
ALL TARGET POPULATIONS ACROSS
ALL PLANS HAVE TO BE UP AND
FUNCTIONAL BY JANUARY ONE OF
TWENTY TWENTY THREE SO WE DO
HAVE SOME PHASING AND NOT WAS A
BASED OFF OF A LOT OF
STAKEHOLDER FEEDBACK THAT WE
OT. ON THE WHEN WE WERE
DISCUSSING THIS AND IS IN THE
UPDATED PROPOSAL. ADDITIONALLY
IN HERE AFTER MANAGEMENT WILL
BE BUILT INTO THE RATE STARTING
JANUARY. OF TWENTY TWENTY TWO-
AND THE DECISIONS ABOUT HOW THE
ENHANCE YOUR MANAGEMENT WILL
SHOW UP IN THE RATE-
DEVELOPMENT TEMPLATE. HAS NOT
BEEN FINALIZED AT THIS TIME BUT
IT WILL BE SEPARATELY
IDENTIFIED TO BE CAN CLEARLY
SEE AND- RESPOND. ON THE
ENCOUNTERS AND THE AT THE RATES
AT SPECIFIC TO ENHANCE YOUR
MANAGEMENT SOMETHING WE REALLY
TRY TO MAKE SURE PEOPLE ARE
UNDERSTANDING- AS I MENTIONED
EARLIER SO I WON'T REITERATE IT
WE DO HAVE POST IMPLEMENTATION
MONITORING. AROUND ENHANCE CARE
MANAGEMENT INCLUDING- SERVICE
PROVISION MEMBERSHIP GRIEVANCE
APPEALS PROVIDER CAPACITY
QUALITY XTERRA. WE WILL BE
WORKING ON HOW WE WILL BE
EVALUATING ENHANCE YOUR
MANAGEMENT I MENTIONED EARLIER
HOW WE'VE DONE THAT THROUGH
WHOLE PERSON CARE. AS WELL AS
HELP HOMES- BUT REALLY FOCUSING
ON BOTH ANNUAL MEDIC A MEDICAL
AUDITS AS WELL AS SOME OF OUR
HE JUST MEASURES TO HELP US-
QUANTIFY. OF THE OUTCOMES OF
ENHANCE CARE MANAGEMENT- AND
THEN LASTLY WE REALLY WILL BE
THINKING ABOUT HOW WE CAN
LEVERAGE AN IN BUILT ON THE
LESSONS LEARNED. THAT WE HAVE
FROM BOTH WHOLE PERSON CARE AND
HEALTH PROBLEMS- REALLY
IMPORTANT THINGS TO MAKE SURE
WE ARE LEVERAGING AND LIFTING
UP. SOME WILL INCLUDE ON THE
IMPORTANCE OF REGULAR
COMMUNICATION BETWEEN MANAGED
CARE PLANS A COMMUNITY BASED
PROVIDERS. AS WELL AS OF REALLY
FOCUSING ON THE OUT REACH AND
ENGAGEMENT OF MEMBERS AND WHAT
ARE SOME OF OUR LESSONS LEARNED
YOUR WHOLE PERSON CARE
ESPECIALLY GIVEN SOME OF THESE
COMPLEX. OUR POPULATIONS. THAT
WERE FOCUSED ON. INVESTING IN
YOUR LOCAL PROVIDER STAFF
TRAINING IS GOING TO BE. OF FOR
THE- IMPLEMENTING. AS WELL AS
COORDINATING AND PARTNERING
WITH OUR COUNTY MENTAL HEALTH
SYSTEMS. AND LASTLY ENSURING
COMMUNITY PROVIDERS HAVE A GOOD
UNDERSTANDING OF THE DATA
SHARING BILLING AND CODING
REQUIREMENTS. OPT FOR THE
ENHANCED CARE MANAGEMENT UP HE
SAYS- AND WE ALSO HAVE BEEN
PARTNERING WITH C. H. THE F.
AND OTHERS TO REALLY DIG INTO
THAT DATA SHARING. AND WHAT IT
MEANS FOR OUR COMMUNITY BASED
ORGANIZATIONS AS IT'S SO
CRITICAL THAT THEY BE AT THE
TABLE EVEN THOUGH THEY ARE SOME
OF THE MORE TRADITIONAL
PROVIDERS. IN THIS SPACE AS WE
START BRINGING CLINICAL AND
NONCLINICAL WORLDS TOGETHER. WE
NEED TO MAKE SURE THAT THEY ARE
GETTING THE ENHANCED TECHNICAL
ASSISTANCE TO BE SUCCESSFUL. I
AND SO THIS IS THE REMAINDER OF
MY COMMENTS ON ENHANCE YOUR
MANAGEMENT AND LOOK FOR TO
QUESTIONS WHEN IS THE
APPROPRIATE TIME. THANK YOU
VERY MUCH NEXT WE WILL HEAR
FROM MAD REZNIKOV WITH THE
LEGISLATIVE ANALYST'S OFFICE.
THANK YOU. FIRST OFF I JUST
WANTED TO MENTION AGAIN THE-
CLOSE THAT WE'VE WRITTEN ABOUT
EQUITY CONSIDERATIONS AND INTEL
AND THAT IS NOW AVAILABLE ON
OUR WEBSITE WHERE WE- WE-
DISCUSS ENHANCE CARE
MANAGEMENT. IN SOME DETAIL.
JUST A- COUPLE OF BRIEF HIGH
LEVEL COMMENTS- AND- YOU SEE A
PROPOSAL- FIRST OF ALL- WE DO
THINK THAT- THIS PROPOSAL DOES
HAVE THE POTENTIAL TO. IMPROVE
HEALTH OUTCOMES FOR THE- TARGET
POPULATION AND THAT IT MAKES A
LOT OF. SENSE TO YOU- DIRECT
MORE RESOURCES TO THE HIGHEST
HEALTH CARE UTILIZES WITHIN
MEDICO- BUT- OUR OUR OUR- ONE
NINE MAJOR QUESTION ON THIS IS
UP. WHETHER THE- AT. THE
CRITERIA FOR WHO FALLS INTO-
YOU TO THE TARGET POPULATION
IS. OVERBROAD WE UNDERSTAND
THAT THE ADMINISTRATION. WAS
INTENDING TO TARGET. POSSIBLY
THE- THE 1% TOP 1% OF- UTILIZE
YOUR ITS WITH A MEDIC CAL. AND
IT'S POSSIBLE THAT THE- THE WAY
THAT THE CRITERIA IS DRAWN
RIGHT NOW COULD COULD CAPTURE A
LARGER POPULATION THAT THAT-
BUT BUT THAT'S- THAT'S REALLY-
IT. IT FOR MY COMMENTS SO-
THANK YOU AND HAPPY TO ANSWER
ANY QUESTIONS. VERY GOOD THANK
YOU WILL GO A AND MOVE ON TO-
ALL. GOOD AFTERNOON THANK YOU
CHAIR WOULD SHARE ARAMBULA AND
COMMITTEE MEMBERS I MERRY THE
VOLATILE HEALTH DIRECTOR FROM
LA CARE HEALTH PLAN- IS THE
NATION'S LARGEST PUBLIC HEALTH
PLAN WITH OVER TWO POINT TWO
MILLION MEDICAL MEMBERS SERVED
ACROSS THE COUNTY OF LOS
ANGELES SINCE NINETEEN NINETY
SEVEN. WE'RE PLEASED TO SEE
THAT CARRYING PROPOSAL
REINTRODUCE. AND WE GIVE THE
COURT A LOT OF THE GOALS AND
INITIATIVES UNDER THE ENHANCED
CARE MANAGEMENT PROPOSAL. IN
PARTICULAR WE'RE LOOKING TO
CARRY FORWARD SOME OF THE
SUCCESSES AND LESSONS LEARNED
FROM OUR HEALTH SOME PROGRAM.
THIRTY FOUR WE HAVE SEEN THERE
ARE HIGHER THAN EXPECTED OFTEN
RATE. THAT MEMBERS ARE EXCITED
AND INTERESTED IN THE SERVICES
PROVIDED UNDER HEALTH HOME. AND
A SIX CORE SERVICES WILL CARRY
OVER AND BEAT A SIX CORE
SERVICES UNDER ENHANCE CARE
MANAGEMENT. WE'VE SEEN UP
22225% OF OUR MEMBERS ACROSS
OUR PROGRAM OPTIONS TO HELP
HOMES. AND SOME OF OUR
COMMUNITY BASED CARE MANAGEMENT
ENTITIES HAVE BEEN ABLE TO BE
UP TO ONE IN Q. MEMBERS. OPTED
INTO THE PROGRAM. THAT NUMBER
GOES HIGHER WHEN WE TARGET THE
RIGHT PROVIDER MEMBER
RELATIONSHIP SO. AS WE
MENTIONED BEFORE AT THE BEEN
MENTIONED BEFORE LOOKING TO
MAKE SURE THAT WERE AND FINING
MEMBERS TO THE RIGHT PROVIDERS
WERE PRE EXISTING RELATIONSHIPS
ARE PRESENT ONE POSSIBLE. WILL
REALLY ENHANCE THE OPTIONS AND
ACCESS TO THE PROGRAM. WE'VE
ALL FIFTEEN THAT THE SERVICES
UNDER HEALTH HOMES IN UNDER
ENHANCE CARE MANAGEMENT IN THE
FUTURE. ARE CRITICAL FOR THIS
GROUP OF HYBRID MEMBERS
PARTICULARLY DURING THE COPA
NINETEEN PANDEMIC AND AS WE
LOOK TO EXIT THE PANDEMIC IN
THE FUTURE. UNDER HEALTH WE SAW
THAT OUR COMMUNITY BASED CARE
MANAGEMENT ENTITIES OR TV CAN
MEET OR ABLE TO HELP OUR
INVOLVED MEMBERS WHO NEEDED
IMPORTANT ACCESS TO FOOD.
BEHAVIORAL HEALTH RESOURCES.
HEALTH EDUCATION AND OTHER
RESOURCES CRITICAL TO
SUPPORTING THIS POPULATION
DURING THE PANDEMIC. FOR THOSE
MEMORY THERE WAS AN SSET TO
HAVE ACCESS TO A CARE
COORDINATOR AND IF HE CAN MEET.
HE WAS ABLE. TO PROVIDE THEM
THE NEEDED INFORMATION. AND
REACHED THAT HOW HOMES HAS
PROVIDE AND FACILITY STRONG
RELATION WITH THE HEALTH. CAN
YOU BASED PROVIDE AND OUR
CALVET. PARTNERS AND WE
TRANSCEND OUR RELATIONSHIP THAT
ONLY CARE WITH OUR FIVE OTHER
HEALTH PLANS SERVING LOS
ANGELES COUNTY. AND WE COME
TOGETHER REGULARLY TO TRY TO
ALIGN ON THE WORK THAT WE'RE
DOING AT OUR HEALTH HOME. AND
ARE TALKING. ABOUT HOW TO ALIGN
UNDER ECM. WHAT ABOUT THE
STRENGTH THAT ARE REALLY WITH
THE COUNTY ENTITIES INCLUDING
THE DEPARTMENT OF HEALTH
SERVICES THE DEPARTMENT OF
MENTAL HEALTH DEPARTMENT OF
PUBLIC HEALTH. UNDER THE WORK
THAT WE'VE DONE UNDER WHOLE
PERSON CARE AND HELP HOMES. AND
WE LOOK AT THE THAT CONTINUE AS
WELL AND- ECM. ADDITIONALLY
WE'VE GOTTEN TO KNOW OUR
COMMUNITY BASED PROVIDERS. IN
MUCH GREATER DETAIL. THAT
STARTED THROUGH LA KERR IS
INVESTMENT. AT THE BEGINNING OF
HEALTH HOMES ON READING OF
ACTIVITY. WHERE WE AWARDED ONE
POINT TWO MILLION DOLLARS IN
START UP GRANTS YOU A SELECT
PORTION OF OUR TV TNT.
UNFORTUNATELY WE WERE NOT ABLE
TO AWARD FUNDS TO ALL OF THEM-
UTILITY FUNDING BUT- THIS WAS
VERY SUCCESSFUL IN HELPING
PREPARE THE ORGANIZATION FOR
HELP HOMES. WE CONTINUE DOCTOR
VARIETY OF TECHNICAL ASSISTANCE
AND LEARNING AND TRAINING
OPPORTUNITIES INCLUDING BI
WEEKLY WEBINARS. THAT HAVE RUN
THROUGH TWENTY NINETEEN TO
CONTINUE TO RUN EVERY OTHER
FRIDAY. AND ARE AVAILABLE AND
YOU PROVIDERS OUTSIDE OF THE
ALLEY CARE NETWORK SO THAT
BENEFIT REALLY CASCADE ACROSS
THE ENTIRE COUNTY- AND YOU
PROVIDERS THAT ARE NOT ONLY
WORKING WITH LA CARE. BUT OTHER
HEALTH PLANS SERVING L. A.
COUNTY. SO WHAT DO WE NEED TO
BE FIXED AT UNDER. WHAT CAN DO
WE- WITH REGARDS HE ON. FIRST
OF AND MOST THE PROPOSAL S
VERY AMBITIOUS AND THE TIMING
IS AGGRESSIVE WE WANTED UNIT
BUT WE WANT TO MAKE SURE THAT
WE DO IT RIGHT. AND WE'RE
ALREADY IN MID MARCH WHICH
MEANS WE HAVE NINE AND A HALF
MONTHS LAST UNTIL JANUARY FIRST
OF TWENTY TWENTY TWO. THE PLANS
ARE DILIGENTLY WORKING TOWARDS
READING IT BUT YOU CAN IN A BIG
WAY. FINDING AND THE- IN. THAT
IS GOING TO BE LARGE FOR
ENHANCED CARE MANAGEMENT
ESPECIALLY IN LOS ANGELES. WE
ESTIMATE THAT THERE COULD BE
THREE TIMES THE SIZE OF WHAT WE
CURRENTLY HAVE AND HEALTH HOME
TODAY. WHEN WE LOOK AT OUR HELP
FROM MEMBERS AND OUR- WHOLE
PERSON CARE MEMBERSHIP WHO ARE
EXPECTED TO BE GRANDFATHERED
INTO THE ECM. IT'S ALREADY
TAKES. 52% OF OUR MEDIC HEALTH
POPULATION. WHY THAN THE ONE
ANTICIPATED. WE KNOW THAT THE
FUNDING HAPPENS SUPPORT THE
PROVISION OF THE INTENSIVE
SERVICES EXPECTED TO BE
PROVIDED UNDER ENHANCE CARE
MANAGEMENT BUT WE ALSO HAVE TO
RECOGNIZE THE INVESTMENTS
REQUIRED BY NOT ONLY ARE
PROVIDERS THAT OFFER THE PLAN-
AS I MENTIONED BEFORE LA CARE
WOULD BE ABLE TO OFFER A ONE
TIME START UP GRANTS TO SOME OF
OUR TV CANDY. BUT IT'S UNLIKELY
THAT THE PLANT WILL BE ABLE TO
OFFER SUFFICIENT FUNDING TO GET
THE THIRD PROVIDERS READY FOR
THE TRANSITION TO ENHANCE CARE
MANAGEMENT. WE HAVE TO CONSIDER
READING THAT'S NOT ONLY BRING
THAT NEW PROVIDERS BUT ALSO
CHANGES AND READY ENOUGH
ACTIVITIES FOR EXISTING THE
VIETNAMESE AS WELL AS EXISTING
WHOLE PERSON CARE PROVIDERS
THAT WILL HAVE TO ADAPT TO NEW
REQUIREMENTS. UNDER ENHANCE
CARE MANAGEMENT. WE'RE LOOKING
FOR TO HEAR. JERRY THIS INCOME
ABOUT THE INCENTIVE PROGRAM. SO
WE CAN I DON'T. HOW TO BUY
SUPPORT BEDIENEN- OUR PROVIDE
NETWORK. WE ALSO ASKED THAT DHS
WORK TWO MINUTE THE
ADMINISTRATIVE. WITH REAL UNDER
HEALTH HOMES AND I OFTEN HEARD
ANYTHING AT ME TELLING ME THAT
THEY HAD TO MAKE CHOICES
BETWEEN HIRING ADMINISTRATIVE
STAFF OUR CLINICAL STAFF WHO
WOULD BE WORKING TWO THIRDS
MEMBER CARE- ADDITIONALLY WE
NEED INFORMATION ON REPORTING
REQUIREMENTS AS SOON AS
POSSIBLE. THIS IS SOMETHING
THAT WE NEED CLARITY ON SO THAT
WE CAN WORK TO HELP PROVIDE I
REDDING AFFECTED WE NEED TO OUR
PROVIDERS ESTABLISHED OUR
INFRASTRUCTURE INTERNALLY AND
ONLINE AND MAKE SURE THAT
WE'RE- DOING WHAT IS. NECESSARY
FOR DH YEAH. ADDITIONALLY WE
ASK FORTY EIGHT YES YOU
CONSIDER. OFFERING REFINEMENT
ON ECM TARGET POPULATION. I
PREVIOUSLY MENTIONED ARE SEVEN
TARGET POPULATIONS THAT THE
EXISTING CRITERIA ARE EXTREMELY
BROAD. THIS POSES ANOTHER
ADMINISTRATIVE CHALLENGE WHEN
YOU'RE IN A COUNTY LIKE LOS
ANGELES THIRD BY SIX DIFFERENT
HEALTH PLANS. WHEN SIX
DIFFERENT HEALTH PLANS HAVE
DIFFERENT INTERPRETATIONS OF
THE CRITERIA YET THEY SHARE
MULTIPLE PROVIDERS THIS CAN BE
VERY COMPLICATED. IN THE I'VE
HEARD OF- STREAMLINING
PROPERTIES AND MINIMIZING I'M
ADMINISTRATIVE BURDEN WE ASK
FOR CONSISTENT CRITERIA. THAT
CAN BE APPLIED BY ALL PLAN. IT
ON MY COMMEND THE DEPARTMENT ON
ITS VISION AND A COMMITMENT TO
SUPPORT OUR MOST AT RISK
MEMBERS. THANK YOU VERY MUCH
FOR YOUR TIME. THANK YOU MISS
OF ALLAH NEXT WE WILL HEAR FROM
LINDA WAY WITH THE WESTERN
CENTER FOR LAW AND POVERTY.
GOOD AFTERNOON AGAIN LED THE
WAY WITH WESTERN CENTER ON LAW
AND POVERTY. WE AGREE WITH THE
AIM TO BE ENHANCED CARE
MANAGEMENT BENEFIT BUT REMAIN
SKEPTICAL OF PLANTED THE LADY
TO PROVIDE ALL OF THE ENHANCE
CARE MANAGEMENT SERVICES GIVEN
THEIR TRACK RECORD. ON REQUIRED
CONVENTION MEDICAL SERVICES AND
CLEANING IT CLANCY NOT
CONSISTENTLY PROVIDE THE
REQUIRED MEDICAL SERVICES THE
AREA IN WHICH THEY ARE EXPERTS
HOW CAN YOU BE EXPECTED TO
ENGAGE IN CASE MANAGEMENT AND
LINKAGE TO OTHER PROGRAMS THAT
THEY HAVE NO EXPERTISE THAT.
RENDON HAD CARE NOW. IS BOTH ON
REFERRALS RATHER THAN THE
DELIVERY MEDICAL SERVICES. IT
IS IMPORTANT THAT PLAN TO
PARTNER WITH TRUSTED COMMUNITY
PROVIDER. WE APPRECIATE IT HAS
CARE MANAGEMENT PROVIDERS
INCLUDE ORGANIZATION SERVING
INDIVIDUALS EXPERIENCING
HOMELESSNESS. AND JUSTICE
INVOLVED INDIVIDUALS I
RECOMMEND THERE BE SPECIAL
EFFORT TO PARTNER WITH SOCIAL
SERVICE ORGANIZATIONS. THAT
HAVE STRONG TRACK RECORD OF
PROVIDING CULTURALLY RESPONSIVE
CARE. PROVIDERS SHOULD NOT ONLY
HAVE EXPERIENCE SERVING THE
POPULATION BUT IT SHOULD ALSO
HAVE EXPERIENCE SUCCESSFULLY
OFFERING THE SERVICES TO THAT
POPULATION. IT'S STILL UNDER.
HOW THE ENHANCED CARE
MANAGEMENT BENEFIT WILL SERVE
POPULATION WHO ALREADY RECEIPT
CASE MANAGEMENT SERVICES SUCH
AS CHILDREN ENROLLED IN
CALIFORNIA CHILDREN SERVICES
REGIONAL CENTER CONSUMERS AND
INDIVIDUALS ENROLLED IN. HOME
AND COMMUNITY BASED SERVICES
WAIVER PROGRAM. YOU UNDERSTAND
THAT THE DEPARTMENT INTENDS TO
PROVIDE GUIDANCE THE PLANS ON
WHAT BASIC AND COMPLEX CASE
MANAGEMENT- DOESN'T HAVE CARE
MANAGEMENT SERVICES ARE
EXPECTED FOR CHILDREN AND
ADULTS SHORTLY. WE RECOMMEND
THE DEPARTMENT CLARIFYING THESE
DOCUMENTS HOW MEMBERS WILL MOVE
BETWEEN THESE CASE MANAGEMENT
REQUIREMENTS AT THEIR NEEDS OR
CIRCUMSTANCES CHANGE AND HOW
THE DEPARTMENT WILL EVALUATE
THE TRANSITION. THIS GUIDANCE
SHOULD ALSO BE SPECIFIC TO EACH
TARGET GROUP TO RECOGNIZE EACH
POPULATION HAS DIFFERENT NEEDS
AND ARE INVOLVED WITH DIFFERENT
HEALTH AND SOCIAL SERVICE. JUST
DONE FOR BOTH THE HANDS CARE
MANAGEMENT BENEFIT AND THE
PROPOSED IN LIEU OF SERVICE
ELIGIBILITY FOR HELPING SUPPORT
SERVICES. WE RECOMMEND STRIKING
AT RISK OF HOMELESSNESS AS AN
ELIGIBILITY CRITERION AS IT IS
DIFFICULT TO DEFINE IN ADDITION
WE RECOMMEND ALLOWING FOR
CONTINUOUS ELIGIBILITY FOR
BENEFICIARIES ONCE THEY'RE NO
LONGER HOMELESS BY ADDING
BENEFICIARY WHO PREVIOUSLY
EXPERIENCED HOMELESSNESS. THAT
ARE NOT. OURS CITING IN SUPPORT
OF HOUSING. AND FINALLY IN CARE
MANAGEMENT AVAILABLE OR DO. X.
FOR THOSE IN REAL IN THE MANY
CONNECT. SO WE RECKON ADDING
LANGUAGE THAT RECORD THESE
DEALS WILL BECOME A- ONE
THIRTY. AND THANK YOU. THINKING
THIS WAY NEXT WE WILL FROM
COOLEY WALLACE. HI MY NAME IS
JULIA WALLACE AND I AM A
COMMUNITY HEALTH WORKER WITH
ACCOUNT LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
WHOLE PERSON CARE PROGRAM AND
I'M ALSO PROUD MEMBER OF S. P.
ARE YOU LOCAL SEVEN TWENTY ONE.
I HAVE ABOUT FIFTEEN YEARS OF
EXPERIENCE WORKING IN COMMUNITY
BASED ORGANIZATIONS AS WELL AS
WORKING WITHIN THE DEPARTMENT
OF MENTAL HEALTH WHOLE PERSON
CARE PROGRAM AND I CURRENTLY
WORK FOR THE COUNTY. I'M HERE
TODAY TO ELEVATE SDSU'S
POSITION REQUIRING MANAGED
CARE. PLANS TO CONTRACT WITH IN
THE COUNTY SYSTEM PROVIDERS OF
CRITICAL HEALTHCARE BEHAVIORAL
HEALTH AND SOCIAL SERVICES AND
ALSO SPECIFICALLY MY WORK OUR
IS LOCATED WITHIN THE SERVICE
PLANNING AREA FOR REGION WHICH
INCLUDES SKID ROW. HOLLYWOOD
CAREER TOWN OF DOWNTOWN LOS
ANGELES MADE CITY MANY OTHER
PLACES SO REALLY AND MY OFFICES
ARE ON SKID ROW SO GROUND ZERO
FOR A LOT OF THE HOMELESSNESS
AND FOLKS LIVING WITH SEVERE
MENTAL ILLNESSES- THESE ARE THE
FOLKS THAT I WORK WITH IN
PARTICULAR. I'M HERE TO SHARE
SOME OF MY PROFESSIONAL
EXPERIENCES AND TO ADVOCATE FOR
THE SERVICES TO BE WITHIN THE
COUNTY ALONG WITH MY
UNDERSTANDINGS OF COMMUNITY
BASED ORGANIZATIONS. FROM MY
EXPERIENCE. IN WORKING WITH THE
COUNTY FOLKS ARE I'VE HEARD
SOME SPEAKERS TALKING ABOUT.
TRAINING AND CONTINUATION OF
KERR AS A COUNTY WORKER I HAVE
SEEN AND EXPERIENCED THE
CONTINUATION OF CARE AND
SERVICES WITH IN THE COUNTY
DEPARTMENT MENTAL HEALTH IN
PARTICULAR THAT HAVE ALLOWED ME
TO ASSIST MY CLIENTS AND ALSO
TO. HELP GET MY CLIENTS
PERMANENT HOUSING AND HAVE
OTHER POSITIVE OUTCOMES. I
WOULD SEE THAT A LOT OF COUNTY
PROVIDERS ARE OFTEN VIEWED AS-
ONE SONG OR INVISIBLE HEROES
BUT ESPECIALLY NOW WITH THE
PANDEMIC I THINK FOLKS ARE MORE
ARE REALIZING THE SERVICES THAT
WE PROVIDE. AND HOW IMPORTANT
CONTINUUM CONTINUUM OF CARE I
FOR FOLKS THAT OFTENTIMES
EITHER LOSE ARE OFTEN DON'T
HAVE A CELL PHONE WORKING WITH
FOLKS AND BEING ABLE TO LOCATE
THEM. OUR WAR IN WITHIN THE
EITHER THE JAIL OR COUNTY
HOSPITAL OR EVEN PRIVATE
HOSPITAL SYSTEMS HAS ALSO
HELPED US BE ABLE TO MAIN
CONTINUUM OF CARE FOR OUR
CLIENTS. SO FOR EXAMPLE I WORK
WITH FOLKS WERE HOW YOU REALIE
THERE'S OF- PSYCHIATRIC
HOSPITALS SO SOMETIMES WHEN I.
HAVEN'T HEARD FROM MY CLIENTS
WHEN WORKED IN COMMUNITY
BASED ORGANIZATIONS I WOULD
JUST EITHER HOPE THAT I CAN
LOCATE THEM- ARE YOU SOME OF
THE PUBLIC FACILITIES PUBLIC
DATABASES TO BE ABLE TO FIND
THEM. BUT WITHIN THE COUNTY- I
HAVE ACCESS TO SOMETHING CALLED
IBIS WHICH IS A FACILITY-
DATABASE THAT TRACKS
HOSPITALIZATIONS AND THE
BECAUSE OF ALSO HAVE THESE
RELATIONSHIPS WITH PROVIDERS
THAT ARE WORKING IN THESE
HOSPITALS. I'M ABLE TO LOCATE
MY CLIENT SPEAK WITH HIM DMH
LIAISONS ARE WORKING WITHIN THE
HOSPITALS. AND ASSIST WITH YOUR
CHARGE PLANNING WITH EITHER
SHORT TERM HOUSING OR GETTING
THEM INTO A CRISIS RESIDENTIAL
FACILITIES AND WORKING WITH
LONG TERM HOUSING. WE'VE ALSO
BEEN ABLE TO WORK WITH FOLKS
AND GETTING THEM SECTION EIGHT
VOUCHERS THROUGH THE DEPARTMENT
OF THE. HEALTH ASSISTING THEM
IN COMPLETING NO. AS THEN ARE
CLIENTS WE'RE GETTING PERMANENT
IT'S MIKE ARE IN THE PROCESS OF
CURRENTLY HAVE PERMANENT WHO
WERE HOMELESS. FOR TWENTY YEAR
OR- I'VE ALSO BEEN ABLE TO-
WORK WITH CLIENTS WHO. HAVE
HAD- ACTIVE WERE ACTIVELY
PSYCHOTIC AND NEEDED ACUTE CARE
AND BEEN ABLE TO LOCATE OTHER
SOCIAL WORKERS AND FOLKS WITHIN
THE HOSPITALS TO BE ABLE TO.
PROVIDE THEM SERVICES AND
THAT'S BECAUSE OF BEING A
COUNTY WORKER AND HAVING ACCESS
TO THOSE RELATIONSHIPS THAT I
DIDN'T REALLY NECESSARILY HAVE.
OUR WHEN I WORKED WITH
COMMUNITY BASED ORGANIZATIONS
AND COMMUNITY BASED
ORGANIZATIONS DON'T NECESSARILY
CURRENTLY HAVE- I THINK
REQUIRING MANAGED CARE PROGRAMS
WITH THE CONTRACT WITH COUNTY
PROVIDERS. WOULD BENEFIT FOLKS
BECAUSE OF THE ROBUST NETWORK
THAT WE ALREADY HAVE- AND
BENEFIT OUR CLIENTS I'M REALLY
REALLY PROUD AND EXCITED THAT I
WAS ABLE AND THAT I'VE BEEN
ABLE TO WORK WITHIN THE WHOLE
PERSON CARE. PILOT PROGRAM AND
OUR TO SEE THIS IT REALLY
HAVING THE OPPORTUNITY TO
EXPAND- I CAN SPEAK TO SOME OF
MY EXPERIENCES AS A COUNTY
WORKER AND ALSO SOMEONE WHO'S
HAD. YEARS OF EXPERIENCE
WORKING WITH PEOPLE WITH SEVERE
MENTAL ILLNESS HOMELESSNESS HIV
POSITIVE IMMIGRANTS LGBTQ FOLKS
WOMEN AND CUT PEOPLE WITH CO
OCCURRING DISORDERS- AND I DO
THINK THAT WE REALLY SHOULD BE
ADVOCATING FOR COUNTY
EMPLOYEES. WHO ALREADY HAVE
THIS NETWORK AND EXPANDING THE
NETWORK OF COUNTY EMPLOYEES TO
BE ABLE TO DO THIS INCREDIBLE
WORKED WITH THE SYSTEMS THAT
ARE ALREADY IN PLACE WE DON'T
HAVE TO REINVENT THE WHEEL A
LOT OF COUNTY WORKERS ARE
ALREADY DOING. AND PEOPLE THE
COUNCIL'S FOR LISTENING TO MY
REMARKS WHATEVER I CAN DO TODAY
GIVE INFORMATION OR INSIGHT
FROM MY EXPERIENCES I LOVE TO.
THANK YOU VERY MUCH NEXT WE
WILL HEAR FROM FAREHAM MCDADE
TEENS WITH THE CALIFORNIA STATE
ASSOCIATION OF COUNTIES. THANK
YOU MISTER CHAIR AND MEMBERS
I'M CERTAINLY DATING WITH THE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES AND I APPRECIATE THE
OPPORTUNITY TO SPEAK- THIS
AFTERNOON I JUST WANT TO SAY
THAT. THE PREVIOUS SPEAKER MS
WALLACE- PRETTY MUCH SAID
EVERYTHING I COULD HAVE
POSSIBLY SAID ABOUT THE
EXPERTISE OF COUNTIES AS WELL
AS THE MULTI DISCIPLINARY
APPROACH OF COUNTIES FOR
DEALING WITH THESE HIGH RISK
HIGH NEED CLIENTS WHAT I'D LIKE
TO GO OVER TODAY IS TO BRIEFLY
TOUCH UPON THE OPPORTUNITIES OF
THE CM WHICH WE RECOGNIZE. THE
RISKS AND SOME POTENTIAL
SOLUTIONS- FIRST FOR
OPPORTUNITIES YOU KNOW THE
OPPORTUNITY UNDER CALTRAIN TO
IMPLEMENT HIGH LEVEL CASE
MANAGEMENT SERVICES- IS
UNPRECEDENTED AND WE APPLAUD
AND THANK THE DEPARTMENTS- THE
HEALTH AND HUMAN SERVICES
AGENCY IN THE GOVERNOR FOR
PROPOSING IT AND ALSO. FOR
TAKING THE BATON BACK UP AFTER
WE ALL GOT DISTRACTED BY
COLLUDED NINETEEN- NOW MORE
THAN EVER WE THINK THAT- HIGH
LEVEL CASE MANAGEMENT IS VERY
IMPORTANT ESPECIALLY FOR THE
POPULATION THAT OFTEN GETS LEFT
BEHIND- OFFERING THESE SERVICES-
THE ENHANCED CASE MANAGEMENT
ECM SERVICES STATEWIDE IS A
HUGE OPPORTUNITY. AS WELL AS
BRINGING IN THE FEDERAL FUNDING
THAT WOULD COME WITH IT FOR
THESE COMPLEX CASES THOSE ARE
THE REALLY THE DRIVING GOALS
BEHIND OFFERING ECM- AND
COUNTIES ARE SUPPORTIVE OF
THOSE OUT WE ALSO APPRECIATE-
THE OPPORTUNITY TO STILL ALLOW
FOR THE CONTINUATION OF NON
DUPLICATIVE COUNTY TARGETED
CASE MANAGEMENT ACTIVITIES. MS
COOPER MENTIONED THAT EARLIER
AND YOU KNOW OUR PROBATION SIDE
OF THINGS ARE BEHAVIORAL HEALTH
SIDE IN A PUBLIC ON SIDE WE
STILL DO USE TARGETED CASE
MANAGEMENT ACTIVITIES SO WE'RE
WE SHOULD HAVE TO BE ABLE TO
CONTINUE TO DO THOSE ACTIVITIES
AS WELL AS COURTNEY.
POTENTIALLY WITH. A NEW ECM
CASE MANAGER. I LIKE TO GET
INTO THE RISK. THEY'RE
IMPORTANT TO KNOW- WE'RE
CONCERNED ABOUT A DISJOINTED
TRANSITION FOR WHOLE PERSON
CARE CLIENTS TO A MANAGED CARE
SYSTEM. INCLUDING SOME OF THE
TECHNICAL DETAILS- THE ABILITY
AS MS WELL AS MENTIONED
PREVIOUSLY- TO REACH THESE
CLIENTS- OFTEN YOU CANNOT REACH
THEM WITH A CELLPHONE. AND
CERTAINLY NOT THROUGH A
COMPUTER OR PERSONAL COMPUTER
INTERFACE- WE ARE ALSO
CONCERNED ABOUT THE DEPARTMENT-
HAS TAKEN IN STAKEHOLDER INPUT
ON THE NEED FOR ACTIVE AND
SUSTAINED OUTREACH. TO THESE
BENEFICIARIES- WE HAVE NOT YET
SEEN THE- YOU KNOW DETAILS
ABOUT HOW THAT WOULD BE%
UNDERTAKEN BY THE HEALTH CARE
PLANS- WHICH BRINGS ME ON TO MY
NEXT POINT WHICH IS- WE'RE
REALLY WORRIED ABOUT REDUCED
ACCESS TO LOCAL MULTI
DISCIPLINARY AT EFFORTS.
ESPECIALLY THE CLOSE
COOPERATION. THAT MANY WHOLE
PERSON CARE PILOTS AND
HOMELESSNESS PROGRAMS HAVE WITH
COUNTY BEHAVIORAL HEALTH
SERVICES- THE NEXT PANELIST
MISS WORLD HOME WILL COVER THAT
IN MORE DETAIL. AND THEN LASTLY
THE RELIANCE ON- THROUGH ECM
WITH A MANAGED CARE PLAN ON A
MEDICAL MODEL. RATHER THAN A
COMMUNITY BASED SOCIAL MODEL.
COOL PERSON CARE AND OTHER
HOMELESS OUTREACH PROGRAMS THAT
WE ARE DOING- AND I MENTION
HOMELESS OUTREACH PROGRAMS AS A
BROAD UMBRELLA OF SERVICES AND
SUPPORTS THE OUNTY'S. OFFER OF.
WE COUNTY ARE RESERVOIR OF
EXPERTISE. IN THE FOR OF FOLKS
LIKE MS WALLACE. WORKERS HEALTH
CRISIS TEAMS AND PUBLIC HEALTH
NURSES AND ALL OF THESE
WORKERS- UNDERSTAND THEY
RECOGNIZE THE COMPLEX SOCIAL
AND ECONOMIC NEEDS. AS WELL AS
THE EFFECTS OF GEOGRAPHY AND
SYSTEMIC RACISM. AMONG ELIGIBLE
BENEFICIARIES AND WE CANNOT
LOSE THIS LEVEL OF EXPERTISE
TEASE OUT REACH AND ENGAGEMENT
AND COMMITMENT TO SERVING THESE
PEOPLE WITH THE IMPLEMENTATION
OF THE ECM. THE COUPLE'S SHORT
SOLUTIONS TO OFFER INCLUDING WE
STRONGLY SUPPORT THE
DEPARTMENT'S PROPOSED SHORT
PHASING IN PERIOD FOR ECM I WAS
DONE WITH THE WHOLE PERSON CARE
PILOTS WE APPRECIATE THEIR
ATTENTION TO THAT INPUT TO
ALLOW A PHASED IN APPROACH.
THIS STATE SHOULD ALSO CONSIDER
ALLOWING REGIONAL MODELS WHICH
I RECOGNIZE IS COVERED IN
ANOTHER PART OF THIS HEARING
BUT IT'S CRITICAL TO BOTH OF
THE SALMON AND IN LIEU OF
SERVICES AS THEIR SUCCESS IS
DEPENDENT ON ACCESS TO MULTIPLE
SPECIALIZED AND TAILORED
SERVICES. DESIGNED TO BE
COMPLEX NEEDS AND THOSE
SERVICES LIKE MEDICAL
SPECIALTIES MAY NOT ALWAYS BE
RIGHT NEXT DOOR IN ACCOUNTING-
THE LAST AND MOST IMPORTANT
SOLUTION FROM THE COUNTY
PERSPECTIVE WILL NOT. COME AS A
SURPRISE TO BOTH- YOU AT CHAIR
WOULD AND YOU WOULD CHAIR EVER
TO BE A LOT OF NEWS TO SHARE
COOPER MENTIONED EARLIER THAT
PLANS ARE ENCOURAGED CONTRACT
WITH COUNTIES THAT THEY
RECOMMEND THEY CONTACT WITH
CANNONS- BUT THERE'S NOT A. THE
FIRM REQUIREMENT TO DO SO. I WE
BELIEVE IT WILL EASIER REQUIRES
INTENSIVE COOPER INCOME. OF THE
LOCAL. AND ROBUST TECHNICAL
ASSISTANCE BY THE STATE WITHOUT
THIS INTENSIVE COOPERATION AND
COMMUNICATION BEGINNING RIGHT
NOW WITH- COUNTIES AND
HOPEFULLY THE MANAGED CARE
PLANS. BEGINNING CONVERSATIONS
BUT ALSO ROBUST TECHNICAL
SUPPORT. UCM WILL FAIL AND SO
WE SUGGEST THAT IT IS REQUIRED-
TO WORK WITH THE COUNTIES AND-
THAT. THE EXPERTISE AT THE
LOCAL LEVEL COUNTY SPECIFICALLY
BUT THEY'RE ALSO VERY VALUABLE
COMMUNITY BASED PROVIDERS. IS
NOT LOST IN THE TRANSITION TO
ECM. COUNTY STAND READY TO
ENSURE COORDINATED PATIENT
CENTERED ECM SERVICES TO
CALIFORNIANS WITH COMPLEX NEEDS
AND WE THANK THE CHAIRS FOR THE
OPPORTUNITY TO SPEAK TODAY.
THANK YOU. THANK YOU NEXT WE'LL
HEAR FROM PAULO WILL HOME
DIRECTOR OF POLICY FOR THE
COUNTY- BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION. THANK
YOU AND GOOD AFTERNOON SHARES
WOULD AND ARAMBULA- AGAIN MY
NAME IS PAULA WILL HOME I
APPRECIATE THE OPPORTUNITY TO
PROVIDE THIS PERSPECTIVE ON
BEHALF OF THE COUNTY BEHAVIORAL
HEALTH DIRECTORS ASSOCIATION.
AS YOU KNOW COUNTIES OPERATE
BEHAVIORAL HEALTH PLANS THAT
COVER SPECIALTY SERVICES FOR
MEDICARE BENEFICIARIES WITH
SERIOUS MENTAL ILLNESS AND
SUBSTANCE USED. CAN YOU MAY
RURAL HEALTH PLAN SUPPORT THE
ENHANCED CARE MANAGEMENT
PROPOSAL AS A WHOLE OUR MEMBERS
ARE EXCITED ABOUT THE
OPPORTUNITY TO OFFER ENHANCED
CARE MANAGEMENT SERVICES TO
COUNTY BEHAVIORAL HEALTH PLAN.
BUT WE ALSO HAVE SOME SPECIFIC
CONCERNS AND POLICY
RECOMMENDATIONS THAT WE BILL
MUST BE ADDRESSED TO MAXIMIZE
THE POTENTIAL BENEFITS OF ECM
FOR PEOPLE WITH BEHAVIORAL
HEALTH CONDITIONS. SPECIFICALLY
WE FELL THE DEPARTMENT OF
HEALTH CARE SERVICES HAS NOT
FULLY ANSWERED FUNDAMENTAL
QUESTIONS ABOUT THE
RELATIONSHIP BETWEEN THE
PROPOSED ECM BENEFIT AND
SIMILAR CARE MANAGEMENT AND
WRAPAROUND SUPPORTIVE SERVICES
THAT ARE CURRENTLY ADMINISTERED
AND FUNDED BY COUNTY BEHAVIORAL
HEALTH PLAN. WE WORRY ABOUT
POTENTIAL SERVICE DUPLICATION
AND NEW LAYERS OF CONFUSION FOR
CLIENTS. THEY'RE ALSO CONCERNED
THAT DH CS OR INDIVIDUAL
MANAGED CARE PLANS MAY
ESTABLISH ELIGIBILITY CRITERIA
FOR ECM BETTER TO NARROW- AND
MAY NOT INCLUDE MANY OF OUR
BEHAVIORAL HEALTH CLIENTS WHO
HAVE THE HIGHEST RISK OF
PREMATURE MORTALITY. I AM WE
APPRECIATE THE DH CS HAS
OFFERED A COUPLE OF
OPPORTUNITIES TO PROVIDE
FEEDBACK- AS THE POLICY WAS
DEVELOPED AND WE HAVE OFFERED
SOME SPECIFIC POLICY
RECOMMENDATIONS TO ADDRESS OUR
CONCERNS. FIRST WE SUGGEST THAT
ELIGIBILITY CRITERIA FOR ECM
SHOULD BE REFINED TO PRIORITIZE
INDIVIDUALS WITH SERIOUS MENTAL
ILLNESS OR SUBSTANCE USE
DISORDER CAN EXPERIENCE
EXTREMELY HIGH RISK FOR
PREMATURE. MORTALITY STRICTLY
DUE TO THEIR BEHAVIORAL HEALTH
CONDITIONS WE DO NOT RECOMMEND
THAT YOU H. C. S. REQUIRE
PHYSICAL ELEMENTS TO BE KNOWN
TO THE MANAGED CARE PLAN AS A
CONDITION OF ENROLLMENT OR
ELIGIBILITY FOR ECM. AND THIS
IS IN EQUITY AND DISPARITIES
ISSUE NATIONALLY IT IS WELL
DOCUMENTED THAT PEOPLE WITH
SERIOUS MENTAL ILLNESS AND
SUBSTANCE USE DISORDERS A
SIGNIFICANT HEALTH DISPARITIES.
MOST NOTABLY PEOPLE WITH
SERIOUS MENTAL ILLNESS OR
SUBSTANCE USE DISORDERS HOW
EXPECTANCY THAT IS SEVEN TO
TWENTY FOUR YEARS LOWER THAN
THE GENERAL POPULATION. THIS IS
LARGELY DUE TO PHYSICAL HEALTH
COMORBIDITIES LIKE
CARDIOVASCULAR DISEASES THAT GO
UNTREATED DUE TO POOR ACCESS TO
PRIMARY CARE AND OFTEN LINKED
TO STIGMA AND BIAS THAT PEOPLE
WITH MENTAL ILLNESS EXPERIENCE
WHEN THEY ACCESS SERVICES IN
THE TRADITIONAL CLINIC SETTING.
WE BELIEVE ONE Q. GOAL OF A
STRATEGY LIKE YOU SEE ECM
SHOULD BE TO IMPROVE
CONNECTIONS TO PHYSICAL HEALTH
CARE SERVICES FOR PEOPLE WITH
SERIOUS BEHAVIORAL HEALTH
CONDITIONS. OUR CLIENTS SHOULD
NOT HAVE TO WAIT UNTIL THEIR
PHYSICAL HEALTH DETERIORATES.
ACCESS ENHANCED CARE
COORDINATION AND WRAPAROUND
GOAL PERSON PARTS. THEREFORE WE
URGE DH CS TO HELP MANAGED CARE
PLANS IMPLEMENT STRATEGIES LIKE
ECM THAT CAN HELP IDENTIFY THE
PHYSICAL HEALTH NEEDS. OF OUR
HIGH RISK BEHAVIORAL HEALTH
CONDITIONS WE'VE BEEN TO BECOME
COSTLY HI UTILIZED EARNERS OF
EMERGENCY OR INPATIENT SERVICES.
OUR SECOND OVER ARCHING POLICY
RECOMMENDATION SIMILAR TO WHAT-
MS MCDADE KING JUST MENTIONED
IS THAT DH CS SHOULD REQUIRE
MEDICAL MANAGED CARE PLANS TO
COLLABORATE WITH COUNTY
BEHAVIORAL HEALTH PLANS. TO
FIRST. I'M SHARED BENEFICIARIES
AND THEN IMPLEMENT ECM PROGRAMS
THAT ARE HIGHLY COORDINATED
MANAGED CARE PLANS SHOULD ALSO
BE EXPECTED TO PURSUE CONTRACTS
WITH COUNTY BEHAVIORAL HEALTH
PLANS TO PROVIDE ECM FOR
BEHAVIORAL HEALTH CLIENTS
UNLESS SPECIFIED EXCEPTION
CRITERIA APPLY. COLLABORATIVE
IMPLEMENTATION OF ENHANCED CARE
MANAGEMENT IS CRITICAL BECAUSE
COUNTY BEHAVIORAL HEALTH PLANS
CURRENTLY OFFER AND PAY FOR
SOME SERVICES THAT RESEMBLE
CORE COMPONENTS OF ENHANCE CARE
MANAGEMENT OR EVEN THE IN LIEU
OF SERVICES DICUSSED. IT'S
PAST. HE'S COUNTY BEHAVIORAL
HEALTH SERVICES MAY INCLUDE
CASE MANAGEMENT BUT SOMETIMES
ADDRESSES PHYSICAL HEALTH
CONDITIONS IN ADDITION TO
BEHAVIORAL HEALTH. SOME OF OUR
COUNTY BASED SERVICES ARE
REIMBURSED UNDER MEDICARE I'LL
AND IN OTHER CASES. WE OFFER
ECM LIKE SERVICES THAT FOR OUT
OF MEDIC HOW BY IMAGE. MENTAL
HEALTH SERVICES I OR A LOCAL
DOLLARS. I'M ALSO WENT TO. MR
IS COMMON BUT DH CS CONTINUE TO
LOOK AT THIS AND- BETWEEN. THE
ENHANCED CARE MANAGEMENT AND
THEN WE WILL SERVE PROPOSALS
AND BEHAVIORAL HEALTH. AND AS
THE POLICY HAS BEEN DEVELOPED.
THE B. H. DA HAS BEEN TO THAT
NEARLY ENCOURAGE MANNER CARE
FOR TO WORK WITH CAN BEHAVIORAL
HEALTH PLAN. MAY NOT CREATE
STRONG ENOUGH GUARDRAILS TO
AVOID POTENTIAL DUPLICATION OF
SERVICES OR ENSURE THAT WE ARE
MAXIMIZING ARTICLE FEDERAL
REIMBURSEMENTS UNDER ECM. AND
COUNTY BEHAVIORAL HEALTH PLANS
ARE NOT EXPECTED TO CONTINUE
PAYING FOR SERVICES THAT CAN BE
COVERED UNDER MEDI CAL- WITH
OTHER FUNDING SOURCES INSTEAD
WE ARE ASKING DH THE S. TO
CONTINUE DEVELOP. STRONGER AND
MORE SPECIFIC GUIDANCE IN THIS
AREA TO CARILLO WHAT IS BEEN
PUT FORWARD FOR SOME OF OUR
OTHER. COUNTY BASED PARTNERS.
AND MEDICAL SERVICE TECHS. IN
CONCLUSION COUNTY BEHAVIORAL
HEALTH PLANS REALLY HOPE TO
PARTNER WITH MANAGED CARE PLANS
TO IMPLEMENT A HIGHLY
COORDINATED ENHANCED CARE
MANAGEMENT PROGRAM. THAT
SUPPLEMENTS ARE COUNTY
BEHAVIORAL HEALTH SERVICES AND
DOES NOT DUPLICATE OR REPLACE
THEM. WE ALSO BELIEVE THAT
STRONGER GUIDANCE IS NEEDED TO
ENSURE WE MAXIMISE
OPPORTUNITIES FOR FEDERAL
REIMBURSEMENT ACROSS OUR MEDIC
HEALTH DELIVERY SYSTEMS AND
INCLUDE OUR HIGHEST REST HERO
HEALTH CLIENTS. WE LOOK FORWARD
TO CONTINUED COLLABORATION WITH
THE DEPARTMENT AND MANAGED CARE
PLANS ON THE PROPOSED ECM
BENEFIT AND WE REALLY
APPRECIATE THE OPPORTUNITY TO
START ITS TOP. THANK YOU VERY
MUCH WITH THAT THAT CONCLUDES
THIS PANEL I WILL NOW- PAUSE
FOR MEMBERS QUESTIONS. MEMBERS.
DR WHAT IS FOR THEN I WILL ASK
THE QUESTION IF I CAN- ITSELF
THE DEPARTMENT TIGHT REALLY-
THE NUMBER OF PEOPLE COMMENT
ABOUT THE CONCERNS REGARDING
TRANSITION. AND WAS HOPING YOU
COULD COMMENT ABOUT WHAT THAT
TRANSITION HOW YOU COULD ALLAY
SOME OF THOSE FEARS. SO ONE OF
THE REQUIREMENTS THAT WE HAVE
WITHIN THE KALANK PROPOSAL FOR
THE TRANSITION OF WHOLE PERSON
CARE AND HELP HOMES. IS THAT
MANAGED CARE PLANS ARE
REQUIRED- TO CONTRACT WITH
WHOLE PERSON CARE AND HELP FROM
PROVIDERS- TO CONTINUE THE
SERVICES BOTH ENHANCE CARE
MANAGEMENT. AS WELL AS THE IN
LIEU OF SERVICES THAT ARE
OFFERED WITHIN CALLING RIGHT TO
CONTINUE AND THERE IS A VERY
SHORT LIST OF EXCEPTIONS- TO.
WIN THAT WOULD NOT HAPPEN
INCLUDING IF A I COUNTY OPT OUT
OF PROVIDING WHOLE PERSON CARE
SERVICES FOR EXAMPLE OR THE ECM
IN LIEU OF SERVICES- AND SO
THAT IS CURRENTLY AVAILABLE FOR
EXAMPLE ON THE INDIVIDUALS THAT
SPOKE EARLIER REGARDING THEIR
WHOLE PERSON CARE PILOT WE ARE
MANDATING WITHIN. THE PROPOSAL
ALREADY TODAY THAT THE MANAGED
CARE PLANS CONTRACTS WITH THOSE
ENTITIES TO CONTINUE THOSE-SERVICES- UNLESS THEY OTHERWISE
CANNOT REACH AGREEMENT UP FOR
THOSE SERVICES- AND SO THAT'S
HOW WE'RE HANDLING THE
TRANSITION OF THE WHOLE PERSON
CARE AND HELP HOMES PROGRAMS-
WITHIN THE PROPOSAL ITSELF. YOU
CAN USE TO THE TIMELINE- WE
HEARD FROM MEMORIES OF ALL OF.
THE DIRECTOR OF HEALTH HOMES
PROGRAMS FOR LA CARE. THAT IT
WAS AMBITIOUS AND WAS HOPING
THAT YOU COULD- COMMENT ON THAT.
SHARP SO- FOR ANYWHERE WHERE WE
HAVE A WHOLE PERSON CARE OR
HEALTH HOMES WE ARE PROPOSING
THAT THOSE COMPONENTS GO LIVE
JANUARY ONE TWENTY TWENTY TWO-
THAT IS A HARD DATE THAT WE
MUST KEEP. JUST TO BE CLEAR-
WITH THE ENDING OF OUR CURRENT
ELEVEN FIFTEEN WAIVER- IF WE
DID NOT ALLOW FOR THAT
TRANSITION WE WOULD HAVE A
CLIFF- IN IN FORTUNATE CLASS
FOUR ARE REALLY IMPORTANT
PUBLIC HOSPITAL SYSTEMS AS WELL
AS COUNTY PARTNERS. YOU PROVIDE
THOSE SERVICES TODAY THROUGH
THE ELEVEN FIFTEEN AND- THAT IS
SOMETHING THAT IS VERY
IMPORTANT THAT WE PROVIDE A
SUSTAINABLE PATHWAY OF FOR
THOSE SERVICES BOTH FOR THE
BENEFICIARIES RECEIVING THOSE
SERVICES. BUT ALSO FOR THE
COUNTIES IN PUBLIC HOSPITAL
SYSTEMS PROVIDING THOSE
CRITICAL SERVICES TODAY- AND SO
WE ARE REQUIRING ALL OF THOSE
TRANSITIONS HAPPEN JANUARY ONE
TWENTY TWO TWO. GIVEN THE
COMPLEXITY OF ENHANCE CARE
MANAGEMENT- WE WERE VERY OPEN
TO THE STAKEHOLDER FEEDBACK
THAT WE RECEIVED IN REGARDS TO
A PHASED IMPLEMENTATION THAT
ESSENTIALLY ALLOWS FOR. THE
OTHER NON WHOLE PERSON CARE
HEALTH HOME POPULATIONS TO COME
UP ON A TWO OTHER CRITICAL TIME
PERIODS SO I'M JULY ONE OF
TWENTY. TWO ON IN JANUARY ONE
OF TWENTY THREE- ARE THE OTHER
TWO DATES IN WHICH THEY CAN
BRING THEM UP MANAGED CARE
PLANS WOULD BE ABLE TO PROPOSED
TO US- WHICH TARGET POPULATIONS
THEY'RE BRINGING UP. ON THOSE
OTHER DATES ALLOWING THEM TO
WHERE THEY HAVE A CONTRACT OR
NEGOTIATIONS IN PLACE TO
PROVIDE THE SERVICES GO UP
SOONER WHERE THEY ARE
DEVELOPING- THAT THOSE NETWORKS
AND PARTNERSHIPS STILL UP TO
HAVE THE LATER DATES ABOUT IT
REALLY ALLOWS US TO KIND OF.
HEALER ASSEMBLY APPROACH THAT
WE DID BOTH HEALTH HOMES AND
WHOLE PERSON CARE AS WAS
MENTIONED OF INDIAN SUCCESSFUL
THROUGH. BOTH OF THOSE PROGRAMS.
HI I WILL- IN MY- QUESTION OR
COMMENTS THE NEW- BUT DO WANT
TO ASK WHAT PAUL WILL HEADS.
ABOUT THERE BEING A POTENTIAL
FOR SERVER SERVICE DUPLICATION.
SINCE I BROUGHT IT UP IN THE
FIRST PANEL I THOUGHT IT
IMPORTANT TO MENTION IT AGAIN
HERE IN THE SECOND PANEL. AND
IT REALLY WILL REQUIRE
COORDINATION AMONGST MANY OF
THE- ORGANIZATIONS WHO HAVE
BEEN ON THIS PANEL TO MAKE SURE
WE DON'T DUPLICATE THOSE
SERVICES. IT'S IT SEEMS TO ME
THAT THERE'S QUITE A BIT OF
OVERLAP BETWEEN. PATIENTS WHO
THE COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION WILL
SERVE AS WELL AS- THOSE WHO
WILL RECEIVE THE ECM. AND JUST
WANTS TO MAKE SURE THAT WE ARE
COMPLEMENTING AND NOT
DUPLICATING SERVICES. WITH THAT
WE WILL CONCLUDE THIS PANEL
WILL MOVE ON THE PANEL THREE.
THANK YOU VERY MUCH DOCTOR
REGULAR OUR THIRD PANEL WILL
LOOK AS A REQUIREMENT FOR
INCENTIVE PAYMENTS TO BE PAID
TO MEDICARE MANAGED CARE PLANS.
ARE WITNESSES ARE- J. C. COOPER
ONCE AGAIN- FROM THE DEPARTMENT
HEALTH CARE SIR FOR A
HEALTHCARE SERVICES. BEN
JOHNSON PRINCIPLE FISCAL AND
POLICY ANALYST FOR THE
LEGISLATIVE ANALYST'S OFFICE.
DR KAREN HANS BERGER- CHIEF
MEDICAL OFFICER FOR THE INLAND
EMPIRE HEALTH PLAN AND LINDA
WAY. FROM THE POLICY ADVOCATE
FROM WESTERN CENTER ON LAW AND
POVERTY SO. TO YOU MISS COOPER.
THANK YOU SO MUCH- SO WHAT I
WANT TO START WITH WHERE WE ARE
CURRENTLY PROVIDING- INCENTIVE
PAYMENTS TO OUR MANAGED CARE
PLANS- TODAY SO I'M CURRENTLY
ON THE DEPARTMENT OF ROLLED OUT
AN INCENTIVE PROGRAM THROUGH
PROP FIFTY SIX- THE BEHAVIORAL
HEALTH INTEGRATION INCENTIVE
PROGRAM- THAT IS CURRENTLY
FUNDED UNDER. THE SAME TYPE OF
FUNDING MECHANISM OF THE 5%
WITHIN A CAPITATION RATE THAT
WE ARE PROPOSING THE- TELLING
INCENTIVE PAYMENTS TO BE
PROVIDED. I'M ESSENTIALLY IT
PROVIDES INCENTIVE PAYMENTS TO
MANAGED CARE PLANS FOR
ACHIEVING- SPECIFIED MILESTONES
IN MEASURES- AND THEN WE PAY A
BASED ON THE OUTCOME OF
COMPLETING THOSE ON THOSE
INCENTIVES- AND SO THAT IS JUST
AN EXAMPLE- WHERE WE WHERE WE
PROVIDE THAT TODAY. UNDER THE
CALLIN PROPOSAL WHAT WE'RE
REALLY LOOKING TO DO IS
ESTABLISH- PLAN INCENTIVES THAT
WOULD REALLY DRIVE TOO MANY OF
THE THINGS THAT WE TALKED ABOUT
TODAY- THE DEPARTMENT THINGS
THAT IS REALLY CRITICAL
ESPECIALLY FOR AREAS THAT
CURRENTLY DON'T HAVE. A THESE
SERVICES IN LIEU OF AND ENHANCE
YOUR MANAGEMENT FOR THEM TO BE
STATEWIDE- BUT WE DO KNOW THAT
THERE'S GOING TO HAVE TO BE ON
SOME INVESTMENTS TO GET US
THERE ARE BECAUSE THAT IS ONE
OF THE FOUNDING PRINCIPLES OF
BEING PROVIDED WE ALSO WANT TO
MAKE SURE THAT THERE IS A
SUSTAINABLE- FUNDING SOURCE FOR
THOSE. SERVICES INCLUDING
FEDERAL FUNDS AT YOUR DRAW DOWN
AND NOT SUBJECT TO LOCAL
ALLOCATIONS ARE DOLLARS BEING
INVESTED INTO THEM- AND SO
REALLY WHAT WE'RE WANTING TO DO
IS INCENTIVIZE THAT BUILD ON
BOTH FOR ENHANCE CARE
MANAGEMENT MODELS ACROSS THE
STATE OF CALIFORNIA. AS WELL AS
THE IN LIEU OF- SERVICES
INFRASTRUCTURE SAID HE'S
INCENTIVE DOLLARS ARE REALLY
FOCUSED ON HOW DO WE GET THE
CAPACITY OF THE INFRASTRUCTURE
OF THE TRAINING THAT I TO OUT
TO INDIVIDUALS AS MENTIONED
EARLIER. ONE OF THE CORE
PRINCIPLES OF ENHANCE YOUR
MANAGEMENT IS THAT THAT ENTITY
IS RESPONSIBLE FOR ALL OF THE
CARE MANAGEMENT SERVICES- THAT
INCLUDES THE PHYSICAL HEALTH OF.
THE BEHAVIORAL HEALTH AS WELL
AS THE SO MITCHELL ASPECTS OF
THAT SERVICE. I'M IN THERE A
LOT OF TECHNICAL ASSISTANCE WE
NEED PROVIDE EVEN SO DOLLAR
WILL HELP WITH SOME OF THAT
TRAINING. BEST PRACTICES
ETCETERA. I WILL ALSO FOCUS ON-
PERFORMANCE IMPROVEMENTS- AND
QUALITY OUTCOMES WHERE WE CAN
SEE DRIVERS. INCENTIVIZE PLANS
TO INCREASE THE USE OF A LOT OF
SERVICES FOR EXAMPLE- ACROSS
THE STATE OF CALIFORNIA. AND WE
IMPORTANT TO DO TO EVENTUALLY
GET TO A PLACE WHERE WE COULD
POTENTIALLY OFFER SOME OF THESE
ADS MEDICARE BENEFITS VERSUS
JUST THE IN LIEU OF SERVICES
PATH. I'M SO CRITICAL COMPONENT
OF THESE DOLLARS- I WOULD ALSO
JUST ADD. IT BESIDES THAT THEY
CAN PAY FOR I'M VERY S. I. T.
WORKFORCE TRAINING AND OTHER
PIECES AND I'LL GO THROUGH A
LIST LATER IN REGARDS TO YOU
SOME OF THOSE PIECES. I WE DO
PLAN ON HAVING AND I'M
CONDUCTING ROBUST STAKEHOLDER
FEEDBACK I'M HOPING THAT- IN
EARLY SUMMER WILL HAVE
SOMETHING FOR PEOPLE TO REVIEW
AND PROVIDE FEEDBACK ON TO THE
DEPARTMENT. SO WE CAN GET THAT
INFORMATION OUT EARLY TO
MANAGED CARE PLANS AND
PROVIDERS ALSO THE UNDERSTAND
THE IN TYPES OF INCENTIVES THAT
WE WILL BE OFFERING THROUGH THE
CALENDAR POSTAL- WE DO PROPOSED
THAT- MILESTONES COULD BE MET
IN DOLLARS CAN FLOW AS SOON AS
JANUARY OF. ONE OF TWENTY
TWENTY TWO. I'M AND- BEING ABLE
TO TRIGGER THOSE INCENTIVE
PAYMENTS ARE REALLY IMPORTANT
ESPECIALLY IF YOU'RE TRYING TO
BUILD CAPACITY FOR EXAMPLE- AND
ENHANCE YOUR MANAGEMENT. THAT
IS OUR TARGET POPULATION AIMED
FOR MAYBE A JANUARY ONE OF
TWENTY THREE TIMELINE- SO WE DO
KNOW THAT WE WANT TO MAKE SURE
THAT INFRASTRUCTURE AND
OPPORTUNITIES AVAILABLE FOR OUR
PLAN INTERPRETERS WHO ARE
WANTING TO YOU- EXECUTE THAT-
SOME EXAMPLES. OF THINGS THAT
COULD BE INCLUDED- DO YOU
ATTRIBUTE THE PAYMENTS INCLUDE.
I WORKFORCE TRAINING TECHNICAL
ASSISTANCE OUR REGULAR DATA
SHARING BETWEEN COMMUNITY BASED
ORGANIZATIONS AND MAKING SURE
THAT THOSE BARRIERS THAT THEY
MAY HAVE ARE BEING REMOVED. SO
THAT THEY CAN BEAT PROVIDERS ON
IN THIS PROGRAM. AT GAP NEEDS
IS. SO BAD UNDER. AT THEIR IS-
ANY. OUT THERE WHO THESE
SERVICES. DOING THAT GAP
ANALYSIS ON THE GROUND TO
UNDERSTAND HOW WE CAN CLOSE
THOSE GAPS WITH ADDITIONAL
INCENTIVES- OR INFRASTRUCTURE
DOLLARS. AS WELL AS CAPACITY
BUILDING ON SUCCESSFULLY
IMPLEMENTING A TRANSITION PLANS
LIKE INCLUDING- AND ENSURING
THAT COUNTY BEHAVIORAL HEALTH
PROVIDERS ARE AT THE TABLE. TO
PROVIDE SOME OF THESE CRITICAL
SERVICES WHEN THEY'RE WILLING
TO ACCEPT THE REQUIREMENTS OF
THINGS LIKE ENHANCE CARE
MANAGEMENT AND WHAT COMES WITH
THAT OF COURSE- THE
DISSEMINATION OF BEST
PRACTICES. AS WELL AS MEETING
VARIOUS OF PERFORMANCE
MEASURES- AND YOU KNOW ACROSS
ACCESS QUALITY OUTCOMES. AS
WELL AS EQUITY- SOMETHING THAT
WILL BE VERY FOCUSED ON IN SOME
OF OUR PERFORMANCE INCENTIVE
DOLLARS THAT WILL BE COMING OUT.
I'M SO I THINK HOSE ARE JUST
SOME EXAMPLES OF THINGS THAT WE
ARE CONSIDERING- AND LOOK
FORWARD TO ENGAGING PEOPLE IN
THE FUTURE IN REGARDS TO THOSE
INCENTIVES. I THINK A BROAD
LEVY INCENTIVES WILL BE PAID-
ON THE MANAGED CARE PLANS BASED
ON THE MILESTONES AS I
MENTIONED EARLIER IN JUST
FLAGGING FOR PEOPLE UNDER
FEDERAL REGULATIONS WE ARE
REQUIRED THAT WE CANNOT GO. YOU
KNOW YOU SEE THAT 5% OF THEIR
CAPITATION PAYMENTS SO WE WILL
BE CLOSELY MONITORING THAT.
THROUGH THIS PROCESS AS WELL.
AND THEN ON THE LAST QUESTION I
REQUESTED FOR THE DEPARTMENT TO
ENSURE WE ADDRESS AROUND SHARED
SAVINGS NO FEDERAL REGULATIONS
DOES REQUIRE THE DEPARTMENT TO
TAKE INTO ACCOUNT BOTH THE
UTILIZATION AND ACTUAL COST OF.
IN LIEU OF SERVICES WHEN
DEVELOPING CAPITATION RATES-
AND THE MANAGED CARE PLANS
ALREADY HAVE AN INHERENT
FINANCIAL INCENTIVE- TO PROVIDE
AUTHORIZED IN LIEU OF SERVICES
VERSUS THE MORE COSTLY STATE
PLAN SERVICES. REGARDLESS OF
THAT RATE METHODOLOGY THAT'S
OUTLINED THAT'S ONE OF THE
INHERENT REASONS WHY WE REALLY
HOPE AND ENCOURAGE ALL OF OUR
MANAGED CARE PLANS. I'M TO
IMPLEMENT THE IN LIEU OF
SERVICES BECAUSE BY NATURE OF
THEM BEING APPROVED THEY ARE
LESS COSTLY THAN STATE PLAN
SERVICES THAT ARE OTHERWISE. A
POTENTIALLY BEING UTILIZED BY
THAT BENEFICIARY. HOWEVER IN
ORDER TO ENCOURAGE MANAGED CARE
PLANS TO FULLY ENGAGE IN THE
GOAL OF DEVELOPING A BOTH LONG
TERM SERVICES AND SUPPORTS
AROUND A LOT OF THOSE HOME
COMMUNITY BASED SERVICES. I
MENTIONED EARLIER AS WELL AS
THE CLINICALLY LINKED- HOUSING
CONTINUUM INFRASTRUCTURE OF THE
DEPARTMENT DID PROPOSED TO
IMPLEMENT A SHARED SAVINGS RISK
MODEL THAT WOULD BEGIN IN
CALENDAR YEAR TWENTY TWENTY
THREE- AND THE SHARED SAVES
RISK MODELING IS BROADER THAN
JUST A LOVE SERVICES WE'RE
REALLY. TRYING TO INCENTIVIZE
THE INVESTMENT IN THOSE TYPES
OF THINGS CARE COORDINATION IN
LIEU OF SERVICES- THAT YOU KNOW
REALLY LOOKING AT HOW YOU CAN
REDUCE THE OVERALL COST. BUT
REALLY IMPROVING THE
BENEFICIARIES HEALTH OUTCOMES
AND THEN MEASURING IT- SO
THAT'S WHERE WE WILL FOCUS THAT
A FURTHER DETAIL ARE STILL. THE
AND RICK TO THAT. A SAVINGS
RISK MY- BUT LOOK FORWARD TO IN.
THE OUT WITH WITH. INDIVIDUALS
AS THOSE DETAILS COME AVAILABLE
AND THAT CONCLUDES MY COMMENTS
AT THIS TIME. THANK YOU VERY
MUCH- ONE BEN JOHNSON. GOOD
AFTERNOON MISTER CHAIR AND-
WELL BOTH CHAIRS UP AND JOHNSON
WITH THE LEGISLATIVE ANALYST'S
OFFICE- TO THE ADMINISTRATION
PROPOSES OUT ULTIMATELY OVER
TWO POINT FIVE YEARS SEVEN
HUNDRED AND FIFTY MILLION
DOLLARS GENERAL FUND ONE POINT
FIVE BILLION DOLLARS TOTAL
FUNDS- FOR THE INCENTIVE
PAYMENTS FOR MANAGED CARE PLANS
TO BUILD INFRASTRUCTURE THAT
DIRECTOR COOPER- JUST DESCRIBED
LARGELY AROUND ENHANCE CARE
MANAGEMENT IN AN LIVE SERVICES.
WE RECOGNIZE THAT THESE
PAYMENTS OUT MAY BE NECESSARY
FOR ONE SUSTAINING THE EXISTING
SERVICE LEVELS- THROUGH
PROGRAMS THAT CALTRAIN WOULD
BUILD UPON A REPLACE THAT SELL
EXISTING IN THIS SERVICE LEVELS
THAT ARE PROVIDED THROUGH
HEALTH HOMES AND WHOLE PERSON
CARE THAT WOULD BILL SUNSET-
NEXT YEAR AS CAL AIMED.
IMPLEMENTS AND IN ADDITION WE
UNDERSTAND THAT THIS IS AN
IMPORTANT CENTER FUNDING AS
WELL FOR MANAGED CARE PLANS TO
REALLY BUILD OUT THE FULL SET
OF EYELASH SERVICES- THAT THIS
THAT THE STATE- POTENTIALLY
HOPES FOR THEM TO PROVIDE UNDER
CALLING. WHATEVER WE DO HAVE
CONCERNS AROUND THE LACK OF
DETAIL- WITH THIS PROPOSAL- TO
DATE THE ADMINISTRATION HAS HAS
NOT PROVIDED A COMPREHENSIVE
LIST OF WHAT PLAN ACTIVITIES
WOULD TRIGGER A PAYMENT DETAIL
ON HOW MUCH FUNDING WOULD. BE
PROVIDED FOR EACH ACTIVITY OR
HOW THE PROGRAM RULES WOULDN'T
SCHERER WHERE APPROPRIATE THAT
THAT CASE MANAGEMENT SUPPORTIVE
SERVICES INFRASTRUCTURE CREATED
UNDER WHOLE PERSON CARE AND
HEALTH HOMES ARE SUBSTANDARD-
AND AS DIRECTOR COOPER NOTED-
THEY DO PLAN TO RELEASE- SORT
OF A BROAD DETAIL ON THIS
PROPOSAL BUT IT SOUNDS LIKE
THEIR INTENTION IS FOR THAT NOT
TO COME OUT UNTIL THE EARLY
SUMMER AND THIS MAY NOT GIVE
THE LEGISLATOR ADEQUATE TIME TO
SCRUTINIZE THE DETAILS OF THE
PROPOSAL PRIOR TO DECIDING. ON
WHETHER OR NOT TO APPROVE THE
FUNDING. R. N. ADDITION DO
QUITE WHETHER THE MULTI YEAR
FUNDING RELATED TO INCENTIVE
PAYMENTS. IS REALISTIC THE
GOVERNOR'S AS I SAID PREVIOUSLY
THE GOVERNOR'S FUNDING PLAN-
WOULD HAVE THE FUNDING SUNSET
AFTER TWO POINT FIVE YEARS- BUT
WE FIND THIS QUESTIONABLE FOR
THE FOR THE FOLLOWING REASONS
FIRST IT'S THAT MEDICARE
MANAGED CARE PLANS. ARE FUNDED
BASED. ON THEIR PRIOR COST
EXPERIENCE AND SO THE ANSWER
FUND IS ALL TO. YOU ON. AND FOR
EXAMPLE I LOW WESTERN. WHOSE
COSTS ARE. THEN MEDICARE
MANAGED CARE PLAN. LIKE WOULD
INCREASE **** TO COVER THE HIGH
RIPPLE CALL. THIS IS NOT A- FOR
IN THE- MULTI YEAR FUNDING PLAN
UNDER CALLAN. ALTERNATIVELY
EVEN IF THE FUNDING DOES NOT
END UP COVERING SUCH
REIMBURSABLE COSTS THERE COULD
BE PRESSURE TO RE AUTHORIZE
THIS FUNDING TO SUSTAIN THE
SERVICES BUT THE INCENTIVE
PAYMENTS WOULD SUPPORT. WELL
THE ADMINISTRATION ASSUMES THAT
SAVINGS FROM IMPROVED COST
EFFECTIVENESS OF- THE SERVICES
PROVIDED TO BENEFICIARIES UNDER
CALLIN COULD SUSTAIN THE
INFRASTRUCTURE- FOR PROVIDING
ECM ARE INTENSE CARE MANAGEMENT
AND LOW SERVICES. WE QUESTION
WHETHER THIS ASSUMPTION IS
REALISTIC PARTICULARLY IN THE
SHORT TERM AS SUCH SAVINGS
COULD TAKE MANY YEARS TO
MATERIALIZE. SO IN SOME WE DO
HAVE- QUESTIONS RELATED TO THE
LACK OF DETAIL ON THIS PROPOSAL
AND ABOUT THE MULTI YEAR
FUNDING PLAN- RELATED THERE TOO
WE ALSO- HAVE OUTSTANDING
QUESTIONS THAT WE RAISED IN A
PREVIOUS ANALYSIS RELATED TO-
THE LACK OF DETAIL ON THE
SHARED RISK SHARE SAVINGS
COMPONENTS. BUT REALLY JUST
THEM I WOULD BE LOOKING FOR
MORE DETAIL BEFORE WE CAN
ADVISE THE LEGISLATURE WHETHER
OR NOT TO APPROVE THAT
COMPONENT. OF THE CALLIN
PROPOSAL THANK YOU. THANK THANK
YOU VERY MUCH- DR HANS BERGER.
A GOOD AFTERNOON ON MY H. P.
APPRECIATE THE DEPARTMENT
ACKNOWLEDGEMENT THAT AN
INCENTIVE PROGRAM IS NEEDED TO
INCENTIVIZE FOUNDATIONAL
INVESTMENTS NEEDED UP FRONT TO
SUPPORT THE HIRING AND THE
BUILDING OUT AS NEEDED CLINICAL
AND TECHNICAL SUPPORT. AS
ILLUSTRATED BY MY EARLIER
COMMENTS A LOT OF TIME AND
RESOURCES WILL BE REQUIRED TO
DEVELOP AND EXPAND THE
INFRASTRUCTURE. GIVEN THE
INCENTIVE PAPER PROGRAM IS TIME
LIMITED AND CONSIDERING THE
EXTENSIVE WORK NEEDED TO BUILD
A FOUNDATION FOR A SUCCESSFUL
LAUNCH AND SUSTAINMENT FOR BILO
S. PROPOSAL. I H. P. SUPPORT
AND INCENTIVE PROGRAM THAT WILL
ALLOW US THE FLEXIBILITY TO
BUILD THE CAPACITY OF PROVIDER
NETWORKS DEVELOP NEEDED
INFRASTRUCTURE AND INVEST IN
DATA SHARING. MAKING SURE THAT
WE ARE SETTING UP THE PROGRAM
FOR THE GREATER POSSIBILITY OF
SIX THAT. WE BELIEVE THE
INCENTIVE PROGRAM SHOULD BOTH
MAINTAIN AND EXPAND EXISTING
INFRASTRUCTURE DEVELOPING
INFRASTRUCTURE WHERE IT DOES
NOT CURRENTLY EXIST. THIS
TYPICALLY. FIRST INCENTIVE
PAYMENT FUNDING SHOULD BE
AVAILABLE FOR THE INITIAL
INVESTMENT TO INCLUDE PLANNING
DEVELOPMENT AND IMPLEMENTING OF
IOWA SERVICES IN MANY CASES THE
FUNDING WOULD BE FOR START UP
COSTS ARE NEEDED FOR SERVICES
THAT COULD BE PROVIDED FOR
EXAMPLE IN THE INLAND EMPIRE WE
DO NOT HAVE ONE SO BRING CENTER
SO THAT WOULD BE A VERY HEAVY
LEFT FOR US TO BE ABLE TO PUT
THAT INFRASTRUCTURE IN. YOUR
GEOGRAPHIC AREA. DEFINITELY
INCENTIVE FUNDING SHOULD ALSO
BE AVAILABLE TO MAINTAIN AND
EXPAND VIOLENCE SERVICES
INCLUDING THOSE PROVIDED BY A
WHOLE PERSON CARE PILOTS. AND
THOSE PROVIDED BY I. H. P.
TODAY. IN THESE AND MANY CASES
THESE SERVICES ARE OFFERED ON A
LIMITED BASIS AND REQUIRE
FUNDING IN ORDER TO EXPAND TO
ADDITIONAL GEOGRAPHIES AND
EXPANDED MEMBER ELIGIBILITY.
LASTLY INCENTIVE PAYMENTS IN
THE EARLY YEARS WE WOULD
ENCOURAGE TO BE FOCUSED ON
PROCESS ACTIVITIES WHILE THE
CAPACITY OF BEING BUILT BUT THE
OUTCOME BASED PERFORMANCE
MESSAGES AFTER. ONE THIRD COULD
PROPERTY AND INFRASTRUCTURE IN
PLACE. FOR EXAMPLE THIS COULD
BE DONE BY LOOKING AT THE END.
THE NUMBER HAS RECRUITED
CALRISSIAN OR NUMBER OF MEALS
SERVED HOUSING PLACEMENTS THAT
ARE FOR THE FOUNDATIONAL
SUPPORT OF FINDING. LATER TO BE
THEN CHANGED OVER TO. A
REDUCTION OF COSTS AND HEALTH
OUTCOMES IN THESE NUMBERS
BETWEEN YOU KNOW THAT YOU
SERVICES TAKE TIME TO BE ABLE
TO AND A RETURN ON INVESTMENT.
AS BRIEFLY MENTIONED IN MY
EARLIER COMMENTS IN ORDER TO
MEET THE JULY TWENTY TWENTY ONE
SUBMISSION DEADLINE FOR OUR
YEAH ECM LOS MODEL A CARE PLAN
DOCUMENT. IT IS CRITICAL THAT
THE PLAN UNDERSTANDS WHAT THE
INCENTIVE PROGRAM STRUCTURE
WILL BE. WE NEED THIS FOR
SEVERAL REASONS INCLUDING TO
GET THE PLAN THE OPPORTUNITY TO
PROPERLY NEGOTIATE CONTRACTS
WITH PROVIDERS. AND ACCURATELY
PROVIDE THE DETAILS NEEDED TO
BE SOLIDLY READY FOR A JANUARY
FIRST TWENTY TWENTY TO GO LIVE.
THANK YOU FOR YOUR TIME AND I
WELCOME ANY QUESTIONS ON THE
PANEL. THANK YOU- MOVING ON NOW
TO LINDA AWAY. FROM WESTERN
CENTER ON LAW AND POVERTY. GOOD
AFTERNOON AGAIN LINDA WAY THAT
WESTERN CENTER ON LAW AND
POVERTY FOR THE DEPARTMENT
ASKED PLAN TO TAKE ON NEW
RESPONSIBILITIES THE STATE MUST
ENSURE PLANS ARE HELD
ACCOUNTABLE FOR MINIMUM
PERFORMANCE STANDARDS NETWORK
ADEQUACY TIMELY ACCESS LANGUAGE
ACTORS AND POLITICAL
INSTABILITY. THE TIMING OF
CALLINAN THE RECURRENT SCHEDULE
ALIGN WELL TO ENSURE PLAN ARE
YOU ABLE TO MEET THESE BASIC
STANDARDS AS A CONDITION OF
CONTRACTOR KNOW. INSTEAD OF THE
MUCH BETTER HEALTH EQUITY AND
FOCUS ON ELIMINATING HEALTH
DISPARITIES AS WELL AS
IMPROVING QUALITY IT IS UNCLEAR
HOW THIS FITS INTO THE STATE'S
CURRENT MANAGED CARE PLAN
QUALITY STRATEGY THE REQUESTED
DEPARTMENT ALIGN ITS QUALITY
AND HEALTH EQUITY EFFORT ACROSS
THE DIFFERENT INITIATIVES. AS
PREVIOUSLY MENTIONED WE HAVE
CONCERNS THAT PLANS WILL RESORT
TO KNOW YOUR PRACTICES AND
CONTRACT WITH MEDI CAL
PROVIDERS AND CLINICS THAT THEY
HAVE AN EXISTING RELATIONSHIP
WITH. THE RECOMMENDED
INCENTIVES BE FOCUSED ON
DEVELOPING PARTNERSHIPS THE
CIVICALLY WITH SOCIAL SERVICE
ORGANIZATIONS THAT HAVE
SUCCESSFULLY OFFERED IN HAND
CARE MANAGEMENT AND INFLUENCER
HI STARTED TO TARGET
POPULATION. THIS CAN INCLUDE
TECHNICAL ASSISTANCE FOR SOCIAL
SERVICE ORGANIZATIONS TO BUILD
THEIR OWN DATA SYSTEM CONTRACT
WITH PLANTS RECEIVE REFERRAL
INFORMATION. FOR MORE
INTEGRATED CARE. THE DEPARTMENT
SHOULD EXPAND ITS FOR.
FINANCIAL INCENTIVE PROGRAMS.
IN AFTER MANAGER AND WITH AT
THEIR AND IT TO EXPECT INTO. OF
THE NEW POPULAR HEALTH
MANAGEMENT INITIATIVE AND
QUALITY PERFORMANCE THRESHOLDS
MORE GENERALLY WHICH WILL
BENEFIT THE ENTIRE MEDICARE
POPULATION. INCENTIVE PAYMENT
SHOULD BE BASED ON IMPROVED
HEALTH OUTCOMES AND HOW MANY
BENEFICIARIES ARE ACTUALLY
CLEAN FOR AND RECEIVING NEEDED
SERVICES. RATHER THAN DRIVEN BY
REDUCED COST AND UTILIZATION.
IT SHOULD ONLY BE PREPARED AND
ABLE TO DRIVE BEHAVIOR. I'M NOT
BE PROVIDED FOR ACTION PLAN
SHOULD ALREADY BE DOING TO
ENSURE THAT THE DEPARTMENT
ACCOMPLISHES GO IT SHOULD
ARTICULATE SPECIFIC MEASURABLE
TARGETS THANKS OR CALLING AND
PLANS WILL BE EXPECTED TO CHEAT
AND REPORT ON THE PROGRESS AT
LEAST. THANK YOU. THANK YOU
VERY MUCH I'M GOING TO
QUESTIONS FROM THE COMMITTEE.
THIS. AFTER REGULAR. THANK YOU
DOCTOR WOULD- I'M GONNA START
TO GET MY QUESTIONS ARE FOR
YOU- MISS COOPER- I'M GONNA
START WITH WHERE BEN JOHNSON.
pDETAIL I WAS- INTRIGUED BY THE
MILESTONES REFERENCED IN THE
AGENDA TODAY AND YOU PROVIDED
SOME DETAILS- REGARDING THOSE
MILESTONES IN THE IN TERMS OF
WORK FORCE TRAINING GAP
ANALYSIS AND CAPACITY BUILDING
BUT WAS HOPING YOU COULD EXPAND
ABOUT WHAT SPECIFICALLY THAT
COULD MEAN FOR COUNTIES AND
CALIFORNIANS. BURKE LET ME GIVE
A FEW MORE EXAMPLES- IF THAT'S
HELPFUL YOUR- OKAY GREAT SORRY-
SO I THINK- THERE'S A NUMBER OF
THINGS FOR EXAMPLE AS WAS
MENTIONED BY ONE OF THE
PREVIOUS SPEAKERS I'M SOME OF
THAT COULD GO TO DIRECT
CAPACITY BUILDING FOR. EXAMPLE
RECUPERATIVE CARE BEDS BY
INCREASING ACCESS TO FIFTEEN
NEW RECRUITMENT OF CARE BEDS
THERE COULD BE AN INCENTIVE
PAYMENTS SO THE IDEA BEHIND
INCENTIVES BUT WE WERE
BUILDING- IS THAT YOU ACTUALLY
HAVE TO HAVE IMPLEMENTED IN A
CHEAP IT TO GET THE DOLLARS- IN
REALLY DRIVING AROUND BUILDING
THAT CAPACITY FOR ENHANCE CARE
MANAGEMENT IN LIEU OF SERVICES
FROM AN INFRASTRUCTURE POINT OF
VIEW. SO THAT'S ONE EXAMPLE
ANOTHER ONE WOULD BE PROMOTING
BEST PRACTICES AND EXPERTISE
FOR ENHANCED YOUR MANAGEMENT-
LOW OF SERVICES PROVDERS SO
MANAGED CARE PLANS THAT
IMPLEMENTED- THE ROBUST
COMMUNITY ENGAGEMENT EFFORTS
WHERE THEY ARE PROVIDING A
ROUTE- YOU KNOW A AROUND OF
TECHNICAL ASSISTANCE- CARE-
KIND OF CORD NATION PIECES AND-
BEST PRACTICES OF FOR ENHANCE
CARE MANAGEMENT AS WELL AS-
PROVIDING TRAINING FOR THOSE
BENEFICIARIES POTENTIALLY WOULD
BE- ONE FOR PAYMENT-
ENCOURAGING. EACH MEANT WITH
PROVIDER SO ACTUALLY ADDS JUST
MENTIONED BY- MS WAY OF LOOKING
AT HOW WE CAN IN INCENTIVIZE
CERTAIN PROVIDERS TO BE OFF THE
TABLE ARE PARTICIPATING
INCLUDING A PUBLIC HOSPITAL
SYSTEMS COUNTY BEHAVIORAL
HEALTH PROVIDERS COMMUNITY
BASED ORGANIZATIONS YOU HAVE. A
LOT OF EXPERIENCE IN THIS
SPACE- AND MAKING SURE THAT
THEY ARE CONNECTING WITH THOSE-
EXPERTISE OF PROVIDERS DO YOU
TO DO THESE SERVICES I THINK
ANOTHER ONE WE ARE LOOKING AT
IS ENCOURAGING DATA REPORTING
AND THE COLLECTION OF THAT AS
WELL AS SOME OF THE
INFRASTRUCTURE NEEDS THAT WOULD
NEED TO BE PUT IN PLACE. OF FOR
THAT WORKFORCE DEVELOPMENT AS
MENTIONED EARLIER- AS WELL AS-
AND A VARIETY OF KIND OF
OUTCOME BASED. MEASURES AND BY
THAT I NEED WE ARE LOOKING AT
BACK WITH MEASURE THAT WE CAN
SEE. AS WELL AS JUST ACTS
MEASURE. SO- INCREASES TO U. N.
CARE. SERVICES TIME- WELL AS
LIEU OF. WE'RE ALSO LOOKING AT
SPECIFIC THINGS WERE WE KNOW
CERTAIN INTO- FOR EXAMPLE.
INDIVIDUALS OF BLACK AND-
AMERICAN BENEFITS. ARE AND
HIGHER NO OF HOW IN THE AND-
CERTAIN MY OF. A TO REDUCE SOME
OF THOSE EQUITY GAPS WOULD BE A
CRITICAL OF PEACE AS WE'RE
BUILDING OUT THE ENHANCE CARE
MANAGEMENT- RE ENTRY FROM THE
JAIL POPULATION. THERE'S GOING
TO BE- INFRASTRUCTURE AND
CAPACITY CHALLENGES THEY'RE
FINDING THE RIGHT WORKFORCE IN
TRAINING THAT WORK FORCE TO DO
THOSE. THINGS WHILE ON IN
PARTNERSHIP WITH OUR COUNTY
COLLEAGUES- INCENTIVE DOLLARS
THERE SO I THINK WE ARE REALLY
FOCUSED ON- ACCENT. STRUCTURE
CAPACITY AS WELL AS THOSE
OUTCOMES IT'S GOT TO BE A
BALANCE OF- SOME OF THE METRICS
THAT WE CAN LOOK AT BUT AS WELL
AS GETTING DOLLARS OUT THE DOOR
TO. INCENTIVIZE MANAGED CARE
PLANS TO CLOSE GAPS WHERE WE
DON'T HAVE IN LIEU OF SERVICES
TODAY- BUILDING THAT AND WHERE
WE ONLY HAVE CAPACITY FOR A
CERTAIN NUMBER OF PEOPLE GROW
IN THAT CAPACITY TO MEET THAT
NEED. AT THAT GIVEN COUNTY.
THANK YOU FOR THAT THE ONE I
DIDN'T HEAR THAT AND- I'VE
ALWAYS BEEN INTERESTED IN IS
REGARDING WORKFORCE TRAINING
AND HOW WE MAKE SURE THAT IT.
REFLECTS THE DIVERSITY OF OUR
STATE. AND AS WE'RE TALKING
ABOUT CLOSING THE GAP I WAS
HOPING YOU COULD TALK ABOUT
WHETHER THESE INCENTIVE
PAYMENTS COULD HELP US TO
ADDRESS THAT ISSUE. SURE SO-
WORKFORCE AND TRAINING CAN
DEFINITELY BE A PART OF THESE
INCENTIVE DOLLARS- ESPECIALLY
BECAUSE A LOT OF THE WORK THAT
WE'RE TALKING ABOUT FOR BOTH
ENHANCE CARE MANAGEMENT AND-
LUKE SERVICES IS BOTH A
COMBINATION OF CLINICAL BUT
REALLY NON CLINICAL. A SERVICES
WHERE I WE REALLY COULD
INCREASE THE WORKFORCE IN THIS
SPACE REALLY ENGAGE WITH PEOPLE
ON TO PROVIDE THESE SERVICES
I'M WHETHER THAT'S COMMUNITY
HEALTH WORKERS AS WAS MENTIONED
PREVIOUSLY- BY ONE OF OUR AS
SPEAKERS- BUT REALLY GROWING
THAT SO YES IT'S DEFINITELY
SOMETHING THAT WE CAN- MAKE
SURE IS INCLUDED IT'S SOMETHING
THAT'S BEEN ON OUR LIST- AND
FIGURING OUT HOW WE GET THAT
WORKFORCE TRAINED AND READY TO.
RIDE THIS WORK WE KNOW IT'S ONE
OF THE BIGGEST OPPORTUNITIES OR
AREAS WE NEED TO FOCUS ON WITH
THESE INCENTIVE DOLLARS.
BECAUSE OF THE NON CLINICAL IF
THAT'S NEEDED AND JUST GIVEN
THE WORKFORCE PRESSURES ACROSS
THE ENTIRE STATE OF TODAY AND
HEALTH CARE. I THOUGHT IT WAS-
PROPRIA ONE WINDOW WAVE UP
NETWORK ATTIC. AND SINCE.
PAYMENTS FOR US TO MAKE SURE
THAT THE MANAGED CARE PLANS ARE
MEETING THOSE REQUIREMENTS. AND
HOPEFULLY IF- THOSE INCENTIVE
PAYMENTS ARE NEEDED FOR US TO
WORK ON WORKFORCE TRAINING. I
THINK MY CONCERN WOULD BE THAT
THERE LIMITED TIME IN NATURE
AND THE NEEDS FOR OUR STATE OUR
GREAT. MY COLLEAGUE AND CO
CHAIR WAS ON A TASK FORCE THAT
LOOKED AT EACH FOR WORKFORCE
AND IDENTIFIED THREE BILLION
DOLLARS OVER THE NEXT. TEN
YEARS AND- REALLY. DO HOPE THAT
WE'VE LEARNED A LESSON FROM
THIS PANDEMIC THAT YOU CAN'T
MAKE DOCTORS AND NURSES
OVERNIGHT. THAT WE HAVE
SHORTAGES IN REGIONS OF OUR
STATE AND THAT THESE
INVESTMENTS. ARE NOT JUST.
IMPORTANT THEY'RE ABSOLUTELY
NECESSARY FOR US. THANK YOU
VERY MUCH- WELL WELL THANK YOU
VERY MUCH I WILL GO AHEAD AND
MOVE ON TO WITH THAT WILL MOVE
ON TO OUR NEXT PANEL. WE WILL
NOW MOVE ON TO MANAGED CARE
MEDICARE MANAED CARE PLANS TO
HAVE A POPULATION HEALTH
MANAGEMENT PROGRAM. WE WILL
HAVE. FIVE PRESENTERS WILL
BEGIN WITH MISS COOPER. ALL
RIGHT. I'M ALSO IN THE CALIPERS
OF THE DEPARTMENT IS
RECOMMENDING TO REQUIRE ALL
MEDICARE MANAGED CARE PLANS TO
DEVELOP IN NINETEEN EIGHTY OR
CALLING A WHOLE SYSTEM PERSONS
AND OUR POPULATION HEALTH
MANAGEMENT STRATEGY- WHICH IS
REALLY A COHESIVE PLAN OF
ACTION FOR ADDRESSING MEMBERS
NEEDS ACROSS THE CONTINUUM OF
CARE BASED ON DATA DRIVEN
INFRASTRUCTURE CATION
PREDICTIVE ANALYTICS AS WELL AS
STANDARDIZED ASSESSMENT-
PROCESS THESE. EACH MANAGED
CARE PLAN- WOULD BE RESPONSIBLE
TO PROVIDE AT A MINIMUM- A
DESCRIPTION OF HOW THEY ARE I'M
DOING THE FOLLOWING UP FOR
ITEMS KEEPING ALL MEMBERS
HEALTHY BY FOCUSING ON
PREVENTIVE SERVICES AND
WELLNESS SERVICES CLOSING
THOSE. GAPS FOR EXAMPLE A
CRITICAL PIECE- THAT WE KNOW
THAT NEEDS TO BE AT THE
FOREFRONT OF WHAT THEY'RE DOING
IDENTIFYING AND SAYS A
NECESSITY MEMBER RISK AND NEED
ON AN ONGOING BASIS SO FOR
EXAMPLE THE AND- IT IT CAN'T
CARE MANAGEMENT SERVICES IN
LIEU OF SERVICES OUTLINED
PREVIOUSLY IN THIS HEARING
INSURING THAT THERE ARE PROCESS
SEES BRIGHT JANET BUYING
MEMBERS WHO WOULD NEED THOSE
TYPES OF SERVICES AS WELL AS
OTHER RISKS AND NEEDS WERE
GROWING NEED OF A POPULATION.
OF THE NEXT ITEM IS A MANAGING
MEMBER SAFETY AND OUTCOMES
DURING TRANSITIONS ACROSS
DELIVERY SYSTEMS- AND SETTINGS-
AS WELL THROUGH THE EFFECTIVE
CARE COORDINATION SO ONE OF THE
PIECES IN OUR PROCUREMENT FOR
EXAMPLE THAT YOU'LL BE SEEING
COMING UP YEARLY INCREASING OUR
MANAGEMENT COMPLEX CASE
MANAGEMENT AND THOSE
COORDINATION PIECES AND REALLY
WILL BE OE OF THE BACKBONES OF
THE POPULATION HEALTH
MANAGEMENT PROPOSAL A VERY
CRITICAL AS SOMEONE IS BEING
DISCHARGED FROM INPATIENT STAY
OR RECENT YOUR VISIT OR SKILLED
NURSING FACILITY STATE THOSE
TRANSITION SHOULD BE SMOOTH.
WHEN INDIVIDUALS ARE ACCESSING
MULTIPLE MEDICAL DELIVERY
SYSTEMS YOU KNOW INTEGRATION
BETWEEN SPECIALTY MENTAL HEALTH
AND PHYSICAL. HEALTH AS
MENTIONED EARLIER REALLY QUITE
A CALL AND MAKE CONSERVE WORK.
AND EXPECT. OF OUR FOR THOSE
TYPES OF TRANSITIONS WILL BE AN
IMPORTANT PART OF POPULATION
HEALTH MANAGEMENT. AND THEN
LAST BUT DEFINITELY NOT LEAST
IDENTIFYING AND MITIGATING
SOCIAL DETERMINANTS OF HEALTH
AND REDUCING DISPARITIES AND
INEQUITIES ANOTHER KEY
COMPONENT OF THE POPULATION
HEALTH MANAGEMENT PLANS. SO
EACH MANAGED CARE PLAN WILL
WORK TO IMPLEMENT- BOTH HEALTH
INFORMATION TECHNOLOGY TO
SUPPORT THE POPULATION HEALTH
PRINCIPLES. INTEGRATE CARE AND
TO DEVELOP THOSE
IDENTIFICATIONS OF WHERE CARE
COORDINATION IS NEEDED ACROSS
THE DELIVERY SYSTEM. PLANS WILL
BE REQUIRED TO PERFORM A
POPULATION HEALTH NEEDS
ASSESSMENT- BUT THEY WILL BE
REQUIRED TO PARTNER UP WITH OUR
PUBLIC HEALTH COLLEAGUES ARE
THERE PUBLIC HEALTH COLLEAGUES
LOCALLY. IN IN REGARDS TO THE
BUILDING OF THAT POPULATION
NEEDS ASSESSMENT- IN ORDER TO
CONNECT MEMBERS TO THE
APPROPRIATE PROGRAMS AND
SERVICES THE MANAGED CARE PLANS
BUT THEN. I'M RESTRICTED BY
THEIR MEMBERS INTO GROUPS OF
PEOPLE WITH SIMILAR HEALTH
NEEDS ARE BASED ON AN ALGORITHM
PROVIDED BY DH CS AND GROUP OF
STAKEHOLDER CONSULTATION. WILL
BE A REQUIREMENT WITHIN THE
PROPOSAL AND THE PLANTS WILL
THEN- YOU KNOW THROUGH THAT
RESTRAINS CATION ALGORITHM THEY
WOULD USE INTEGRATED DATA SO
FOR EXAMPLE WE'RE REQUIRING. OF
CLAIMS DATA PHARMACY DATA
REFERRAL- PRIOR SCREENING AND
ASSESSMENT RESULTS ALL BE
INCORPORATED INTO THAT RICH
STRATIFICATION. AND THE
DEPARTMENT IS CURRENTLY WORKING
ON HOW WE CAN ENHANCE AND
IMPROVE THE DATA FEEDS THAT WE
PROVIDE MANAGED CARE PLANS
TODAY. FOR EXAMPLE WE PROVIDE
OUR PLANS ALL FEE FOR SERVICE-
BENEFICIARY INFORMATION SO
THEY'RE AWARE OF THE OTHER
SERVICES BENEFICIARIES ARE
RECEIVING OUTSIDE OF THE
MANAGED CARE PLAN. WILL BE A
REQUIREMENT THAT THEY INCLUDE
THAT IN THEIR ASSESSMENT OF
SERVICES ARE. IN WE DO KNOW
THAT WE'VE GOT SOME FEEDBACK
FROM PLANS IN REGARDS TO MAKING
THAT FILE A USER FRIENDLY AND
WE ARE WORKING ON THOSE ITEMS.
SO BASED. ON THEIR ALGORITHMS
MANAGED CARE PLANS WILL BE READ
PRIOR TO YOU- USE EIGHTEEN THE
S. RISK HERE. ARE DESIGNED MAN
INTO OF. RISK YEARS WHOA MEDIUM
FIVE RISING. FIVE OR UNKNOWN
UNKNOWN REALLY IS WHEN WE HAVE
NO DATA ON AN INDIVIDUAL
THEY'RE NEW TO THE PLAN EXCEPT
ROCK. SO A MANAGED CARE PLANS
WILL THEN BE REQUIRED TO YOU-
ADMINISTER. INDIVIDUAL RISK
ASSESSMENTS TO MEMBERS I WOULD
JUST NOTE THERE WILL BE A
SEPARATE INDIVIDUAL RISK
ASSESSMENT FOR CHILDREN VERSUS
ADULTS- AND- THAT INFORMATION
WILL BE FED INTO THEIR RISK
HERE- IT WOULD BE REQUIRED FOR
ANYONE WHO HAS AN UNKNOWN RISK
HERE. AS A WAY OF GETTING
ADDITIONAL INFORMATION ON A NEW
THAT AND IF THIS YEAR-
ADDITIONALLY I TO ACCOUNT FOR
THE NEEDS OF THE MEMBERS. OF
THE ANNUAL NEEDS ASSESSMENT
POPULATION RESULTS WOULD BE
SHARED- IN REALLY HELP US FOCUS
ON AND UNDERSTAND WHERE MANAGED
CARE PLANS ARE BUILDING THOSE-
LOCAL ENGAGEMENT RELATIONSHIPS
WITH PUBLIC HEALTH WITH
BEHAVIORAL HEALTH WITH
COMMUNITY BASED ORGANIZATIONS
WITH SCHOOL DISTRICTS EXCEPT-
ROCK. I'M TO REALLY INFORM
WHERE THERE ARE PROVIDING
SERVICES- WHERE THEY'RE
FOCUSING ON DELIVERY SYSTEM
TRANSFORMATION INITIATIVES TO
CLOSE THOSEHEALTH INEQUITIES
THAT I MENTIONED EARLIER AS
WELL AS ADDRESSING THE SOCIAL
DRIVERS OF HELP. TO REALLY
THINKING COMPREHENSIVELY ACROSS
THE ENTIRE POPULATION IN
THINKING ABOUT THINGS AND MAYBE
A DIFFERENT WAY ON THEN SOME
PLANS DO WE DO KNOW THAT SOME
PLANS HAVE- ROBUST POPULATION
HEALTH MANAGEMENT STRATEGIES
TODAY. BUT IT DOES VERY ACROSS
ACROSS THE STREET THE STATE SO
WE'RE LOOKING FOR THAT
STANDARDIZATION AND REALLY UP
BEING- THE REQUIREMENTS IN
REGARDS TO ACCOUNTABILITY AND
EXPECTATIONS THAT WE SET OUT
FOR MANAGED CARE PLANS IN
REGARDS TO. SOME OF THE
COMPONENTS THAT I MENTIONED
EARLIER- AGAIN THOUGH REALLY
JUST WANT TO REITERATE HERE ARE
WE ARE LOOKING FOR THE PLANS TO
PARTNER UP WITH THE PUBLIC
HEALTH DEPARTMENTS WITH SOCIAL
SERVICES LOCALLY- BEHAVIORAL
HEALTH DEPARTMENTS. TO BUILD A
COMPREHENSIVE PLAN FOR MOVING
FORWARD. I'M SAID THIS WOULD BE
ONE MORE ADDITIONAL KIND OF
POINT I WANT TO MAKE SURE THERE
WAS SOME QUESTIONS- DH CS IS
REQUIRING MANAGED CARE PLANS TO
IDENTIFY AND ADDRESS- BIASES IN
THE ALGORITHM- THROUGH TESTING-
VIEW. WOULD REQUIRE THAT THEY
WE WILL GIVE THEM GUIDANCE TO
THE PLANS IN REGARDS TO HOW
THEY HAVE TO DO CERTAIN
TESTING- AND THEY WOULD HAVE TO
FILE THOSE WITH THE DEPARTMENT
TO ENSURE THAT- THE VICE
ANALYSIS AND- RECTIFYING ANY
BIASES HAVE BEEN IDENTIFIED AND
SO WE'LL WORK WITH OUR PLANS. A
CLOSELY ON ON WHAT THAT LOOKS
LIKE OVER THE COMING YEARS. AND
BEFORE THE POPULATION HEALTH
MANAGEMENT PIECE WERE OUT I'M
SO HAPPY TO ANSWER ANY. WHEN
THAT TIME. AND OPERATION OF
PUBLIC POPULATION HEALTH
MANAGEMENT PROGRAMS. AND THIS
WOULD IMPROVE PLANS ABILITY TO
CONNECT THE MEMBERS
PARTICULARLY THOSE WITH HIGH
NEEDS TO NECESSARY SERVICES.
AND IN DOING SO IMPROVE HEALTH
OUTCOMES AS WELL AS HEALTH
EQUITY. WE WOULD RAISE TWO
ISSUES FOR CONSIDERATION- FIRST
EXPANDING IN STANDARDIZING
POPULATION HEALTH MANAGEMENT
SERVICES TO ALL PLANS SHOULD
INCREASE THE PLANS
UNDERSTANDING OF THEIR MEMBERS
NEEDS. HOWEVER IT IS UNCLEAR
HOW THIS INFORMATION WOULD BE
LEVERAGED TO IMPROVE IMPROVE
STATE POLICYMAKERS
UNDERSTANDING OF MEDICARE
BENEFICIARIES NEEDS. AND HOW
THE NEW SERVICES UNDER CAL AIM
ARE BETTER ADDRESSING THOSE
NEEDS. IN A REPORT ON EQUITY
CONSIDERATIONS IN CALAIS MA'AM
WE RECOMMEND A SET OF EQUITY
RELATED METRICS THAT COULD BE
COLLECTED AND REPORTED AT THE
STATE LEVEL- CERTAIN OF THESE
METRICS WOULD RELY A
POTENTIALLY ON THE ENHANCED
DATA COLLECTION. ON MEMBERS
NEEDS THAT PLANS WOULD HAVE TO
PERFORM. UNDER THIS NEW CALIBER
CHOIR MAN SO FOR EXAMPLE D. H.
U. S. M. WOULD IMPOSE A- WOULD
HAVE A- A STANDARDIZED RISK
ASSESSMENT WHERE. PLANS WOULD
COLLECT SELF REPORTED HEALTH
STATUS- HOUSING STABILITY
FUNCTIONAL LIMITATIONS AND- WE
WOULD LIKE TO EXPLORE HOW THIS
DATA COULD BE- BROUGHT UP TO
THE STATE LEVEL IN THE FORM OF
PUBLIC REPORTING SO THAT WE CAN
UNDERSTAND. BETTER THE MEDIC
MEDIC KHALFAN FISHERIES NEEDS
AND THE SERVICES THAT
RECEIVING. SECOND WE DO WE
RECOGNIZE AS DIRECTOR COOPER
JUST DISCUSSED STYLE ON. THAT
DAY YOU KNOW IT THAT ALGORITHMS
CAN ASSIST IN THE
IDENTIFICATION IDENTIFICATION
OF BENEFICIARIES. WHO BENEFIT
FROM ENHANCED CARE COORDINATION
OTHER SERVICES BUT RESEARCH HAS
SHOWN THAT- SUCH ALGORITHMS CAN
DISPLAY RACIAL AND ETHNIC BIAS
OUT PREVENTING HIGH NEEDS
INDIVIDUALS- FROM- FROM CERTAIN
RACIAL GROUPS FROM RECEIVING
EQUITABLE. ACCESS TO SERVICES
AND SO JUST WITHOUT- SIX TO THE-
TO AS DH CS IMPLEMENTS- THIS
THIS NEW PROGRAM PROVIDED IT IS
APPROVED BY THE LEGISLATURE
TENT JUST CONTINUE TO
SCRUTINIZE THE GUIDANCE AND
OVERSIGHT THAT DHS IS PROVIDING
OVER- POPULATION HEALTH
MANAGEMENT. AS REGARDS THE RISK
STRATIFICATION OF- OF DIFFERENT
PEOPLE INTO THE DIFFERENT TIERS
AND THAT CONCLUDES MY REMARKS
THANK YOU. THANK YOU NEXT WE
WILL HEAR FROM CATHERINE
BARRESI WHO IS THE DIRECTOR OF
CARE COORDINATION AT
PARTNERSHIP HEALTH PLAN OF
CALIFORNIA. EIGHT THINK PEOPLE
CARE WITHIN TURN AROUND ELEVEN-
PARTNERSHIP HEALTH PLAN OF
CALIFORNIA IF A NONPROFIT
COMMUNITY BASED. ORGANIZATIONS
THAT STRIVE ON MEETING THE
NEEDS OF OUR COMMUNITIES AND OF
THE FOURTEEN NORTHERN
CALIFORNIA COUNTIES THAT WE
SERVE- PARTNERSHIP IT IS A VERY
SUPPORTIVE OF THE POPULATION
HEALTH MANAGEMENT PROPOSAL
WITHIN COUNTY AND- IT WILL
ALLOW FOR AN ORGANIZED APPROACH
TO THE IDENTIFICATION AND
VARIOUS NEEDS OF OUR MEMBERS-
IN ADDITION TO IDENTIFYING THE
NEEDS OF DIRECT SUPPORT OF
SERVICES SUCH AS BASIC AND
COMPLEX CASE MANAGEMENT PLANS
WILL HAVE THE OPPORTUNITY WITH
THE PROPOSAL TO READILY
IDENTIFY SUBPOPULATIONS. WITHIN
THEIR RESPECTIVE MEMBERSHIP-
THAT MAY BE EXPERIENCING HEALTH
CARE AND HEALTH OUTCOMES
DIFFERENTLY DUE TO SOCIAL
DETERMINANTS OF HEALTH AND
HEALTH EQUITY- THE CHALLENGE
WITH THE WITH THE CURRENT
POPULATION- PROPOSAL WITH AN
ACCOUNT NAME IS THAT IT IS NOT
IN ALIGNMENT WITH NCQA
DEFINITIONS ACTIVITY FOR
POPULATION HEALTH UNDER NCQA-
THE CURRENT KELLY PROPOSAL- FOR
INSTANCE INCLUDES THE MANDATORY
TIERED SYSTEM BUT- A DIRECTOR
FOR PROJECT SPOKE TO- AND THAT
MAY OR MAY NOT ALIGN. WITH
EXISTING MANAGED CARE PLAN
RESTAURANT OF PETITIONS IN
PLACE- THIS DISCONNECT MAY
ACTUALLY RESULT IN THE PATIENT
BEING CATEGORIZED AT ONE LEVEL
FOR THE STATE AND AT A
DIFFERENT LEVEL FOR THE NCQA OR
PLAN THE THING PURPOSES. OUT WE
WOULD ADVOCATE THAT IN ORDER TO
ENSURE THE SUCCESS OF BOTH A
COMPREHENSIVE POPULATION HEALTH
MANAGEMENT PROPOSAL THAT THE
DEPARTMENT ALIGNED AND TIME TO
SPEAK THE PROPOSAL WITH THE
PROPOSED AND SECURE WAY MANDATE
LANGUAGE WITHIN THE CAL IN
PROPOSAL- DOCTOR. THAT SHIF IN
THE TIMELINE WOULD ALLOW THE
DEPARTMENT IMPLANTS MORE
COHESION AND THOUGHTFUL
PLANNING IN CROSS WALKING SOME
OF THE INITIATIVES THAT DCS- IS
LOOKING TOWARDS PLANS TO
IMPLEMENT ALONG WITH THE
EXISTING FRAMEWORK. AND
REQUIREMENTS OF AND KEEP YOU
WAYS THAT CAN BE QUITE
RIGOROUS- FOR EXAMPLE-
CURRENTLY STATE IN THE NCQA
STANDARDS- POPULATION HEALTH
MANAGEMENT FIVE IS ACTUALLY
COMPLEX CASE MANAGEMENT AND
SUBJECT TO FINAL REVIEW AND
HAVE ABOUT TWENTY TWO DIFFERENT
DATA ELEMENTS POINTS. TO WHICH
AND TO KEEP A LOOK THAT. MMHM I
DON'T WANT THE OTHER COMMENT
REGARD BIAS- WE DO SEE AND IT
IS- AND FACE THAT YOU THINK.
BASED ALLOW. TO RESTAURANT PLAN
A POPULATION FIFTY THREE- IT
SHOULD FIVE AND THAT WE THERE
ARE- POPULATE. AND FOLK THAT
ARE OUT MARK. AND NOT
PRACTICING SIR. THEREFORE DATA
IS NOT IN THAT UTILIZATION. SO
TO PREVENT THIS- WE DEFINITELY
WOULD WELCOME AND SUPPORT AN
ADVOCATE FOR DCF TO EXPLORE
OTHER. AVENUES OF- ALTERNATE
GATED TO SUPPLY TO THE PLAN-
WHEN COMING UP WITH A
FRAMEWORK- LOOKING TO OTHER.
DEPARTMENTS SUCH AS THE
DEPARTMENT OF SOCIAL SERVICES
IN THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH. AND ALIGNING
THEIR INITIATIVE- BETTER
CLEARLY OUTLINED WITH SOME
LOCAL POPULATIONS MEANS- SO
THAT ARE WORKING BE- IN
ALIGNMENT AND NOT. AFTER THE
FIRST ONE OTHER. THANK YOU SO
MUCH FOR TIME FOR HAPPY TO
ENTERTAIN ANY QUESTIONS. THANK
YOU VERY MUCH NEXT WE'LL HEAR
FROM MIKE THOSE WITH CHILDREN
NOW. GOOD AFTERNOON MY NAME.
YOU HAVE TO LIVE TODAY DIRECTOR
OF HEALTH POLICY AT CHILDREN
NOW THE NONPARTISAN WHOLE CHILD
RESEARCH POLICY DEVELOPMENT AND
ADVOCACY ORGANIZATION. FIRST
LIKE TO THANK THE ASSEMBLY FOR
HOLDING THIS IMPORTANT HEARING
ANY KNOWLEDGE THE HARD WORK OF
THE DEPARTMENT OF HEALTH CARE
SERVICES AMERICANS JUST HOW IT.
ALSO AS YOU KNOW MEDICAL COVERS
HALF OF ALL CHILDREN IN PLACE
FOR OVER HALF OF ALL. STATE HI
AND THIS. IS COMING AT A TIME
WHEN THEY ARE PERSISTENT AND
SIGNIFICANT RACIAL AND
LINGUISTIC DISPARITIES IN
CHILDREN'S ACCESS TO CARE. SOME
OF THE FOCUS OF POPULATION
HEALTH MANAGEMENT. ACCOUNTING
IS A MOVE IN THE RIGHT
DIRECTION IT'S ACTUALLY THE
FINANCING THAT IS THE INTERVAL.
THAT IS INTEGRAL TO THE MANAGED
CARE BUSINESS MODEL SO
FINANCING HAS TO BE GOING TO
POPULATION HEALTH MANAGEMENT
STRATEGY. BUT THERE T BE
ACTION AND ACCOUNTABILITY. BUT
THE STATE HAS NOT PROPOSED ANY
NEW INCENTIVES RESOURCES OR
INFRASTRUCTURE HELPING TO
SUPPORT POPULATION HEALTH
MANAGEMENT. SO IT'S SORT OF
TRUSTING THAT MEANS ARE GOING
TO TAKE IT. SERIOUSLY- AND
EXECUTED. THE STRUCTURE
STRUCTURAL WHAT FINANCING
DYNAMIC IS PRECISELY WHY. YOU
SEE LOWER RATES OF UTILIZATION
AND SCREENING AND MANY YEARS OF
LOW AND DECLINING QUALITY OF
CARE FOR CARE. IN PRACTICE THIS
MEANS THAT KIDS AREN'T LOSING
OUT THEY'RE NOT GETTING
VACCINATIONS FOR MEASLES WHICH
ARE OFTEN STAY SAFE FROM
DISEASES LIKE MEASLES WHICH IS
THAT WE ARE FOR BAND BAND
COBIT. AND THEY ARE GETTING THE
DEVELOPMENTAL SCREENINGS
IDENTIFIED TO MY- THAT CAN BE
ADDRESSED IT'S COMPLY. I'M IN
OTHER WORDS THE FISCAL AND- BY
WHICH THE STATE HE'S AN
OVERSEAS PLANS ARE
CONDITIONALLY MISALIGNED.
INCENTIVES FOR PROACTIVELY
MANAGING TO HELP MEMBER
POPULATION. TO ALIGN WITH
POPULATION HEALTH MANAGEMENT
AND- WE SUGGEST THAT THE STATE
ONE ESTABLECER APARTMENT THAT
TRANSCEND A MINIMUM AMOUNT OF
THEIR CAPITATED PAYMENT PRIMARY
AND PREVENTIVE CARE- THEY MAKE
INVESTMENTS IN BASIC CARE
COORDINATION BECAUSE THAT
INFRASTRUCTURE REALLY DOESN'T
EXIST TODAY. AND THREE
ESTABLISH A QUALITY IMPROVEMENT
PROGRAM USING WITHHOLDING
INCENTIVES TO ENCOURAGE CLIENTS
TO IMPROVE QUALITY OF CARE FOR
THE MEMBER POPULATIONS.
PREVENTION POPULATION HEALTH
WILL CONTINUE TO ACT ACCORDING
IN ATTENTION UNLESS PAYMENT
REFORMS ARE SIMULTANEOUSLY
UNDERTAKEN AND THERE'S A
MEANINGFUL COMMITMENT BY THE
STATE THE WHOLE PLANS ACCOUNT.
SPECIFICALLY AS IT RELATES TO-
WHAT'S BEEN PROPOSED ALREADY IN
CALTRAIN IT'S NOT BEEN MADE
CLEAR HOW. THE CALEDON COAL
MINE WITH OTHER POPULATION
HEALTH MANAGEMENT APPROACHES
LIKE TO ST PAUL HOW- SO MY
RECOMMENDATION IS THAT THE
STATE BE MORE TRANSPARENT IN
THEIR DEVELOPMENT I HAVE MORE
BUILT IN TIME ONCE FOR
STAKEHOLDER FEEDBACK AND
COMMUNITY ENGAGEMENT
REPUTATION. I'D ALSO RECOMMEND
THAT THE STATE TAKES STEPS TO
PROTECT THE FOUNDATIONAL PSTG
GUARANTEE THAT KIDS IN MEDICAL
CAN ACCESS ALL THE- MEDICALLY
NECESSARY SERVICES AVAILABLE.
AND THIS SHOULD BE DONE
CONSISTENTLY ACROSS ALL
DELIVERY SYSTEMS AND CONTRACTS
AND GUIDANCE. AND FINALLY WE
HAVE A CONCERN ABOUT THE
POTENTIAL INEQUITIES THAT COULD
RESULT FROM THE WILD VARIATION
AND FLEXIBILITY. GIVEN TO HELP
INSTEAD OF BUYING NEW VALUE
RATE RISK. ARTERIAS DIFFERENT
PLAN CHOICES COULD RESULT IN
VERY DIFFERENT BENEFITS WERE
SIMILARLY SITUATED CHILDREN
READING SERIOUS CONCERNS ABOUT
COMPOUNDING AND EXACERBATING
INEQUITIES. SO IN CLOSING I
WOULD JUST OFFERED AT THE STATE
AND CITY MORE ON HOW THE CASE.
IS FOR CHILDREN'S CHARACTER OUT
MEDIC HOW- AND SPECIFICALLY BY
MAKING FINANCING REFORMS THAT
WILL BETTER ALIGN WITH MARTIN
STATED GOALS OF POPULATION
HEALTH AND PREVENTION. THANK
YOU. THANK YOU MR DAY NEXT
WE'LL HEAR FROM KERRY SANDERS
SENIOR POLICY DIRECTOR FOR THE
CALIFORNIA. PAN ETHNIC HEALTH
NETWORK. I AFTERNOON A CHECK
AND- MY NAME IS CARRIE SANDERS
ASKING YOUR POLICY DIRECTOR
WITH THE CALIFORNIA PAN ETHNIC
HEALTH NETWORK- DEPEND IS A
pADVOCACY ORGANIZATION DEDICATED
TO ELIMINATING HEALTH
DISPARITIES. AND ACHIEVING
HEALTH EQUITY FOR CALIFORNIA'S
DIVERSE COMMUNITIES OF COLOR.
STEPHEN WAS ACTIVELY ENGAGED IN
THE CALENDAR SESSIONS AT THE
MEMBER THE POPULATION HEALTH
MANAGEMENT AND NCQA
ACCREDITATION WORKGROUPS. AND
AUTOMATIC COMMENT LETTERS ON
THE COMPREHENSIVE SET OF
PROPOSALS AND COUNTING. I'D
LIKE TO THANK THE ASSEMBLY FOR
HOLDING THIS JOINT HEARING
TODAY AND THE STAFF AT DH THE
ASK. FOR THEIR HARD WORK ON
ADVANCING THE FOUNDATION'S
BETTER PROPOSAL. ALERT THE
MAJORITY OF ENROLLEES MEDICARE
MANAGED CARE CONTINUE TO
EXPERIENCE DISCRIMINATION. AND
HAVE POOR OUTCOMES ON KEY
HEALTH INDICATORS INCLUDING
ASTHMA. DIABETES AND MENTAL
HEALTH. CALIFORNIA CALLING
PROPOSAL INCLUDES FAR REACHING
REFORMS AND A STATED COMMITMENT
TO ADDRESSING HEALTH
DISPARITIES. YET VERY FEW
PAYMENT AND DELIVERY REFORM
EFFORTS ARE TIED DIRECTLY TO
MEASURABLY REDUCING THAT.
CHALLENGE FOCUSED ON EXPANDING
ACCESS TO HEALTH RELATED SOCIAL
NEEDS. THROUGH THE NEW
POPULATION HEALTH MANAGEMENT
PROPOSAL IS AN IMPORTANT STEP.
TOWARD THE MORE UPSTREAM
COMPREHENSIVE APPROACH TO CARE.
WITH THE PHM INITIATIVE
CALIFORNIA JOINS OTHER STATES
AND ADDRESSING THE SOCIAL
DETERMINANTS OF HEALTH. WHICH
DISPROPORTIONATELY IMPACTS
COMMUNITIES OF COLOR AND HAVE
BEEN SHOWN TO IMPACT HEALTH
OUTCOMES. HOWEVER THE COUNTY
PROPOSAL AND- INITIATIVES A
VERY NARROW DEFINITION THE
POPULATION HEALTH MANAGEMENT.
WELL PLANNED- ACQUIRED STRATIFY
IN SEGMENT THEIR ENTIRE
POPULATION THE PRIMARY
OBJECTIVE OF THIS RESTAURANT
EDUCATION IMPLEMENTATION
EXERCISE. IS IDENTIFIED MEDICAL
BENEFICIARIES WHO ARE AT THE
HIGHEST RISK FOR TOP ONE TO
FIVE PERCENT. THE GREATEST
UTILIZES OF HEALTH CARE
SERVICES AND WHO INCURRED THE
HIGHEST FOR BENEFICIARY COST.
TO THE EXCLUSION OF THE
REMAINING 95% OF MEDICARE
BENEFICIARIES YOU ALSO NEED
MORE PREVENTATIVE AND I'M
STRETCHING INTERVENTION. WELL
THERE CERTAINLY SHOULD BE
STRATEGIES AND INTERVENTIONS TO
SUPPORT THESE HIGH INTEREST
BENEFICIARIES WHO MAY BE MORE
LIKELY TO HAVE COMORBIDITIES. A
TRULY COMPREHENSIVE POPULATION
HEALTH MANAGEMENT STRATEGY WHAT
ADDRESS THE NEEDS OF THE ENTIRE
POPULATION. THIS IS ESPECIALLY
IMPORTANT FOR MEDICAL
POPULATION TO ARE FROM LOW
INCOME BACKGROUNDS RACIAL AND
ETHNIC COMMUNITIES AND LOCAL
PLUMMETED INTO PROFICIENTLY
PROFICIENCY AS THERE ARE
ALREADY MORE LIKELY TO HAVE
HEALTH RELATED SOCIAL NEEDS.
AND HAVE EXPERIENCED ADVERSE.
SOCIAL DETERMINANTS OF HEALTH.
IT'S POPULOUS NEAR CLUB OF CARE
TO KEEP THEM HEALTHY YET MANY
PLANS ARE STILL FALLING SHORT
TODAY ON DELIVERING THE BASICS
INCLUDING THE PROVISION OF
LANGUAGES THE CONSERVATIVE.
TIMELY PRIMARY AND SPECIALTY
CARE ACCESS AND REASONABLE
ACCOMMODATIONS FOR PEOPLE WITH
DISABILITIES. IN ORDER TO
ENSURE THE PHM INITIATIVE IS
TRULY MEETING UPDATED OBJECTIVE
IN MANAGING CARE FOR THE ENTIRE
POPULATION WE PUT FORTH TO THE
FOLLOWING SIX RECOMMENDATION.
FIRST WE RECOMMEND TO FINANCIAL
INCENTIVES IN CALLING BE TIED
TO ACHIEVING POPULATION HEALTH
MANAGEMENT GOALS FOR THE ENTIRE
MEDICAL POPULATION. THIS
INCLUDES THE FOUNDATIONAL
PREVENTATIVE CARE AND OVERALL
CARE COORDINATION
INFRASTRUCTURE. ALSO THIRD THE
OTHER 95299% AND IT'S IN GREAT
NEED OF ATTENTION AND
IMPROVEMENT. SECOND WE STRONGLY
AGREE WITH THE L.
RECOMMENDATION THE DHS
FORMULATE SPECIFIC EQUITY
METRICS TO ENSURE CALENDAR
MEETING POLITICAL. IT'S NOT
TRICKS WOULD NOT ONLY BE
INCLUSIVE OF CARE DELIVERING
pINCLUDE PREVENTATIVE HEALTH
CARE SOCIAL SERVICE PROGRAM
PARTICIPATION HOUSING STABILITY
AND BEHAVIORAL HEALTH.
INVOLVING CONSUMER STAKEHOLDERS
IN THE DEVELOPMENT OF THE TYPE
OF DASHBOARD SHOULD BE
REQUIRED. THIRD ALL THE METRICS
AND THE POPULATION HEALTH
MANAGEMENT AND THE FINISH THAT
AND ANY INITIATIVE A MEDIC CAL
SHOULD BE COLLECTED AND
REPORTED BY AGE SEX RACE
ETHNICITY LANGUAGE SEXUAL
ORIENTATION GENDER IDENTITY AND
DISABILITY STATUS AT A MINIMUM.
ALTHOUGH THE STATE IS SUPPOSED
TO BE COLLECTED IT'S NOT
HAPPENING TODAY MANAGED CARE
PLANS MUST BE REQUIRED TO
REPORT THIS DATA AND DHS NOT
URGENTLY INVEST IN THE DATA
INFRASTRUCTURE NEEDED INCLUDING
MUCH NEEDED UPGRADES TO THE
MATH SYSTEM TO FACILITATE THE
TYPE OF REPORTING. FOR H. OF
MESSENGER RESTAURANT OCCASION
SEGMENTATION DOES NOT FURTHER
EXACERBATE HEALTH DISPARITIES.
RESEARCHERS AND COMMUNITY
ADVOCATES HAVE RAISED CONCERNS
ABOUT DATA ANALYTICS TOOL THESE
PERFECT HEALTH RISK THE MAIN
COULD RACIAL AND ETHNIC BIASES
THAT AND INTO UNTESTED
PERPETUATE HEALTH INEQUITIES.
WORTH MOST HEALTH SYSTEMS
CHOOSE COST OR UTILIZATION OF
THE PROPERTY FOR HEALTH USING
MEDICAL CLAIMS DATA TO PREDICT
NEED FOR CARE MANAGEMENT AND
OTHER SUPPORT. NEXT GROUP
PATIENTS OF COLOR. PERSONS WITH
DISABILITIES AND LGBTQ PLUS
PATIENTS WHO IS DIRECTLY HAVE
LESS ACCESS TO BOTH PRIMARY AND
SPECIALTY CARE DUE TO
DISCRIMINATION POVERTY. AND
OTHER STRUCTURAL BARRIERS. IF
THESE BARRIERS TO ACCESSIBLE IN
LOWER UTILIZATION AMONG
PATIENTS OF COLOR DESPITE
EQUIVALENT DIAGNOSES THE NEED
FOR SERVICES SOME RISK
ALGORITHMS MAY INADVERTENTLY
PERPETUATE DISPARITIES BY
COATING THE PATIENT. HAS LEFT
THE NEED OF CARE MANAGEMENT AND
OTHER SUPPORT. IT WAS RECOGNIZE
THE POTENTIAL BIAS AND HEART IN
ALGORITHMS AND NOT CORRECTLY
STATED IT WILL QUITE REQUIRE
HEALTH PLANS TO CORRECT THIS.
BY REQUIRING PLANT INCORPORATE
OTHER DATA SUCH AS HEALTH
CONDITIONS. RISK FACTORS AND
DISEASE PROGRESSION. AND I
EQUITY AND- IDENTIFYING CORRECT
BY THE- AND SUBMITTING TO DO.
HE LIST OF THANK- AND I DATA
SOURCE. OF ALL PLANS MAKE
REPEAT OF AND OF FOR VIEWING ON
THE WEBSITE. WHICH ON THE NEW
REQUIRE- WE PART HEALTH PLAN IN
CALLING TRADITIONAL DATA
SOURCES TO BE USED. BEYOND
CLINICAL CLAIMS DATA CONSUMER
STAKEHOLDERS SHOULD BE AFTER
CONDITIONALLY HELP PROVIDE DHS
ON ITS ALGORITHM GUIDANCE. AND
DHS REQUIRED TO REPORT TO THE
LEGISLATURE ON ANY ISSUES OR
CONCERNS. CONCERNS THAT WE
RECOMMEND STRONGER TRANSPARENCY
IN TERMS OF IMPLEMENTATION OF
PHM REQUIREMENTS. UNDER CALLING
PLANS WILL BE REQUIRED TO
DEVELOP POPULATION HEALTH
MANAGEMENT STRATEGIES THAT
INCORPORATE THE FINDINGS OF
DHS'S POPULATION NEEDS
ASSESSMENT. AND NCQA POPULATION
HEALTH PROGRAM REQUIREMENTS. HE
ACCEPTED PNA FOR THE PRIMARY
TOOL TO HELP PLANT USED TODAY
TRANSFORM THE REQUIRED
DISPARITIES THAT PREVENT
PROJECTS. GET THERE NO CLEAR
DISPARITIES REDUCTION TARGETS
FOR FINANCIAL INCENTIVES TIED
TO CHEESE ACHIEVING PNA
DISCOURAGE REDUCTION GOAL AND
NOT BECAUSE OF BEEN TRYING
UNSUCCESSFULLY FOR YEARS TO
VIEW- THE PLAN IN ORDER TO GAIN
A BETTER UNDERSTANDING. OF WHAT
HEALTH PLANS ARE ACTUALLY DOING
TO CLOSE GAPS IN DISPARITIES IN
CARE. ALL OF THESE PLANS WILL
STRATEGIES AND FINING SHOULD BE
SHARED PUBLICLY. LASTLY IT
MOVING FORWARD WE RECOMMEND THE
DHS EXPAND OUR CONSIDER
EXPANDING THE INFLUENCE
SERVICES BENEFITS TO INCLUDE
ADDITIONAL HEALTH RELATED
SOCIAL NEEDS. AND MAKE SERVICES
AVAILABLE TO THE BROADER
MEDICAL POPULATION OF STATES
LIKE OREGON HAVE DONE. THESE
COULD BE USED TO COVER THINGS
LIKE NON EMERGENCY MEDICAL
TRANSPORTATION FOOD FROM FOR
THE FARMERS MARKET SUPPLEMENTAL
FOOD TEMPORARY HOUSING OR
SHELTER UTILITIES AND REPAIRS.
THEY COULD BE INCLUDED AS
MEDICAL COSTS IN THE MLR AND
INCLUDED IN FUTURE RATE
SETTING. BURGUNDY FEELS WORKED
WITH REGIONAL MULTI STAKEHOLDER
COALITION SIMILAR TO
CALIFORNIA'S ACCOUNTABLE
COMMUNITIES FOR HEALTH.
IMPLEMENTING THE LESSONS AND
EXPERIENCES OF OUR OWN- CATCHY
SITES COULD BE APPLIED YOU
IMPLEMENTATION THE- AS WELL AS
THE- CALLING AND I'LL LAST. AND
I POPULATION HEALTH MENTIONS
TO. INCLUDE WE WOULD LIKE TO
BECOME DO MORE TO DRAW POP IN A
AND CAL AND TO CALLING MORE
BROADLY. THANK PAYMENT AND
DELIVERY OF STRATEGY WITH THE
TYPE. FOR THE REDUCTION OF
HEALTH INEQUITIES OVER IN
BETTER HEALTH OUTCOMES FOR ALL
MEDICARE BENEFICIARIES. THANK
YOU FOR THE OPPORTUNITY TO
TESTIFY AND I LOOK FORWARD TO
ANSWERING ANY OF YOUR QUESTIONS.
THANK YOU VERY MUCH THAT DOES
CONCLUDE THIS PANEL I WILL NOW
ASK IF THERE ARE ANY MEMBERS
QUESTIONS. DOCTOR WOULD. YES SO
THIS QUESTION IS FOR THE
ADMINISTRATION- AND I THINK
YOU'VE HEARD SOME OF THE
SUGGESTIONS OF THE- OF THE-
STAKEHOLDERS- SO I'M MY
QUESTION IS HOW IS WHAT YOU'RE
PROPOSING HERE DIFFERENT. THAN
WHAT THE PLANS CONTRACTUALLY
REQUIRED TO DO NOW. SO THAT'S A
REALLY LONG LIST OF THINGS JUST
TO BE CLEAR SO THERE ARE SOME
COMPONENTS IN AB MENTIONED BY
SOME I'M SOME OF OUR MANAGED
CARE PLANS ARE NCQA ACCREDITED-
AND SOME ARE NOT- AND SO WHERE
THERE IS OVERLAP THERE WOULD BE
APPLIED THOSE PLANS TO BE IN.
HAVE BECOME INSECURE ACCREDITED
AND FOCUS ON SOME OF THE
POPULATION HELP PIECES- BUT THE
DEPARTMENT DOES NOT WANT TO
WAIT FOR OUR NCQA PROPOSED
REQUIREMENT. OF A TWENTY TWENTY
SIX TO- INSURE THAT ALL MANAGED
CARE PLANS ARE THINKING ABOUT
AND PROVIDING THESE SERVICES- I
THINK ONE OF THE PIECES THAT WE
WILL BE VERY FOCUSED ON AS
MENTIONED IN MY OPENING
COMMENTS. HAS TO DO AROUND FOR
EXAMPLE IDENTIFYING AND
REPORTING UP SOCIAL
DETERMINANTS OF HEALTH ONE OF
THE REQUIREMENTS IN CAROLINE IS
GOING TO BE THAT MANAGED CARE
PLANS AS THEY GATHER THAT
INFORMATION INCLUDING PROVIDERS
REPORT THAT UP TO THE
DEPARTMENT WITH CPT CODES FOR
EXAMPLE- AND THAT IS REQUIRED
TO BE INCLUDED IN THE
RESTAURANT LOCATION DATA- WELL
I LISTED A FEW EXAMPLES THAT
WAS NOT AN EXHAUSTIVE LIST.
LIST OF SERVICES AND INCLUDES
BOTH CLINICAL AND NONCLINICAL
COMPONENTS FOR THAT RESTAURANT
EDUCATION- THE OTHER THING IS
THAT WHILE SOME MANAGED CARE
PLANS MAY DO A RESTAURANT THE
KITCHEN TODAY- INDOOR
PREDICTIVE ANALYTICS IT WOULD
BE STANDARDIZED STATEWIDE. SO
THAT IF THE BENEFICIARY
TRANSITIONS FROM PLAN TO PLAN
THERE IS A- A SENSE OF.
UNDERSTANDING IF THAT'S GOING
TO GO ACROSS THE VARIOUS
MANAGED CARE PLANS IN REGARDS
TO- LOW AT MEDIUM RISING HIGH
OR UNKNOWN RISK- SO THAT'S
ANOTHER PIECE I WOULD MENTION-
BEAR. WE ALSO- WELL I AGREE I
HISTORICALLY WE HAVE IDENTIFIED
A LARGE NUMBER OF DISPARITIES
ARE INEQUITIES REPORTED THOSE
THINGS PUBLICLY- AND REQUIRED
CERTAIN COMPONENTS WITHIN THE
POPULATION HEALTH MANAGEMENT
THE DEPARTMENT OF HEALTH CARE
SERVICES IS. VERY COMMITTED TO
DEVELOPING BOTH A SHORT. TERM
AND LONG TERM- AT WITH THE ROAD
MAP WHERE WE ARE IT'S- GET
CLOSURE IN BOTH QUALITY METRICS
AS WELL AS- INFRASTRUCTURE.
INVESTMENT AND DEVELOPMENT OF
DELIVERY SYSTEM TRANSFORMATION
FOCUSED ON CERTAIN POPULATIONS-
ESPECIALLY AROUND THE
POPULATION HEALTH NEEDS
ASSESSMENT- THAT WE ARE
REQUIRING- WANTING IN REGARDS
TO THAT WE WILL BE REQUIRING
THAT PLANS CLOSELY ENGAGED
WITH. THEIR PUBLIC HEALTH
COLLEAGUES. AS WELL AS REALLY
INCREASING THE COMMUNITY
ENGAGEMENT AND WORKING WITH
INDIVIDUALS TO BUILD MODELS
THAT ARE GOING TO CLOSE THOSE
EQUITIES. AND GAPS OF CARE OF
FOR BENEFICIARIES ACROSS THE
STATE. SO THOSE ARE JUST A FEW
OF THE THINGS THAT THE LIST IS
ACTUALLY QUITE EXPENSIVE- EVEN
HAVE STANDARDIZED A TRANSITION
REQUIREMENTS OF THAT CURRENTLY
ARE NOT IN OUR MANAGED CARE
PLAN CONTRACTS TODAY. THE ONE
THING I WOULD SAY- THAT IS
CLEAR TO ME IS THAT THE PLAN
CONTRACT HAS CERTAIN CLEAR
AREAS WHERE THE LANGUAGE IS. I
BEG- AND THAT HAS ALLOWED FOR A
LARGE DIFFERENCE OF PLANT PLAN
IN REGARDS TO HOW THEY HAVE
IMPLEMENTED CERTAIN COMPONENTS
THAT THEY ARE CLEARLY.
RESPONSIBLE FOR TODAY AND THE
DEPARTMENT- EXPECTS- REALLY
TIGHTEN UP ON THOSE
EXPECTATIONS TO MAKE IT CLEAR-
CERTAIN MINIMUM CRITERIA OF
ACTIONS OR RESPONSIBILITIES
THAT MUST TAKE PLACE IN REGARDS
TO- THOSE ACTIONS AS WELL AS-
RELATIONSHIPS THAT WE THINK ARE
CRITICAL TO MOVE. THE NEEDLE IN
THAT SPACE AND SO- I COULD GO
ON- BUT- JUST WANTED TO NAME A
FEW OF THOSE AREAS WHERE WE ARE
REALLY FOCUSED ON DIFFERENCES
FROM. WHAT THE PLANS DO TODAY.
APPRECIATE THAT- AS WE LOOK AT
A POPULATION HEALTH MANAGEMENT
PROGRAM- CAN YOU TELL ME HOW
YOU'RE GOING TO GET DATA WHAT
DATA YOU'RE YOU MIGHT BE
REQUIRING AN AND HOW YOU'RE
GOING TO UTILIZE THAT DATA I
MEAN. WE NEED SOME YET THERE
NEED TO BE METRICS OBVIOUSLY
AND THERE'S A LOT TO BE LEARNED
HERE FROM THIS SO WHAT IS THE
DATA PART OF THIS GOING TO LOOK
LIKE AND- WHERE WE'RE AT THE
REQUIREMENTS TO SUBMIT.
POPULATION HEALTH DATA SO WE
UNDERSTAND SO WHAT TO EXPECT
HAVE SOME METRICS FOR SUCCESS
HERE. YES SO- I MEAN I THINK IF
THERE'S A FEW DIFFERENT
COMPONENTS ANYTHING ABOUT THERE
WE WILL BE REQUIRING PLANTS
USE- A PRETTY EXTENSIVE LIST OF
DATA THAT THEY HAVE THEMSELVES.
AS WELL AS- DATA THAT THE
DEPARTMENT HAS WHETHER IT'S
FROM- OUR ENCOUNTER DATA OR
OTHER DATA THAT WE GET FROM.
SISTER DEPARTMENTS THAT WE FEED
TO OUR MANAGED CARE PLANS- IT
WOULD ALSO INCLUDE SOME OF THAT
NON CLINICAL DATA THAT WILL ALL
ROLL UP INTO THE VARIOUS RISK
CATEGORIES. ON THAT WILL BE
SOMETHING THAT WOULD HAVE TO BE
REPORTED TO US I THINK THE
OTHER BIG ITEM IS THE SOCIAL
DETERMINANTS OF HEALTH DATA
BEING REPORTED TO THE
DEPARTMENT. THAT WILL GREATLY
ALLOW US TO LOOK AT DATA AND
SLICE DATA AND LOOK AT
OPPORTUNITIES FOR BENEFITS AS
WELL AS- DELIVERY SYSTEM
CHANGES POLICY PIECES THAT WE
DON'T CURRENTLY HAVE INSIGHT
INTO TODAY- IN COLLECTING AND
USING THAT FOR ANALYTICS I
THINK IT'S GOING TO BE. REALLY
IMPORTANT AS WE CONTINUE TO
BUILD ON THIS POPULATION HEALTH
MANAGEMENT STRATEGY AND
APPROACH- I THINK THE OTHER
THING IS THAT- WE'RE GOING TO
HAVE TO LOOK AT HOW AND WHAT
MEASURES WE LOOK AT THE CROSS
OVER ONE OF THE BIG PIECES THAT
WE'RE LOOKING AT IT. WHAT ARE
THOSE QUALITY METRICS THAT
CLEARLY OF GO ACROSS OUR
DELIVERY SYSTEMS WE REALLY WANT
TO FOCUS ON SOME OF THOSE
QUALITY METRICS BECAUSE IT
SHOWS THAT THE MANAGED CARE
PLANS HAVE PUT IN-
COMPREHENSIVE CARE
COORDINATION. REFERRAL OF A
KIND OF MECHANISMS AND
REQUIREMENTS TO ENSURE THAT
BENEFICIARIES ARE GETTING LOST
AS THEY TRANSITION FROM ONE
DELIVERY SYSTEM TO THE OTHER
FOR EXAMPLE IS MIKE WAS
MENTIONING EARLIER ON THE
DENTAL SERVICES ENSURING THAT
THOSE GAPS ARE BEING CLOSED IN
THAT INDIVIDUALS ARE GETTING
ACCESS TO DENTAL SERVICES. SO
THAT IS WHERE WE WILL BE
FOCUSING SOME OF OUR EFFORTS IN
REGARDS TO LOOKING AT
POPULATION HEALTH MANAGEMENT TO
ENSURE ONE OUT WERE CLOSING-
GAPS ACROSS DELIVERY SYSTEMS-
SURE THAT THOSE. ARE ENTERED.
IN THE- COURT NEEDED AND THEN
ASK MENTIONED EARLIER LOOKING
AT CLOSING THOSE EQUITY GAPS
AND WE ARE CURRENTLY LOOKING AT
WHAT THAT WOULD BE. I DON'T
HAVE A LIST FOR YOU TODAY BUT I
DO KNOW THAT WE PLAN ON FULLY
ENGAGING WITH STAKEHOLDERS AND
THE LEGISLATURE. IN REGARDS TO
WHAT YOU WOULD LOOK AT BERMAN
EQUITY POINT OF VIEW AND HOW WE
WILL MEASURE THAT ALL PLANS
ACCOUNTABLE IN INCENTIVIZE
THAT- THROUGH VARIOUS
MECHANISMS. THANK YOU I GUESS I
ENVISION. DATA COLLECTION. IN A
VERY VERY BROAD WAY THAT'LL
ALLOW US TO BE ABLE TO
ACTUALLY. DO THE RESEARCH
NECESSARY FOR ENTIRE POPULATION
HEALTH SO I'M I'M HOPEFUL THAT.
THAT THIS DATA THREE DH CS IT
WILL BE COLLECTED. WILL ALSO BE
ABLE TO BE COORDINATED WITH
OTHER DATA THAT'S NOT
NECESSARILY MEDICARE AS WE
START LOOKING INDIVIDUAL
POPULATIONS OUT THERE. AND THE
SOCIAL DETERMINANTS OF HEALTH
AND HOW WE CAN MAKE THINGS
BETTER MORE EFFECTIVE FOR
EVERYONE HERE IN CALIFORNIA SO
ANYWAY. THAT'S JUST MY
EDITORIAL PART THERE SO. THANK
YOU VERY MUCH APPRECIATED
CHASING. I WILL HAVE ONE MORE
QUESTION BEFORE WE CLOSE THIS
PANEL- AND IT'S- FOR DH CS
AGAIN. ARE THERE CURRENTLY ANY
EXISTING MODELS OF MANAGED CARE
POPULATION HEALTH MANAGEMENT
THAT WE WANT THE PLANS TO
FOLLOW. FOR EXAMPLE DOES KAISER
AND THEIR COMMERCIAL COVERAGE
UTILIZED THIS APPROACH.
INTERESTING QUESTION- SO I
THINK- YEAH I THINK KAISER IS A
GREAT EXAMPLE TO BE HONEST WITH
YOU OF WHERE YOU CAN SEE AN
EFFECTIVE POPULATION HEALTH
MANAGEMENT TIED TO- OVER A BEST
ELECTRONIC MEDICAL RECORD THAT
REALLY- IT ALLOWS YOU TO
IDENTIFY. CERTAIN POPULATIONS
AND ENSURE THAT- CARE GAPS ARE
BEING CLOSED I THINK IT'S ONE
OF THE VALUES OF AN INTEGRATED
MODEL WHERE YOU CAN KIND OF
DRIVE TO SOME OF THOSE FACTORS
I DO STILL THINK THAT THERE
ARE. OPPORTUNITIES ON THERE OF
COURSE- BUT- CLEARLY-
RESPECTIVE OF SOME OF THEIR
QUALITY SCORES BEING SOME OF
THE PAST IN IN MEDICARE LIKE IF
HE GETS A GREAT EXAMPLE I ALSO
THINK THAT IN C. Q. A. OUR
POPULATION HEALTH MANAGEMENT
PIECES ARE ARE GOOD- HOWEVER
CALIFORNIA'S WANTING TO RAISE
THE BAR A LITTLE BIT BE A
LITTLE. BIT MORE AGGRESSIVE IN
REGARDS TO OUR POPULATION
HEALTH MANAGEMENT REQUIRED
REQUIREMENT SO WHILE I- RESPECT
AROUND ALIGNING WITH NCQA I
THINK WHAT WE WOULD SAY IS
CALIFORNIA WOULD RATHER PARTNER
WITH NCQA- TO YOU- REALLY
ENSURE THAT WE ARE AND GETTING
THE MOST OUT OF THE POPULATION
HEALTH MANAGEMENT CHANGES- SO
THOSE WOULD BE SOME OF THE
COMMENTS THAT WOULD ADD TO YOUR
QUESTION. THANK YOU VERY MUCH
WITH THAT WE WILL THANK THE
FOURTH PANEL. AND MOVE ON THE
PANEL FIVE. THANK VERY MUCH
DOCTOR. WORK MOVE ON A FIFTY.
WHICH IS THE REQUIREMENT ON DH
CS TO STANDARDIZE THE MEDICARE
BENEFIT PACKAGE. I WAS FOR A
SMALL PORTION OF THIS LAST
WEEK- RELATED TO KAISER
COVERAGES SPECIALTY MENTAL
HEALTH SERVICES IN TWO
COUNTIES. WE HAD A LATE
SUBSTITUTION ON THE PANEL
STACEY SOLOMON DIRECTOR OF
OPERATIONS AT MOUNTAIN SHADOWS
WILL BE SPEAKING ON THIS PANEL.
SHE IS TAKING THE PLACE OF MARC
CLAUS. SO THE PANEL WILL
INCLUDE A J. C. COOPER. ARC-
CHIEF DEPUTY DIRECTOR OF HEALTH
CARE PROGRAMS AND THE TEN OR
STATE MEDICAID DIRECTOR- BEN
JOHNSON- ARE THERE ARE
PRINCIPLES. AND POLICY ANALYST
WITH THE L. A. O. ABIGAIL. FOR
ABBY- COURSE SELL. A SENIOR
ATTORNEY FOR THE NATIONAL
HEALTH LAW PROGRAM AND STACEY
SOLOMON AS I MENTIONED EARLIER
THE DIRECTOR. OF OPERATIONS FOR
MOUNTAIN SHADOWS SO BEFORE WE
DO THAT I WANT TO TELL PEOPLE
THAT WE- WE GAVE YOU A NUMBER-
FOR COLIN IS THIS IS THE FIFTH
PANEL WE HAVE ONE MORE AFTER
THIS BUT I WANT TO. AND IT WILL
BE A REPEATED AGAIN BUT THE
CALL IN NUMBER WE GET WAS
CORRECT. BUT THE CODE WITH
ACCESS CODE WAS NOT SO THOSE
PEOPLE WHO MIGHT BE CHOMPING AT
THE BIT TO GET. IN LINE FOR
PUBLIC COMMENT- THE PUBLIC-COMMENT- CALL IN NUMBER IS
EIGHT SEVEN SEVEN. SIX NINE
TWO. EIGHT NINE FIVE SEVEN AND
THE ACCESS CODE IS. SEVEN THREE
TWO. SIX TWO FOUR TWO. SO ONCE
AGAIN IT'S EIGHT SEVEN SEVEN
SIX NINE TWO. EIGHT NINE FIVE
SEVEN. AND THE ACCESS CODE IS.
SEVEN THREE TWO SIX TWO FOUR
TWO AND WITH THAT WE'LL GO
AHEAD AND- AND- THE CHEAPER-
CONTINUE- THIS COOPER. THANK
YOU. SO ONE OF THE GUIDING
PRINCIPLES AROUND CALTRAIN IS
TO STANDARDIZE- ACROSS THE
ENTIRE STATE OF CALIFORNIA- I
THINK ONE OF THE THINGS THAT WE
THINK IS REALLY IMPORTANT IS
THAT THE COUNTY THAT YOU LIVE
IN- DOESN'T DICTATE ON THE
KERRY HERBAL- WHERE YOU GET OR
WHO'S RESPONSIBLE FOR
COORDINATING AND SO ON THAT IS
THE ONE OF THE KIND OF CORE
PIECES HERE SO WE ARE PROPOSING
TO STANDARDIZE THE BENEFIT OF
WHAT'S PROVIDED THROUGH OUR
MEDICARE MANAGED CARE PLANS ON
STATEWIDE- THAT DOES INCLUDE-
CARVING OUT. ON CERTAIN
SERVICES FOR EXAMPLE WE AT
EVERYONE IS VERY WE'RE
PROPOSING TO CARVE A PHARMACY-
SERVICES I'M OUT OF THE MANAGED
CARE PLANS- THE DATE FOR THAT
TRANSITION IS STILL TO BE
DETERMINED BUT WELL INFORMED
INDIVIDUALS AS SOON AS WE HAVE
A NEW CAR ABOUT DATE I'M ALSO-
BY JANUARY ONE OF TWENTY TWO
PROPOSING A TO CARVE OUT THE
SPECIAL TEAM A MENTAL HEALTH
SERVICES- IN BOTH SOLANO IN
SACRAMENTO CURRENTLY PROVIDED
BY KAISER I'M BACK TO AT THE
COUNTY BEHAVIORAL HEALTH
ENTITIES THAT WAS HEARD AT THE
PREVIOUS HEARING- AND THEN
LASTLY CARVING OUT THE-
MULTIPURPOSE SENIOR SERVICES.
AFTER WE ARE PROPOSED TO CARP
IN- HANDFUL OF BENEFITS-
JANUARY OF TWENTY ALL ORGANS
NOT KERR WITHIN SCOPE OF ANY OF
THE MANAGED CARE I'M THEIR JUST
NOTATING THE SOME OF OUR
MANAGED CARE PLANS ALREADY HAVE
A MAJOR ORGAN TRANSPLANTS CARP
IN ONTO THEIR RESPONSIBILITY-
AND JUST STANDARDIZING THAT
ACROSS THE STATE AND THEN
ADDITIONALLY I BY JANUARY ONE
TWENTY TWENTY THREE-
INSTITUTIONAL LONG TERM CARE.
I'M NOT CURRENTLY WITHIN THE
SCOPE OF MANY MANAGED CARE
PLANS BEING CARP IN. THE TO THE
MAIN CARE PLANS. AND THEN IT
THERE ALSO WOULD HIGHLY THAT.
ON LONG TERM IS CAR INTO CODES
CANNY COUNTIES AS WELL AS C. C.
I TELL- ARE SOME OF OUR-
COUNTIES BUT IT. A NUMBER OF
LICENSE. HERE AGAIN JUST ASKIN.
THAT ACROSS THE ENTIRE STATE
REGARDLESS OF MODEL OF MANAGED
CARE THAT YOU'RE AN- IDEA ACS I
DOES HAVE THE ABILITY- TODAY TO
DETERMINE WHAT BENEFITS ARE
PROVIDED THROUGH MANAGED CARE
VERSUS THE FOR SERVICE.
CURRENTLY WE DO THAT THROUGH-
TYPICALLY THE BUDGET PROCESS IT
FOR MAKING LARGE CHANGES
THROUGH THAT MANAGED CARE PLAN
CONTRACT CHANGES AS WELL AS- DO
YOU HAVE TO HAVE THAT WITHIN
OUR ELEVEN FIFTEEN WAIVER THAT
WE FILED WITH CMS AS IT IS.
CRITICAL TO NOTE WHICH DELIVERY
SYSTEM IS REQUIRED FOR WHICH
SERVICES. I'M DCS DOES INTEND
TO USE THE MANAGED CARE PLAN
CONTRACTS TO ADD THE NEW
BENEFITS- THAT ARE PART OF THE
CALLIN PIECES THAT I JUST
RECOMMENDED. I'M INCLUDING
CLEAR- EXPECTATIONS IN REGARDS
TO THOSE AT TRANSITION AND
SERVICES- AT THE END IT
SHOULD'VE UP PROPOSES TO EXTEND
THE COVERAGE OF. MAJOR ORGAN
TRANSPLANTS TO ALL NON- CODES
COUNTIES I MENTION THAT BECAUSE
CURRENTLY BECAUSE COUNTIES TO
COVER A LARGE VARIETY OF. THE.
MORGAN THE FORGET- THAT TRAIN.
SERVICES AT TODAY AND OF OUR
CARE COVER SOME OF VERY SHORT
LIST OF- ORGAN TRANSPLANTS-
TODAY'S BOB. UNDER THE
REIMBURSEMENT OF BAD LANGUAGE
THAT'S PROPOSED IN THE TRAILER
BILL THEIR CREDIT TO PRIMARY-
ARE PROPOSAL REASONS OF WHY WE
INCLUDED ON THAT LANGUAGE THE
FIRST IS TO YOU- GUARANTEE
PROVIDERS HAVE THE OPTION. TO
RECEIVE AT LEAST THE SAME RATE
THAT THEY WOULD OTHERWISE GET
FROM OF THE APPLICABLE SERVICES
BEING PROVIDED THROUGH MEDICARE
FEE FOR SERVICE SO ESSENTIALLY
ENSURING. THAT MEDICARE FEE FOR
SERVICE RATES FOR
BENEFICIARIES- I MEAN PROVIDER
SORRY- AS WELL AS TO PROVIDE
THE MANAGED CARE PLANS THE
ABILITY TO OFFER THE BENEFITS
AND EXPAND THEIR NETWORKS
ACCORDINGLY FROM A- LESS
DISADVANTAGED POSITION- WHICH
HELPS LIMIT POTENTIAL FINANCIAL
COSTS. THAT THE MANAGED CARE
PLANS ON MAKING HER IF A LARGE
NUMBER OF THESE PROVIDERS FOR
EXAMPLE ARE TAKING THE MEDICARE
FEE FOR SERVICE RATES TODAY- WE
WOULD WANT THEM TO AT A MINIMUM
I TAKE THAT RATE AS OF THE
MANAGED CARE PLANS WOULD BE
ABLE TO. MEET OUR EXPECTATIONS
IN REGARDS TO NETWORK ADEQUACY
WITH THE BENEFIT TRANSITIONS
AND CONTINUE TO HAVE THOSE
PROVIDERS AS A PART OF THEIR
NETWORK OF COURSE THE TRAILER
BILL ALLOWS FOR THE FLEXIBILITY
FOR MANAGED CARE PLANS AND
PROVIDERS TO YOU COME TO A-
NEGOTIATION. A MUTUAL AGREEMENT
IN NEGOTIATION OF AN
ALTERNATIVE AMOUNT OR PAYMENT
METHODOLOGY- SO WE DO A LOT FOR
THAT FLEXIBILITY- THIS IS FOR
BOTH MAJOR ORGAN TRANSPLANT
TRANSITIONS AS WELL AS LONG
TERM CARE- AND WHAT WE FEEL IS
A CRITICAL COMPONENT WHICH IS
WHY- YOU REALLY SEE THAT PART-
LISTED IN THAT THE TRADE. BILL
LANGUAGE. SO I KNOW ONE THING I
DO WANTED OF FOUGHT FOCUS ON IT
IS WHY. WE ARE. LOOKING BOTH
LONG TERM CARE TRANSPLANTS- SO
AS A- PREVIOUS LONG TERM CARE
IS. CARP IN IN COAST- AS WELL
AS IN CCI- BY COUNTIES- WITH
THE MAJORITY- SORRY WITH THE
MANDATORY ENROLLMENT
REQUIREMENTS. FOR TOOLS PARTIAL
BOWLS AND NON TOOLS- IT ALSO
REALLY ALLOWED US TO INCLUDE-
LONG TERM. CARE SHARE COST
BENEFICIARIES FOR EXAMPLE- BY
TWENTY TWENTY THREE WERE
PROPOSING TO PARK LONG TERM
CARE AND- MAKE MANDATORY BOTH.
OR DUAL- PARTIAL DUAL AND NON
TOOLS TO BE MANDATORY MANAGED
CARE- AND THAT INCLUDED THE
SHERIFF COSTS THE REASON WHY
THAT'S IMPORTANT IS BECAUSE
MOST LONG TERM CARE.
BENEFICIARIES A MEET THEIR
SHARE OF COST ON THE- ON THE
FIRST DAY- OF THAT SHARE COSTS
AND SO- IN A CRITICAL KIND OF.
ADDED THAT IS DIFFERENT THAN
THE REST THAT PROPOSAL THERE.
IT REALLY WILL ALLOW THE PLANS-
TO HAVE- YOU NEED TO MAXIMIZE
THE ENHANCED CARE MANAGEMENT IN
THE LIEU OF SERVICES THAT ARE
GOING TO BE ADDED THROUGH
CALLING- AND THE RESULTING
SAVINGS UP FOR THE STATE AND
PLANS BY- ENSURING THAT THEY
ARE MAXIMIZING THOSE INTO OF
SERVICES. IN TRANSITIONING
PEOPLE WHEN APPROPRIATE- TO
THEIR HOME AND OR COMMUNITY OF
AND SO BY MAKING BOTH THE
POPULATION TO BE MANDATORY FOR
MANAGED CARE THAT VARIES ACROSS
THE STATE. CARVING IN LONG TERM
CARE GIVING THEM THE ENHANCE
CARE MANAGEMENT THAT HAS A
SPECIFIC TARGET POPULATION ON
TRANSITIONS FOR IN INDIVIDUALS.
AND INSTITUTIONAL A LEVEL OF
CARE AND THAT. THAT SWEET EVAN
LOW SERVICES AROUND TRANSITIONS
HOME MEDICALLY TAILORED MEALS
HOME MODIFICATIONS THAT ALLOW
SOMEONE TO RESIDE SAFELY IN
THEIR HOMES. WE DO THINK WE'RE
GIVING THE MANAGED CARE PLANS
ALL THE TOOLS TO BE SUCCESSFUL
ON TO BUILD OUT- THAT DELIVERY
SYSTEM. AND THEN LASTLY ON ON.
THAT FRONT FOR THE LONG TERM
CARE AS WE BILD UP THOSE
INCLUDE SERVICES IT REALLY
GIVES US THE ROAD NOW TO. A
MANAGED TERMS. IN SUPPORTS BY
TWO TWENTY SO. FOR THAT NEXT.
SUBMISSION TO MAKE SURE THAT WE
ARE. THAT COULD HOUSE IN OUR
MANAGED CARE PLANS AND MAKING
SURE THAT BENEFICIARIES ARE
GETTING THE SERVICES THAT THEY
NEED- IN THE LOCATION. OF THAT
IS MOST APPROPRIATE FOR THEM
AND THEIR FAMILIES-
ADDITIONALLY FOR THE TRANSPLANT
SERVICES WOULD JUST. FOCUS HERE
THAT YOU KNOW. WE WENT ACROSS
THE STATE AND HEARD A FEEDBACK
FROM PEOPLE AROUND TRANSPLANT.
THE WAY THAT WE ARE CARVING OUT
SOMEONE NEEDS A MAJOR ORGAN
TRANSPLANT FROM MANAGED CARE TO
FEE FOR SERVICE. IT REALLY IS
JUST CREATING A LOT OF. ISSUES
FOR OUR BENEFICIARIES I'M GOING
IN AND OUT OF MANAGED CARE TO
FEE FOR SERVICE FOR ON THIS
SPECIFIC TYPE OF SERVICE. ARE
BOTH CONTINUITY OF CARE AS WELL
AS JUST RELATIONSHIP WITH THE
PROVIDER AND FAMILIES. REALLY
CREATED A LOT OF CHALLENGES.
AND WE HAD SUCCESS IN CERTAIN
COUNTIES WITH TRANSPLANTS BEING
CARVED IN A WE WILL BE
CONSIDERING THINGS LIKE CENTERS
OF EXCELLENCE IN ENSURING THAT
BENEFICIARIES ARE GETTING A
GREAT ACCESS TO- THOSE MAJOR
ORGAN TRANSPLANT SERVICES- BUT
REALLY THINK THAT IT IS IN THE
BEST INTEREST. OF THE
BENEFICIARY FOR THAT TO BE
CARVED IN IN STANDARDIZED
ACROSS THE STATE OF CALIFORNIA.
ON A DAY THE CURRENT NETWORK
ADEQUACY REQUIREMENTS FOR
SKILLED NURSING FACILITIES. AND
INTERMEDIATE CARE FACILITIES IS
TIMELY. ACCESS SINCE THE MEMBER
DOES NOT TRAVEL TO THE FACILITY
OUR TIME AND DISTANCE
REQUIREMENTS WERE NOT
IMPLEMENTED AT THE TIME. THAT
THE NETWORK ADEQUACY STANDARDS
WERE CODIFIED IN STATE-
STATUTE- THIS THERE IS NO
STANDARD IN STATE LAW A TWO
DAY. WHEN CONSIDERING THAT
SETTING TIME AND DISTANCE
STANDARDS- DUE TO DO AN OVERALL
KIND OF SHORTAGE. OF LONG TERM
CARE BEDS STATEWIDE- THE
DEPARTMENT WOULD NEED TO TAKE
INTO CONSIDERATION MANY FACTORS
SUCH AS BED AVAILABILITY.
DISABILITY CAPACITY AND
AVAILABILITY OF SPECIALTY
FACILITIES THAT MAY BE OUTSIDE
OF THE MEMBERS COUNTY OF
RESIDENCE. ON THE DEPARTMENT
DOES NOT RECOMMEND IMPLEMENTING
TIME DISTANCE STANDARD- FOR
LONG TERM CARE AT THIS TIME-
BUT- HAPPY TO ENGAGE IN ENSURE
THAT BENEFICIARIES HAVE. ON THE
OPTION FOR SERVICES REALLY
FOCUSED ON LOOKING AT ALL THE
AVAILABLE POTENTIAL SERVICES
INCLUDING- PROVIDING THOSE
ADDITIONAL ROB SERVICES SO
SOMEONE CAN REMAIN IN THEIR
HOME- TRANSITIONS TO ASSISTED
LIVING. FACILITIES AS MENTIONED
EARLIER UNLIKE RCF VI'S AND
ARCS I'M IN LOOKING AT THE FULL
ARRAY OF OPTIONS FOR SOMEONE IN
LONG TERM SERVICES AND SUPPORTS
AND NOT ONLY LOOKING AT.
SKILLED NURSING FACILITIES ARE
REALLY FOCUSING ON. A NETWORK
ADEQUACY TO ALL OF THOSE
SERVICES INCLUDING THE RAMP UP
OF OUR AND- OF SERVICES OFFERED
THROUGH- CALLIN. AND LASTLY
WOULD JUST NOTE THAT CURRENTLY
THE DEPARTMENT REVIEWS MEMBER
EXPERIENCE FOR THOSE SERVICES
FOCUSED ON- CURRENTLY DONE
THREE STUDIES CONDUCTED BY OUR
EXTERNAL QUALITY REVIEW.
ORGANIZATIONS UP THAT.
CONCLUDES MY COMMENTS AT THIS
TIME. THANK YOU VERY MUCH. WE
WILL NOW ON TO OUR SECOND
PANELIST- BEN JOHNSON. GOOD
AFTERNOON I HAVEN'T WE
RECOGNIZE THAT THE BENEFITS OF
STANDARDIZING WHICH MEDIC CAL
DELIVERY SYSTEM IS RESPONSIBLE
FOR WHICH BENEFITS- AND NOW
ALSO JUST TURNED- SORT OF
REALLY FOCUSING ON ON THE
TRANSITION OF INSTITUTIONAL
LONG TERM CARE SERVICES INTO
MANAGED CARE ON A ON A
STATEWIDE BASIS- WE TAKE NO
ISSUE WITH THE PROPOSED CARBON
OF THIS BENEFIT AND DO YOU SEE
THE BENEFITS THAT DIRECTOR
COOPER- DISCUSSED ALIGNING THE
FINANCIAL RESPONSIBILITY FOR
INSTITUTIONAL LONG TERM CARE
AND THE LONG TERM SERVICES AND
SUPPORTS RELATED IN THE
SERVICES AND OTHER CALLIN
BENEFITS THAT- THAT- THAT ARE
PROPOSED. HAVING PLANS BOTH
COVER BOTH DAYS BOTH OF THESE
SERVICES GIVES THEM THE FISCAL
INCENTIVES TO DIVERT
UNNECESSARY INSTITUTIONAL LONG
TERM CARE PLACEMENTS- THROUGH
THE PROVISION OF IMPROVED CORN-
PREVENTIVE CARE AND WE'D ALSO
JUST NOTE THAT THIS FISCAL
INCENTIVE IS FURTHER IMPROVED
BY THE ADMINISTRATION'S
PROPOSAL TO BLEND THE CAPITATED
RATES PAID TO PLANS FOR SENIORS
AND PERSONS WITH THE
DISABILITIES- THAT RESIDE IN
THE COMMUNITY AND THOSE THAT
RESIDE IN LONG TERM CARE
FACILITIES WHICH REALLY PLACES
PLANS AT RISK- FOR THE LONG
TERM CARE STAYS. OF THEIR
MEMBERS TO A GREATER DEGREE
THAN CURRENTLY- AND THEN LASTLY
WE DON'T HAVE CONCERNS WITH THE
GOVERNOR'S PROPOSALS TO
PROPOSAL TO TIE THE RATES OF-
THESE CARVINGS TO- MEDIC
HEALTHY FOR SERVICE RATES-
UNLESS ANOTHER RATE IS MUTUALLY
AGREED UPON- WEEK WE FIND THAT
THE POLICY PROTECTS BOTH PLANS
AND PROVIDERS AS WELL FROM
ABRUPT CHANGES TO THE RATES
THAT ARE PAID WHICH WE
UNDERSTAND HAVE OCCURRED DURING
PAST BENEFIT TRANSITIONS-
DESPITE THEIR REALLY BEING NO
UNDERLYING CHANGES IN IN THE
COSTS OF PROVIDING THOSE
SERVICES- AND THAT WITH THAT.
WITHOUT I WILL CONCLUDE MY
REMARKS THANK YOU. THANK YOU
VERY MUCH AND WE MOVE ON ABBY
COURSE ALL- SENIOR ATTORNEY FOR
NATIONAL HEALTH LAW PROGRAM.
THANK YOU VERY MUCH MY NAME IS
ATTY COURSE ON A SENIOR
ATTORNEY WITH THE NATIONAL
HEALTH LAW PROGRAM BASED IN LOS
ANGELES OUR MISSION IS TO
PROTECT AND ADVANCE THE LOK THE
HEALTH RIGHTS OF LOW INCOME AND
UNDERSERVED INDIVIDUALS AND
COMMUNITIES. AND WITH THE
WESTERN CENTER ON LAW AND
POVERTY WE SERVE AS ONE OF THE
SUPPORT CENTERS FOR THE HEALTH
CONSUMER LINES. I'M REALLY
GRATEFUL TO THE COMMITTEES FOR
HOLDING THIS IMPORTANT HEARING
TODAY. AND WE REALLY APPRECIATE
APARTMENTS WORK ON THE REVISED
TELLING PROPOSAL WHICH HAS
GREAT POTENTIAL TO IMPROVE THE
HEALTH OF CALIFORNIA'S THIRTEEN
MILLION MEDICARE BENEFICIARIES
AND START MOVING OUR STATE
TOWARD REDUCING HEALTH
DISPARITIES. WE SUPPORT THE
PROPOSAL TO STANDARDIZE
BENEFITS OFFERED BY MANAGED
CARE PLANS ACROSS THE STATE IN
CONCEPTS. HAVING ONE SORT OF
CARVED IN BENEFITS- FOR THE
STATE WILL LESSEN
ADMINISTRATIVE. BURDEN FOR ALL
STAKEHOLDERS. I MEAN WILL
REDUCE CONFUSION FOR PROVIDERS
BENEFICIARIES AND PLANS- WE
REALLY EMPHASIZE THOUGH THAT
TRANSITIONS MUST BE MANAGED
CAREFULLY TO ENSURE THE CHANGES
DON'T DISRUPT CARE FOR
BENEFICIARIES. AS YOU'RE WELL
AWARE PASSED BENEFIT TRANSITION
TO MEDICARE HAVE NOT ALWAYS
PROCEEDED SMOOTHLY AND
SOMETIMES HAVE RESULTED IN
MAJOR SERVICE DISRUPTIONS AND
BENEFITS YEAR IS EXPERIENCING
GAS. MANAGING THIS TRANSITION
IT CAREFULLY IS REALLY
IMPORTANT ESPECIALLY GIVEN THAT
IT'S TIME TO COINCIDE WITH THE
UPCOMING OTHER TRANSITIONS
INCLUDING BUT CARVE OUT OF
PRESCRIPTION DRUGS THAT JC
MENTIONED- AS WELL AS THE
CHANGES TO WHO WILL BE
MANDATORILY ENROLLED IN MANAGED
CARE. SO WE'RE CONCERNED THAT
ALL OF THESE CHANGES HAPPENING
AROUND THE SAME TIME WILL BE
PARTICULARLY CONFUSING. TO
ENSURE THAT THE TRANSITION AS
SMOOTH WE RECOMMEND THE
LEGISLATURE PROVIDE MORE
DIRECTION TO DCS AND MAINTAIN
OVERSIGHT OVER THE TRANSITION.
SPECIFICALLY WE RECOMMEND THAT
THE LEGISLATURE SPECIFYING
STATUTES WHICH BENEFITS WILL BE
DELIVERED ON THE MANAGED CARE
VERSUS THE FOR SERVICE BASIS.
AND WE ALSO RECOMMEND THAT THE
LEGISLATURE. ADOPTED A STATUTE
AND ADAPT EXISTING PROTECTION
FROM ALL PLANNED LETTER
EIGHTEEN DASH OH OH EIGHT. AND
THE KNOX KEEN ACTS TO ENSURE
THAT ALL BENEFICIARIES WHO
SERVICES ARE MOVING FROM ONE
DELIVERY SYSTEM TO ANOTHER. ARE
GUARANTEED AT LEAST TWELVE
MONTHS OF CONTINUITY OF CARE
WITH THEIR EXISTING PROVIDER
AND THAT SHOULD HAPPEN IN BOTH
DIRECTIONS REGARDLESS OF
WHETHER SOMEONE IS MOVING FROM
MANAGED CARE TO FEED YOU FOR
SERVICE OR VICE VERSA. THE
LEGISLATURE SHOULD ALSO WORK
WITH THE EACH YES TO ENSURE
THAT IT. PROVIDES TIMELY
ADEQUATE NOTICE AND OTHER FORMS
OF OUTREACH TO BENEFICIARIES
PROVIDERS AND CAREGIVERS. OF
THE TRANSITION AND THE CHANGES
FULL OF WELL IN ADVANCE. I
NOTICED AN AVERAGE MUST BE
CONDUCTED IN ALL THRESHOLD
LANGUAGES IDEALLY IN
PARTNERSHIP WITH COMMUNITY
BASED ORGANIZATIONS. FINALLY
GIVEN THE MULTITUDE OF CHANGES
COMING TO MEDIC HOUSE SAME TIME
LEGISLATURE SHOULD CONTINUE
FUNDING ADDITIONAL CONSUMER
SYSTEMS THE MEDIC HOW FISHERIES
TO HELP OUR REGION THIS
POPULATIONS. AND TO INFORM
PEOPLE OF THE UPCOMING CHANGES
AND ASSIST THEM IN NAVIGATING
THE CHANGES AS THEY OCCUR. WITH
RESPECT TO THE QUESTION OF
RATES- ENSURING PROVIDERS OF
BENEFITS ARE MOVED FROM THE FOR
SERVICE TO MANAGED CARE PAID AT
LEAST THE SAME RATE ARE
CURRENTLY PAID. IS A KEY
COMPONENT OF ENSURING THAT
MEDIC COUNTY TEENS A ROBUST
NETWORK OF THESE PROVIDERS.
IT'S ALSO CRUCIAL THAT
PROVIDERS ACCEPT THIS PAYMENT
AS PAYMENT IN FULL AS REQUIRED
BY FEDERAL LAW AND DO NOT
BALANCE BILL BENEFICIARIES FOR
SERVICES. OVER THE PAST SEVERAL
YEARS THIS LEGISLATURE HAS
TAKEN SEVERAL HISTORIC STEPS TO
REGULATE NETWORK ADEQUACY FOR
MEDICO. TO ENSURE THE
BENEFICIARIES HAVE ACCESS TO
COVER SERVICES AND TO COMPLY
WITH THE FEDERAL MEDICAID
MANAGED CARE RULES. THOSE
INCLUDE TIMELY ACCESS STANDARDS
OF STACY MENTION FOR SKILLED
NURSING AND INTERMEDIATE CARE
FACILITIES. THE BENEFICIARY SO
OFTEN STRUGGLE TO ACCESS THE
FULL RANGE OF LONG TERM
SERVICES AND SUPPORTS. THEY
NEED ESPECIALLY AT HOME AND IN
THEIR COMMUNITIES. THE
LEGISLATURE SHOULD DIRECT YOU
SEE HAS TO WORK WITH
STAKEHOLDERS INCLUDING
BENEFICIARY ADVOCATES. TO UP A-
ADOPT APPROPRIATE NETWORK
ADEQUACY STANDARDS FOR THE FULL
RANGE OF LONG TERM COMMUNITY.
LONG TERM SERVICES AND SUPPORTS
INCLUDING GEOGRAPHIC ACCESS
STANDARDS. AND MONITOR ACCESS
TO THOSE SERVICES. TO ENSURE
THAT ALL BENEFICIARIES HAVE
ACCESS TO WHAT THEY NEED. THANK
YOU AGAIN FOR THE OPPORTUNITY
THAT CONCLUDES MY REMARKS.
THANK YOU VERY MUCH. WILL MOVE
ON TO STACEY SOLOMON. A
DIRECTOR OF OPERATIONS FOR
MOUNTAIN SHADOWS. ATM GOOD
AFTERNOON MISTER CHAIR AND-
MEMBERS I WANT TO THANK YOU FOR
THE OPPORTUNITY TO PARTICIPATE
THIS AFTERNOON. AND TO THANK
YOU AND YOUR COLLEAGUES FOR
YOUR TREMENDOUS SUPPORT THIS
PAST YEAR MY NAME IS STACEY
SOLOMON I'M THE PRESIDENT OF
DEVELOPMENTAL SERVICES NETWORK.
AN ASSOCIATION OF SMALL
RESIDENTIAL PROVIDERS- MAINLY
FORTY SIX BEDS TO SUPPORT
RESIDENTS WITH DEVELOPMENTAL
AND INTELLECTUAL DISABILITIES.
I'M ALSO THE DIRECTOR OF
OPERATIONS OF MOUNTAIN CHAU
SUPPORT GROUP AND COMMUNITY
BASED NONPROFIT WHICH IS
PROVIDED SERVICES AND SUPPORTS
TO INSTANCE ADOLESCENTS ADULTS
SENIORS WITH INTELLECTUAL AND
DEVELOPMENTAL DISABILITIES
INSTATED WHEN RIVERSIDE OVER
THIRTY FIVE YEARS. OUR SMALL
HOMES FORTY SIX BEDS PROVIDE
TWENTY FOUR HOUR PERSONAL CARE
SPECIALIZED ABILITY SHIN AND
DEVELOPMENTAL IN SUPPORT OF
HEALTH SERVICES. WE ARE CALLED
ICF DD AND AN H. FACILITIES AN
OUTDATED TERM USED BY THE
FEDERAL GOVERNMENT HOWEVER OUR
HOMES ARE NOT FACILITIES THEY
ARE HOMES WE ARE FOR PEOPLE
WITH INTELLECTUAL AND
DEVELOPMENTAL DISABILITIES A
VALUED COMMUNITY LIVING OPTION.
THAT ALSO PROVIDES SPECIALIZED
HEALTH CARE IN THE BILL TATIAN
SERVICES. THERE ARE
APPROXIMATELY ONE THOUSAND AND
THIRTY FIVE ICF HOMES MAINLY
FOR SIXPENCE SERVING SEVEN
THOUSAND PEOPLE IN COMMUNITIES
THROUGHOUT CALIFORNIA. LOW
PROVIDERS. OPERATE ONE OR TWO
HOMES THERE THE SMALL PROVIDERS
WE ARE 100% RELIANT ON THAT
ACCOUNT FOR REIMBURSEMENT
MEDICARE AND COMMERCIAL
INSURANCE DID NOT COVER
RESIDENTIAL SERVICES OUR
RESIDENTS MAKES IS VERY DIVERSE
FROM CHILDREN LIKE TO RURAL
BABY ARE WHO LIVES IN ONE OF
OUR HOMES IN RIVERSIDE TO
SENIORS LIKE RICHARD WHO'S
EIGHTY TWO YEARS YOUNG AND
LIVES IN ONE OF OUR HOMES AND
CBO. WE ADDRESS INDIVIDUAL
NEEDS BASED ON PERSON CENTERED
APPROACH MOST RESIDENTS LEAVE
LIVE IN THE SAME HOME FOR MANY
YEARS. WE ARE GOVERNED BY THREE
STATE DEPARTMENTS THE
DEPARTMENT AVAILABLE SERVICES
THE DEPARTMENT OF PUBLIC HEALTH
AND THE DEPARTMENT OF HEALTH
CARE SERVICES. WE'RE BEING-SWEPT UP INTO CAL IN ONLY
BECAUSE WE'RE PAID BY DH CS ON
A FEE FOR SERVICES BASIS. AND
PROVIDE LONG TERM RESIDENTIAL
SERVICES WITH SPECIALIZED
ASSISTANCE. FROM A SERVICE
PROVIDER AND GOVERNANCE
PERSPECTIVE WE ARE PART OF THE
DEPARTMENT OF VALUABLE SERVICE
AND REGIONAL CENTER SYSTEM. OUR
RESIDENTIAL SERVICES ARE FOR
INDIVIDUALS WITH INTELLECTUAL
AND DEVELOPMENTAL DISABILITIES.
THIS IS NOT HISTORICALLY AN
AREA MUCH MEDIC CAL MANAGED
CARE PLANS ARE KNOWLEDGEABLE.
THE PROPOSED COUNTING CHANGE
AFFECTS FOR MEDICAL RATES AND
ALSO AFFECTS FOR GOVERNANCE
STRUCTURE FOR IT SHIFTS OUR
PROGRAM FROM BEING UNDER
DEPARTMENT OF JOB DEVELOPMENTAL
SERVICES. AND THE REGIONAL
CENTER SYSTEM TO BEING UNDER
MEDICARE MANAGED CARE. ANY
BROAD MOVEMENT INTO MEDICAID
MANAGED CARE REQUIRES A CLEAR
AND DIRECT PROCESS AS WELL AS
DISCUSSIONS WITH THE DEPARTMENT
OF VITAL SERVICES. AND THE
REGIONAL CENTERS TO ADMINISTER
THE SERVICE DELIVERY SYSTEM
WITH DH CS WHO PAYS A RATES.
THIS HAS NOT OCCURRED THERE HAS
BEEN NO CAL NO COUNTY WORK
GROUP TO DISCUSS THE SPECIFIC
NEEDS OF OUR HOMES FOR THE MOST
IMPORTANTLY THE RESIDENTS WITH
ID THAT WE SUPPORT. WE HAVE
SUBMITTED LETTERS TO THE
ADMINISTRATION DH CS AND DS
LAST YEAR AND AGAIN THIS YEAR
WITH DETAILED QUESTIONS.
HOWEVER WE HAVE NOT YET
RECEIVED ANY MEANINGFUL
ENGAGEMENT REGARDING OUR
QUESTIONS FOR EXAMPLE. REGIONAL
CENTER REFER PEOPLE WITH ADD TO
US BASED UPON OUR PERSON
CENTRED PLANNING PROCESS AND WE
WORK WITH THE INDIVIDUAL FAMILY
AND REGIONAL CENTER SERVICE
COORDINATOR TO CHOOSE A HOME.
THAT MEETS THEIR NEEDS WELL
MEDICAID MANAGED CARE PLANS NOW
HAVE THIS ROLE. HOW WILL THE
CAL IN CRISIS INTERACT THE
OVERSIGHT AND PROGRAM
REQUIREMENTS. DDS AND THE
REGIONAL CENTERS. CALENBERG
PERSONNEL MAN CARE TO SERVE NEW
LONG TERM CARE POLICY TO PURSUE
TO. D. H. C. IS. AS PART OF
THIS CONVERSATION WE ARE
UNCLEAR AND HOW THIS WILL
AFFECT OUR SERVICES ARE HOMES
AND THE RESIDENTS. I HAVE A
HOME MAY HAVE RESIDENTS FROM
DIFFERENT REGIONAL CENTERS.
UNDER CAL AIN'T THERE WOULD BE
THE LIKELIHOOD OF HAVING AT
LEAST TWO MEDICARE MANAGED CARE
PLANS. AND POTENTIALLY SOME FEE
FOR SERVICE INDIVIDUALS HOW
WILL THIS BE COORDINATED AND
WHAT ENTITY WILL BE RESPONSIBLE
FOR THE COORDINATION. OUR
MEDICAL RATES CONTINUE TO BE
FROZEN AT THE TWO THOUSAND.
EIGHT NINE LEVEL WHAT THE
TEMPORARY SUPPLEMENTAL PAYMENTS
SINCE TWO THOUSAND SEVENTEEN
EIGHTEEN AND A MUCH NEEDED AND
APPRECIATED TEMPORARY COVER
NINETEEN RATE ADJUSTMENT. I
WILL COUNTY AND RESOLVE ISSUES
WITH THE CURRENT RATE STRUCTURE
BEFORE SYSTEM CHANGES OCCUR.
STANDARDIZED CONTRACTS
STANDARDISED PAYMENT CLARITY ON
DISPUTE RESOLUTION PROCESS ARE
ALL NEEDED AND ARE AND ARE ALL
PRESENTLY UNKNOWN AT THIS TIME
IT'S ALSO UNCLEAR IS HOW
NETWORK ADEQUACY FOR THE ICF DD
AND ACH HOMES WILL BE
DETERMINED. OUR HOMES ARE
LINKED WITH THE DEPARTMENT OF
DEVELOPMENT SERVICES REGARDING
THE FUNDING OF DAY PROGRAM AND
TRANSPORTATION SERVICES
RECEIVED BY RESIDENTS RESIDING
IN OUR HOMES. THIS ARRANGEMENT
GENERATES OVER SIXTEEN MILLION.
AND GENERAL FUND ANALYSTS AT
THE STATE HOW THIS MAY INVOLVE
WITH CAROLINE WE DO NOT BELIEVE
THE STATE CAN OBTAIN THESE
GENERAL FUND REVENUES ANY
LONGER UNDER THE COUNTING
CHANGES. THESE ARE BUT IF
YOU'RE A QUESTIONS AND WE HAVE
MANY MORE. YET THERE'S BEEN NO
ACTIVE ENGAGEMENT BY THE
ADMINISTRATION AND NO RESPONSES
TO THE LETTERS WE SENT LAST
YEAR MOST OF THIS YEAR.
THEREFORE WE ASK THE HOUSE
COMMITTEE TO DELAYAYE CFDT N.
H. HOMES FROM THE CALTRAIN
PROPOSAL UNTIL AFTER A WORK
GROUP. UNDER UNIQUE ISSUES HAS
BEEN CONVENED WITH
RECOMMENDATIONS REPORTED. OUT
THANK YOU. FOR YOUR
CONSIDERATION AND FIND. THANK
YOU VERY MUCH- TURN BACK TO THE
COMMITTEE PER OR COMMENTS
NOBODY. I HAVE A I HAVE A
COMMENT AND THEN I DID THEN IT
AND THEN A QUESTION- AND THIS
IS JUST- THIS IS FOR THE
DEPARTMENT SO- YEAH MOST
MEDICARE BENEFICIARIES- HAFTER
ENROLL IN A PLAN BY LAW. AND I
THINK THE PROPOSED LANGUAGE
HERE NEEDS TO BE MORE FOCUSED
ON THE SHIP OF BENEFITS
PROPOSING CAL NAME AS PROPOSED
TO GRANTING DEPARTMENT BROAD
AUTHORITY TO SHIFT BENEFITS IN
AND OUT OF MANAGED CARE- I.
COMMENT AT THIS POINT- BUT IT'S
PRETTY BROAD AUTHORITY AND- I
DO I DO GET CONCERNED THAT-
THAT AFFECTS HOW THE
LEGISLATURE MIGHT INTERACT IN
THE FUTURE SO- NOT ASKING FOR
COMMENT THIS POINT IT'S JUST
IT'S JUST- A CONCERN THAT I
HAVE. BUT ALSO I WILL GO TO A
QUICK QUESTION AND CONCERN- NOW
BROUGHT THE CONCERN BROUGHT UP
BY- MISS SULLIVAN- IN THE
DESIRE FOR A WORK GROUP HERE-
TO DISCUSS SOME OF THE ISSUES
OF CONCERNS- DO YOU CAN I GET A
REACTION FROM THE
ADMINISTRATION ON THAT- IS
THERE A PLAN FOR A WORK GROUP
TO LOOK AT SOME OF THESE ISSUES.
SO WE DON'T HAVE PLANS FOR A
FULL WORK GROUP BUT WE HAVE
REACHED OUT OF REQUESTING A
MEETING TO DISCUSS OF THE ITEMS
THAT WERE REYES WE ALSO HAVE
BEEN WORKING WITH. THE
DEPARTMENT OF DEVELOPMENTAL
SERVICES- ENGINES WOULD KNOW
THAT WE DO HAVE AYE CFTC'S
CARDEN IN COAST COUNTIES TO
DAY. OF INTO WORKING AND
LEVERAGING OUR LESSONS LEARNED
FROM THAT AS WE TAKE THE
PROPOSAL- STATEWIDE- AND KNOW
THAT WE HAVE HAD A HANDFUL OF
CONVERSATIONS INTO THE SPACE
BUT WE ARE. A VERY ODD YOU KNOW
WEB NO PROBLEM ENGAGING OUR
ANSWERING ADDITIONAL QUOTES.
THE ACCORD NEEDING IN ENSURING
THAT THESE INDIVIDUALS HAVE- NO
NO CHANGES IN REGARDS TO THE
SERVICES THAT THEY ARE
RECEIVING AND IT'S ME THIS
TRANSITION OF POSSIBLE- AND-
TRULY SOME POTENTIAL BENEFITS
IN REGARDS TO- THE
COORDINATION- AND REYES ASPECTS
REYES DID. IN REGARDS TO THE
TRANSITION TO MANAGED CARE
STATEWIDE AGAIN IN ADDITION TO
WHERE WE ALREADY HAVE A. CARD
INTO MANAGED CARE BECAUSE
COUNTIES TODAY- WELL I GUESS I
GUESS THEN THAT IF THERE IS A
NOTE IN THERE THERE'S NO PLAN
FOR A WORK GROUP IT. IT STILL
SOUNDS LIKE. CORNIA ALL OF AND
THAT A LOT OF THEIR LETTERS AND
CONCERNS. HAVE KIND OF FALLEN
ON DEAF EARS THERE HASN'T BEEN
ANY ENGAGEMENT WITH
STAKEHOLDERS SO WHAT IS THE
PLAN IF YOU YOU SAID YOU'RE
WILLING TO BUT WHAT IS THE
PLAN. TO ACTUALLY ENGAGE-
BECAUSE THESE THESE ARE BIG
CHANGES- AND- THAT'S WHAT THE
REASONS WERE HAVING HEARING
HERE TODAY- IS TO LOOK AT SOME
OF THESE SO WHAT ARE YOU KNOW
WHAT IS THE PLAN TO ENGAGE-
WITH WITH STAKEHOLDERS. SO WE I
BELIEVE THERE'S ALREADY A
MEETING ON THE BOOKS IN REGARDS
TO MEETING AND HEARING FROM
STAKEHOLDERS- THE- BASED ON THE
LETTER THAT WE RECEIVED- AND IF
THE MEETING ISN'T ALREADY ON
THE BOOKS I KNOW THAT WE ARE
ACTIVELY WORKING TO SCHEDULE IT
AS WE'VE HAD A LOT OF
CONVERSATIONS WITH- YES THEN ON
COORDINATING THAT. AND HAVE HAD
CONVERSATIONS REGARDING THE
ITEMS REYES WITH A DDS SO WHAT
I WOULD SAY IS YOU KNOW WE'RE
NOT GOING TO HAVE A LARGE.
WORKGROUP WE ARE VERY COMMITTED
TO WORKING WITH STAKEHOLDERS
TO. PROVIDE RESPONSES- AND WORK
THROUGH ANY OF THE ISSUES-
NECESSARY- AND HAPPY TO EVEN
REACH OUT DIRECTLY TO MISSILE
THEN AFTER THIS MEETING TO
ENSURE THAT. I'M SHE AND OR ANY
REPRESENTATIVES ARE INCLUDED
AND NOT JUST- SOME OF THE
INDIVIDUALS WHO ARE CURRENTLY
COORDINATING TO GET THAT
MEETING ON THE BOOKS. OKAY
THANK YOU AND WE WILL FOLLOW UP
AND- AFTER AFTER THAT MEETING
TAKES PLACE AND SO THANK YOU
VERY MUCH. I THANK YOU TO THE
ENTIRE PANEL- MUCH MUCH
APPRECIATED- WE'LL GO AHEAD
AND- HAVE. DOCTOR ARAMBULA
INTRODUCE OUR FINAL PANEL.
THANK YOU. WE WILL NOW HAVE OUR
LAST PANEL ON PROPOSED TO
STANDARDIZATION OF MANDATORY
ELIGIBILITY FOR MEDICARE
MANAGED CARE PLANS. WE WILL
HAVE FOUR SPEAKERS ON THIS
PANEL WE WILL BEGIN WITH G. C.
COOPER FOLLOWED BY BEN JOHNSON.
LINDA WAY AND THEN WHEN
CHRISSY. TRACY CAN YOU BEGIN
PLEASE. OUR AND SO IN THIS
PROPOSAL- THE DEPARTMENT IS-
PROPOSING YOU STANDARDIZE WHO.
TODAY ENROLLMENT IS BASED ON A
NUMBER OF FACTORS IT BURIES
BASED ON GEOGRAPHICAL AREAS-
THE MANAGED CARE MODEL AND OR
VARIOUS EIGHT CODE- THAT THE
BENEFICIARIES AND KIND OF
DETERMINING WHERE INDIVIDUALS
ARE ENROLLED. ON THE CALIPER
POSTAL WORKS TO STANDARDIZE
WHICH AID- CODE GROUPS WILL
REQUIRE MANDATORY MANAGED CARE
VERSES- MANDATORY FEE FOR
SERVICE ENROLLMENT STATEWIDE.
IMPLEMENTATION DOES OCCUR IN
TWO PHASES SO TRANSITIONING NON
DUAL ELIGIBLE POPULATIONS IN
TWENTY TWENTY TWO AND DUAL
ELIGIBLE AND LONG TERM.
INSTITUTIONAL POPULATIONS IN
TWENTY TWENTY THREE I'M SO BY
THE END OF ALL THOSE
TRANSITIONS ARE WE ARE
PROPOSING. MANDATORY MANAGED
CARE IN ADDITION TO OF COURSE
THOSE THAT ARE IN THAT CATEGORY
TODAY ALL DUEL AND NON DUAL
INDIVIDUALS ELIGIBLE FOR LONG
TERM CARE SERVICES. ALL FULL
SCOPE PARTIAL AND FULL DUAL
EIGHT CODE GROUPS AMERICAN
INDIANS HOWEVER WITH NOTES HERE
ARE THEY DO HAVE THE OPTION TO-
VOLUNTARILY GO TO FEE FOR
SERVICE- FOR AMERICAN INDIANS
THE FEDERAL RIGHT WHICH WE ARE
PROTECTING FOR THEM. AS WELL AS
BENEFICIARIES WITH OTHER HEALTH
COVERAGE I'M HERE I WOULD JUST
NOTE AS WE LOOKED AT OUR DATA
OVER 70% OF INDIVIDUALS WITH
OTHER HEALTH COVERAGE WERE
ALREADY ENROLLED IN MANAGED
CARE. IN WE HAVE ROBUST A
REQUIREMENTS IN REGARDS TO
COORDINATION OF CARE FOR
INDIVIDUALS WITH OTHER HEALTH
COVERAGE WITHIN OUR MANAGED
CARE PLAN SO- WHICH IS WHY WE
ARE RECOMMENDING THOSE I MOVED
TO MANDATORY MANAGED CARE
VERSUS PREVIOUSLY WAS. A
VOLUNTARY. AYE BENEFICIARIES
LIVING IN ROLES THAT CODE SO WE
STILL HAVE CERTAIN ZIP CODES WE
HAVE NOT MOVED INTO MANAGED
CARE- AND THAT WOULD BURKE-
OUTPUT IS AT A STATEWIDE-
MANAGED OPPORTUNITIES FOR
BENEFICIARIES. AS WELL AS- SOME
OTHER POPULATIONS INCLUDING-
TRACK- TRAFFICKING AND CRIME
FIX A VICTIM ASSISTANCE
PROGRAMS INDIVIDUALS
PARTICIPATING IN ACCELERATED
ENROLLMENT- AND A CHILDREN AND
HELP- CTP IN THE DEEMING WITH
ALSO GO INTO MANDATORY MANAGED.
CARE FOR THE POPULATIONS WOULD
BE. ON THE- REMAINING AT
MANDATORY FEE FIRST IN. BUT
INCLUDE RUSHED SCOPE INTO. ARE
THAT DON'T OTHERWISE HAVE ON
THE SCOPE BENEFITS. I'M SURE
CLASS INTO THE- INCLUDING INTO
THE AND CO TOWN- WHO ARE HAVE
SHARE CALL EXCLUDING. LONG TERM
CARE SHARE. UNDER THEN BECAUSE
ELLA IS WELL. FOR PREGNANCY
RELATED EIGHT CODES WE COOPER
TO ALL CITIES. OF EIGHT CO TO
FALLS MANY CARE ZERO TWO THREE
AND TWENTY TWO PER FEDERAL
POVERTY LAW. CURRENT A HUNDRED
THIRTY EIGHT OF THEM TWO
HUNDRED AND- PERCENT OF FEDERAL
POVERTY LEVEL WAS CARVED FEW
BEEPER SERVICE AND SO WE ARE
RECOMMENDING ACROSS THE ENTIRE
OF THE PREGNANCY RELATED EIGHT
CODES ALL TO BE OUR MANAGED
CARE FOR THAT PARTICULAR GROUP.
I GET WOMEN IN RESTAURANTS
SCHOOL DO TO ON. IN THE STATUS-
WOULD REMAIN IN FEE FOR SERVICE
DELIVERY SYSTEM ARE THE ONLY
EXCEPTION HERE IS TITLE TWENTY
TWO S. CHIP INDIVIDUALS TWO
HUNDRED AND THIRTEEN TO THREE
HUNDRED. AND 22% FEDERAL
POVERTY LEVEL WHICH WOULD
REMAIN IN MANAGED CARE WHERE
THEY ARE TODAY SO NO CHANGE FOR
INTO PREGNANT WOMEN- WITH
UNSATISFACTORY IMMIGRATION
STATUS IN REGARDS TO THEIR- I'M
ENROLLMENT IN MANAGED CARE AND
FEE FOR SERVICE. ADDITIONALLY
AS NOTED IN CALAIS AND WE HAVE
MADE NO OF PROPOSED CHANGES FOR
INDIVIDUALS WHO ARE. IN FOSTER
CARE- SERVICES ABOUT CHILDREN
YOUTH THEIR- WE ARE CURRENTLY
STILL CONVENING OUR FOSTER CARE
WORKGROUP WHO'S INFORMING
RECOMMENDATIONS THAT WORKER
GOES THROUGH JUNE OF TWENTY
TWENTY ONE. IN ANY
RECOMMENDATIONS WILL INFORM THE
DEPARTMENT'S FUTURE PROPOSAL
REGARDING CHANGES OBSERVED
TODAY IT IS STILL STATUS QUO.
FROM A BUDGET PERSPECTIVE ON
THE WITH THE PROPOSED CHANGES
BUT I WOULD NOTATE HERE IS THAT
THE ENROLLMENT CHANGES ARE
BUDGET NEUTRAL- ESSENTIALLY NO-
NEXT COSTS OR SAVINGS OVERALL.
I'M HOWEVER GIVEN THE FACT THAT
WE ARE A CASH BASED BUDGET- YOU
WILL SEE SOME- COSTS SCORED IN
THE BUDGET- IT TO REFLECT THE
CHANGE OF POPULATIONS AND
THAT'S REALLY BECAUSE IF YOU'RE
TRANSITIONING. POPULATION FROM
FEE FOR SERVICE TO MANAGE CARE
FOR EXAMPLE- YOU HAVE TO START
PAYING THE MANAGED CARE PLAN
THE CAPITATION RATE UP FOR THAT
TRANSITION IMMEDIATELY HOWEVER-
PROVIDER STILL HAVE UP TO THREE
HUNDRED SIXTY FIVE DAYS TO
SUBMIT ANY CLAIMS. ON A PAPER
SERVICE BASES THAT WERE
PROVIDED TO THAT BENEFIT YEAR
THE YEAR PRIOR TO THAT
TRANSITION- AND SO WE DO HAVE
TO ACCOUNT FOR THOSE TYPES OF
TRANSITIONS ON A CASH BASIS- SO
THAT'S WHY YOU SEE THAT
REFLECTED. WHEN IT COMES TO
CAUGHT OF CARE OFFERED. OF
POPULAR THAT ARE CHANGING- TO
MANAGE MANAGED. IN A DH CS WILL
REQUIRE THAT MEASURE PLAN- CAR
OF CARE THE EXIT COVER. OF
MANAGED CARE PLANS MUST ALLOW
THIS. EVEN IF THE PROVIDERS
OUTSIDE OF THE MANAGED CARE
PLANS NETWORK- AS LONG AS THE
PROVIDER IS WILLING TO ACCEPT
THE PLAN REIMBURSEMENT RATES-
AND THERE ARE NO QUALITY ISSUES
THIS IS IN ALIGNMENT WITH OUR
EXISTING CONTINUITY OF CARE
REQUIREENTS FOR MANAGED CARE
PLANS. IN WOULD BE REINFORCED
THAT THROUGH ALL OF THESE
TRANSITIONS OF COURSE THE ACS
WILL UPDATE ALL PLAN LETTERS
REGARDING THIS AS APPLICABLE TO
THIS TRANSITION TO ENSURE. A
MANAGED CARE PLANS KNOW THE
RESPONSIBILITIES FOR THESE
TRANSITION POPULATIONS AND OF
COURSE WE'LL DO OUR NORMAL AYE
TRANSITIONING MONITORING
EFFORTS AROUND. A CONTINUITY OF
CARE. UN READINESS BURKE. TO
ENSURE PLAN ARE A FOR THE
TRANSITION PHD WILL BE
RELEASING- AND ALL PLAY LETTER
THAT WILL OUTLINE THE GUARDIAN
REGARD THE TRANSITIONS- AND
WHAT WOULD BE REQUIRED FOR THE
PLANT TO ANSWERING FREQUENTLY
ASKED QUESTIONS AS WE TYPICALLY
DO. A THROUGH- THAT ALL PLANNED
OUT PROCESS- WE DO PLAN ON
ISSUING READY S. DELIVERABLES
NO LATER THAN JUNE OF TWENTY
TWENTY ONE SO PLANTS HAVE
ADEQUATE TIME TO PREPARE- THOSE
DELIVERABLES- AS WELL AS- ANY
OF THE MANAGED CARE PLANS
SPECIFIC BENEFICIARY DATA- FROM
THE FEE FOR SERVICE SO THEY
UNDERSTAND. THE TRANSITIONING
POPULATION WILL BE PROVIDED TO
THE MANAGED CARE PLANS IN THE
SPRING OR EARLY SUMMER OF
TWENTY TWENTY ONE SO MANAGED
CARE PLANS CAN- BE PREPARED FOR
THOSE TRANSITIONS. AS WELL AS
DH CS WILL BE ISSUING ANY
NETWORK ADEQUACY REQUIREMENTS
AND EXPECTATIONS OF FILING- TO
ENSURE THAT THE MANAGED CARE
PLANS KNOW WHAT THEY NEED TO
CONSIDER FOR THEIR FILING OF
NETWORK ADEQUACY IN TWENTY ONE.
BOARD JANUARY. OF TWENTY TWENTY
TWO. PRIOR TO IMPLEMENTING. OF
THE DEPARTMENT ALSO. A
COMMUNITY OUTREACH PLAN TO
INCLUDE VARIOUS- THAT THE
IMPACTED BENEFICIARIES WILL
RECEIVE COMMUNICATION- SUCH AS
MEMBER INFORMING NOTICES
REGARDING THE CHANGE OF
INFORMATIONAL MATERIALS ON PLAN
ENROLLMENT. AND MAKING SURE
THEY UNDERSTAND THEIR RIGHT TO
CONTINUITY OF CARE ON THROUGH
THE TRANSITION POST
IMPLEMENTATION WE WILL
IMPLEMENT OUR TRANSITIONAL
DAILY MONITORING- AS WELL AS
THE ONGOING QUARTERLY
MONITORING OF ALL ENROLLMENT
TRACK CHANGES. AS WE TYPICALLY
DO AS WE ARE CHANGE FROM PEOPLE
SERVICE TO MANAGED CARE SURE WE
ARE WATCHING THIS I TRANSITIONS
CLOSELY. AND THAT WOULD BE- ALL
MY COMMENTS AT THIS TIME. THANK
YOU VERY MUCH NEXT WE'LL HEAR
FROM BEN JOHNSON. WITH THE
LEGISLATIVE ANALYST'S OFFICE.
GOOD OR EVENING HERE- AGAIN J.
WANT TO START BY RECOGNIZING
THE BENEFITS OF STANDARDIZING-
MEDICAL POLICY ON A STATEWIDE
BASIS TO A GREATER DEGREE THAN
EXISTS TODAY WHERE DELIVERY
SYSTEM RESPONSIBILITY FOR
COVERING I CAN BENEFIT OR IN
ROWLEY POPULATION THIS CASE
THAT CAN VARY SIGNIFICANTLY.
JUST HAVE A COUPLE OF- I'VE
OUTSTANDING QUESTIONS THE FIRST
RELATES TO THE PROPOSED
TRANSITION OF WOMEN WITH
PREGNANCY ONLY COVERAGE TO
MANAGED CARE AND THIS RELATES
TO WHETHER ROLLING WOMEN. WITH
THIS COVERAGE IN MANAGED CARE
COULD CAUSE SOME DISRUPTIONS IN
THE CARE THEY RECEIVE-
TYPICALLY WHEN A NEW MINUTE
MEDICARE BENEFICIARY JOINS THE
PROGRAM- THEY WOULD FOR A
PERIOD OF TIME ACCESS SERVICES
THROUGH THE STATE'S FEE FOR
SERVICE DELIVERY SYSTEM
PROBABLY FOR AT LEAST A MONTH
MAYBE. MAYBE NINETY DAYS AND-
AND THEN THEY WOULD TRANSITION
OVER OVER TO MANAGED CARE SO
AND ROLLING- INDIVIDUAL WOMEN
WHO ARE IN COVERAGE FOR ALL-
ONE TO TWO YEARS COULD IT IN
THAT INITIAL PERIOD. CAUSE THEM
TO HAVE TO- POTENTIALLY SWITCH
UP A PROVIDER UNLESS- UNLESS
CERTAIN ADDITIONAL PROTECTIONS
WERE PUT IN PLACE FOR THIS
UNIQUE POPULATION SO. QUESTIONS
AROUND CONTINUITY OF THAT OF
THAT LIMITED TERM CARE THE
SECOND ONE IS THAT OVERALL- CAL
AIM REALLY EXPANDS THOSE THE
BENEFITS AND SERVICES THAT
MANAGED CARE PLANS WOULD BE
PROVIDING TO THEIR- TO THEIR
BENEFICIARIES. AND SO AND-
NATURALLY THEN THESE BENEFITS
WOULD LARGELY BE AVAILABLE TO
THOSE WHO ARE ENROLLED IN IN
MANAGED CARE. AND THIS LEAVES-
THIS COULD LEAVE OUT FOLKS- IN
RELEASING THE PROGRAM WHO
REMAIN ENROLLED IN THE STATE'S
FEE FOR SERVICE SYSTEM
INCLUDING CERTAIN- PRETTY HIGH
RISK HIGH NEED POPULATIONS- THE
NON. NON LONG TERM CARE- SHARE
OF COST SENIORS THE PERSON THAT
THIS. AS WELL AS FAR CHIU- WE
RECKON THE A WORKER CAN. ON ALL.
HOW IMPROVE CARE FOR FOSTER AND
SO DO LOOK FORWARD TO THE
RECOMMENDATIONS OF THE
WORKGROUP BUT AS THE
LEGISLATURE CONTINUES TO
DELIBERATE CALLING WAIT WE JUST
RECOMMEND THAT SOME THOUGHT BE
GIVEN TO- HOW- THESE NON
MANAGED CARE POPULATIONS ARE
GOING TO SHARE IN. MANY OF THE
NEW BENEFITS AND SERVICES THAT
CALLING WOULD CREATE THANK YOU.
THANK YOU NEXT WE WILL HEAR
FROM LINDA WAY WITH THE WESTERN
CENTER OF HOME LAUNCH POVERTY.
GOOD AFTERNOON AGAIN LED THE
WAY WITH WESTERN CENTER ON LAW
AND POVERTY WE HAVE CONCERNS
WITH THE DEPARTMENT'S PLAN TO
MOVE FORWARD WITHOUT ADEQUATELY
CONSIDERING THE FOLLOWING. AN
EVALUATION OF THE POPULATION
SPECIFIC PLAN READY NEXT
CRITERIA. SHARE AND GRAYSON
THIS MOMENT PASSED FOR
INDIVIDUALS OR CARE DOES NOT
WORK. FOR MAKING ANY CHANGE
DIRECT TENER. TO AND IN AN
ACCOUNT CARE PLAN THE
DEPARTMENT OF FIRST.
CHARACTERISTICS OF THE POPULAR
AND PROPOSED TO MOVE AND WHAT
YOU NEEDS THAT. HAS AND HOW
THEY WILL BE ADDRESSED IN THE
BENNETT. NEED UNTIL EARNED THEM.
WE UNDERSTAND THAT HAS EITHER
RUN I NEVER COLLECTED AND
CONTINUE TO REQUEST BE SURE
PUBLICLY. PRIOR TO ANY. THE
MUST ENSURE THAT IT TO APPLY
READING IT ABOUT YOU EACH THE
BEACH FOR COPY. AND AUTHORIZED
THE CHANCE TO BEGIN UNTIL IT IS
INSURED THE PLANT NETWORK ARE
ADEQUATE TO. NEED TO DOUBLE.
AND POPULATION HEALTH
MANAGEMENT. WE ARE CONCERNED
THAT THE DEPARTMENT TIMELINE OF
TRANSITIONING FROM POPULATION
AS EARLY AS NEXT JANUARY DOES
NOT ALLOW SUFFICIENT TIME TO
CONDUCT THE REQUISITE. THAT
LEVEL OF READINESS REVIEW AND
AS A RESULT SOME BENEFICIARIES
MAY EXPERIENCE DISRUPTIONS IN
CARE. THE DEPARTMENT MUST ALSO
PROVIDE SUFFICIENT ADVANCE
NOTICE OF THE TRANSITION TO THE%
AFFECTED POPULATION AND PROVIDE
CONTINUITY OF CARE AS OUTLINED
BY AND COURSE OLD TESTAMENT
WHICH INCLUDE NOT MAKING
CHANGES FOR PEOPLE NAY
PREGNANCY. DURING SOMEONE WHO
ROLLED IN PREGNANCY MEDICAID
HEALTH JULY AND IT DUE TO
DELIVER A BABY NEXT MARCH
SHOULD NOT BE FORCED TO CHANGE
DELIVERY AND MET. IN JANUARY.
WE ALSO QUESTIONED THE NEED TO
TREAT PREGNANT PEOPLE
DIFFERENTLY BASED ON
IMMIGRATION STATUS WE ARE
CONCERNED ABOUT THE EFFECT OF
MOVING ALL BUT CERTAIN
IMMIGRANTS NTO MANDATORY
MANAGED CARE WILL HAVE. ON THE
IMMIGRANT COMMUNITY GIVEN THEIR
CONCERNS REGARDING THE PRIVACY
OF THEIR INFORMATION. WE ALSO
REQUEST COMMUNITY CARE
PROTECTIONS THE INFECTION FOR
ALL NEWLY ENROLLED MEDICAID
MANAGED CARE MEMBERS. WHO
REQUEST COMPANY NEED CARE THEY
SHOULD BE ALLOWED TO CONTINUE
TO BE PROVIDERS WITH WHICH THEY
HAVE A PRE EXISTING
RELATIONSHIP FOR AT LEAST
TWELVE MONTHS FOR THE COURSE.
OF THEIR TREATMENT. FINALLY
BASED ON HALF TRANSITION WE
KNOW THAT MANAGED CARE DOES NOT
WORK FOR ALL MEMBERS. THE
REQUESTED THE MOMENT PROTECTION
HE SAID THAT YOU AND NOT BE.
OVERLY BURDENSOME NUMBER. NO
CAL ENROLLEES WITH UNSTABLE
COMPLEX CAN. THAT ARE LIKE.
SHOULD THE CHOICE TO STAY OUT
OF MANAGED CARE WITHOUT A TIME
LIMIT. ON THAT ACCOUNT AND
RELEASED LEVIN MEDICALLY
SUPPORTED REASON TO STAY MANAGE
CARE. SUCH AS NOT BEING ABLE TO
ACCESS THE RIGHT NATIONALIST
SHOULD BE ABLE TO REQUEST AN
EXTENSION. AT ANY TIME. THANK
YOU. THANK YOU NEXT WE WILL
HEAR FROM LYNN KERR C. WITH THE
MATERNAL CHILD HEALTH ACCESS.
AFTERNOON CHAIRS AND COMMITTEE
MEMBERS- MY NAME IS LYNN PERCY
I'M EXECUTIVE DIRECTOR FOR
MATERNAL AND CHILD HEALTH
ACCESS IN LOS ANGELES IT'S A
DIRECT SERVICE AND POLICY
ORGANIZATIONS CELEBRATING
TWENTY FIVE YEARS OF IMPROVING
COMMUNITY HEALTH. WE APPRECIATE
THE OPPORTUNITY TO SPEAK WITH
YOU THIS AFTERNOON GIVEN OUR
GRAVE CONCERNS ABOUT THE
PROPOSALS AND COUNTING TO
SWITCH TO MEDICARE RECIPIENTS
FROM SERVICE TO MANAGE CARE
DURING PREGNANCY. AND FOR
CHILDREN. WE BELIEVE CALIFORNIA
NEEDS TO IMPROVE SERVICES FOR
ALL CHILDREN AND PREGNANT
PEOPLE REGARDLESS OF THE
DELIVERY SYSTEM AND THAT WE
NEED TO FOCUS THEIR- STARTING
WITH SWITCHING INTO MANAGED
CARE DURING PREGNANCY THE
PERSON'S OF SOME ESSENTIAL
PERINATAL SPECIALTY CENTERS AND
HOSPITALS UCLA CEDARS
HUNTINGTON PASADENA ONLY
ACCEPT. MEDICARE FEE FOR
SERVICE LOSING ACCESS TO THESE
INSTITUTIONS AND SPECIFIC
CLINICS OFFEND THEM ESPECIALLY
PROBLEMATIC FOR HIGH RISK
PREGNANCIES. SECONDS AT THE
SERVICES TO ADDRESS ADDRESS THE
SOCIAL DETERMINANTS OF HEALTH
DURING PREGNANCY THROUGH THE
COMPREHENSIVE TECHNICAL
SERVICES PROGRAM ARE MORE
READILY AVAILABLE IN MANY CASES
WHEN MEDICARE OUT ISN'T THE FOR
SERVICE. ADDRESSING THE SOCIAL
DETERMINANTS IS A STATED GOAL
HELLO A- DEFECT ON THE A
DOCUMENT IS THE UNDOCUMENTED
HUSBAND STATED BY THE LAST TWO
SPEAKERS ONLY IN THIS PROPOSAL
ONLY INDIVIDUALS WHO ARE
UNDOCUMENTED MAY REMAIN IF YOU
FOR SERVICE DURING THEIR
PREGNANCIES. THIS REDESIGN A
PREGNANCY RELATED MEDICARE
PROGRAM TO COVER ONLY
UNDOCUMENTED PERSONS. BUT
UNDERMINE CONFIDENCE IN THE
PROGRAM. FOR THIS THE GROUP
TRAILER BILL LANGUAGE DISTRACT
TO BROWN IT WOULD GRANT EACH
YEAR THOR TERM MEDIC MEDICAID
MANAGED CARE ON ANY TYPE OF
PRESUMPTIVE XCELERATED PROGRAM
AS DETERMINED BY THE DEPARTMENT.
FINALLY THE CALIBER CLOSE WOULD
MAKE ACCESS TO A MIDWIFE EVEN
MORE DIFFICULT THAN IT ALREADY
IS BECAUSE MIDWIVES ARE NOT
ADEQUATELY CONTRACTED MEDICARE
MEDICARE DEPARTMENT POLICY
PREVENTS PLANS TO CONTRACT WITH
AS FEW AS ONE NURSE MIDWIFE ONE
LICENSED MIDWIFE. AND THIS
RATIO IS WOEFULLY INADEQUATE.
MOVING TO CHILDREN- CURRENTLY
CHILDREN ARE TEMPORARILY
ENROLLED THE ACCELERATED AT THE
MOMENT THEY RECEIVE THEIR
MEDICARE ON THE FOR SERVICE AND
ONE FINAL MEDICARE ELIGIBILITY
TO PROVE UP TO FORTY FIVE DAYS
LATER. THE FAMILY THEN HAS
ANOTHER THIRTY DAYS TO SELECT
THE PLAN PROVIDER UNDER THE
HEALTH CARE OPTIONS PROCESS. WE
COUNTY PROPOSAL WOULD MAKE
MANAGED CARE ENROLLMENT
MANDATORY DURING THE FIRST
THIRTY DAYS OF THE FOR SERVICE.
THIS WOULD MEAN A FAMILY COULD
HAVE AS MANY AS FORTY FIVE
FEWER DAYS TO ACCESS PEDIATRIC
PROVIDERS TO GET EXPERIENCE
WHICH PLANS AND SUPPLEMENTS
SUBGROUPS OF PROVIDERS. AND YOU
KNOW THE LAYERS COMPRISE THE
BEST NETWORK FOR THEIR THEIR
CHILDREN. A CHANGE OF THIS KIND
SHOULD NOT BE MADE UNDER THE
COVER OF CALTRAIN. WITHOUT
PROVISIONS- FOR AN OPPORTUNITY
TO. FOCUS GET COME SORRY
WITHOUT. THAT OPPORTUNITY FOR
FOCUS INPUT FROM AFFECTED
COMMUNITIES. SIMILARLY CALLIN
ALSO PROPOSES TO MOVE CERTAIN
INFANTS BORN TO MOM ON MEDICARE
OUT FROM PAPER SERVICE TO
MANAGED CARE IN THE MONEY INTO
THE MOTHER'S MEDICAL PLAN WHEN
THE FAMILY SEEKS TO PREVENTIVE
CARE CHECK UP. THIS WOULD
COMPLETELY BYPASSED THE
MANDATED HEALTH CARE OPTIONS
PROCESS AND MAKE THIS CHOICE
FOR THE FAMILY REGARDLESS OF
WHETHER THE FAMILY WOULD CHOOSE
ANOTHER SUPPLIER NOT. FAMILIES
WE GET NO PRIOR NOTICE THAT
THEY NEED TO CHOOSE A PRIMARY
CARE PROVIDER OR WHAT WHAT TO
DO WHEN THEY WANT TO MOVE A NEW
FOR TWO DIFFERENT PLANTS. THESE
CONCERNS ARE BASED ON ACTUAL
PROBLEMS BECAUSE FOR THE LAST
SEVERAL YEARS THE DEPARTMENT
HAS BEEN ENROLLING INFANTS INTO
PLANS WITHOUT EVEN GIVING PRIOR
NOTICE TO THE FAMILY ABOUT THE
PLANET ROAMING. IN JANUARY OF
THIS YEAR WE HELPED A FAMILY OF
A NEWBORN WITH INFECTIONS. AND
A COLLAPSED LUNG. AT SIX DAYS
AND UNIT INTENSIVE CARE YOU.
THE DEPARTMENT. ROLL THE INPUT
INTO THE MOTHER'S PLAN WITHOUT
PRIOR NOTICE TO THE MOTHER OR
THE OPPORTUNITY TO SELECT. AN
APPROPRIATE PLAN PROVIDERS AS A
RESULT THE END BUT MISSED. OUR
NICK YOU FOLLOW UP APPOINTMENTS
IT TOOK SIX WEEKS TO GET THIS
VERY VULNERABLE IN FACT.
ASSIGNED TO THE PEDIATRICIAN
SHE WAS SUPPOSED TO SEE. A
POSITIVE ALTERNATIVE TO THIS IS
ADOPTING MANAGE PAPER SERVICE
SOMETHING CALLED MANAGEMENT FOR
SERVICE FOR PREGNANCY RELATED
MEDICAL. CONNECTICUT HAS DONE
THIS FOR ITS MEDICAID
RECIPIENTS ALL THE WHOLE STATE
TO GREAT SUCCESS. ROBUST
OVERSIGHT AND MONITORING OF THE
SOCIAL DETERMINANTS AND OTHER
COMPONENTS OF THE EVIDENCE
BASED AND FEDERALLY FUNDED C.
DSP PROGRAM AND MANAGED CARE.
FOR THIS. C. S. B. WITH HOME TO
SUCH PROGRAMS BECAUSE
POSTPARTUM VISITS WHICH ARE
HEATERS ARE QUALITY MEASURE FOR
MANAGED CARE PLANS. HAVE NEVER
BEEN ADEQUATE IN THE PLANTS
BUT- MET 8290% BUT A HOME
VISITORS INVOLVED. AND FOURTH
REMOVING BARRIERS TO THE
PARTICIPATION OF MIDWIVES AND
MEDICAL. WE LOOK FORWARD TO
CONTINUING TO WORK WITH THE
DEPARTMENT TOWARD THE
SUBMISSIONS. AND I THANK YOU
FOR THE OPPORTUNITY TO SPEAK
TODAY. THANK YOU VERY MUCH AND
THAT CONCLUDES THIS PANEL I
WILL LOOK TO SEE IF THERE ARE
ANY QUESTIONS. I JUST I JUST
WANT YES THANK YOU THANK YOU
DOCTOR AND JUST A COUPLE- SO
OBVIOUSLY WE'VE HEARD. A LITTLE
BIT OF A CONCERN ABOUT. HER
FROM THE L. A. O. AND A COUPLE
OF OUR WITNESSES ABOUT
CONTINUITY OF CARE. AND THE
SWITCH. THE FOR SERVICE TO
MANAGED CARE. I LIKE TO THE
ADMINISTRATION TO COMMENT ON
THAT I MEAN YOU KNOW ONCE YOU
START IN A SYSTEM. WHERE YOU
KNOW PREGNANCY IS A FINITE
PERIOD OF TIME SO WHY NOT YOU
KNOW GRANDFATHER THAT PERSON IN
AND LET THEM STAY IN THAT
PROGRAM. RATHER THAN
TRANSITIONING TRANSITIONING
THEM AND WE HEARD YOU KNOW ALSO
CHEN CHALLENGES WITH LANGUAGE
AND SO ON SO WHY WHY THE DESIRE
TO- TO SWITCH YOU KNOW PEOPLE
THAT ARE IN THEIR PREGNANCY
ALREADY ALREADY IN THEIR
PREGNANCY TO IT TOO. TO A PLAN
IF THEY'RE IN THE FEE FOR
SERVICE SO JUST TO BE CLEAR AND
I KNOW THAT THERE'S NOT A LOT
OF DETAIL IN OUR PROPOSAL BUT
WE HAVE HAD CONVERSATIONS WITH
MANY STAKEHOLDERS REGARDING
THOSE THAT. ARE PROPOSAL WOULD
NOT BE TO TRANSITION SOMEONE
DURING THEIR PREGNANCY- IT
WOULD JUST BE THAT OUR FUTURE
FORWARD INDIVIDUALS AND ROLLING
IN. THE PROGRAM- AFTER THAT
THAT DATE OF JANUARY ONE OF
TWENTY TWENTY TWO THAT THEY
WOULD. IMMEDIATELY GO INTO
MANAGED CARE VERSES IN THE FEE
FOR SERVICE ENVIRONMENT AND SO
INTENTION IS NOT TO DISRUPT
SOMEONE'S OUT CURRENT PREGNANCY
BUT TO SET A FUTURE-
REQUIREMENT AROUND. MANDATORY
MANAGED CARE FOR THE
POPULATION- AS WELL AS I'M
REALLY JUST FOCUSING ON THE
FACT THAT- CURRENTLY. THERE IS
JUST A ONE OFF BEFORE THE
POPULATION THE 1-003-822-0013
PERCENT OF FEDERAL POVERTY
LETTER IS THE ONLY ONE- WITHIN
THE- LOCKLEY. PRESIDENT OF THE-
POPULATIONS AT LEAST- BUT
WITHIN VIEW FOR SERVICE ALL OF
THE OTHERS ARE CURRENTLY IN
MANDATORY MANAGED CARE JUST TO
BE CLEAR. OUR MANAGED CARE
PLANS HAVE A LOT OF EXPERIENCE
WITH- WITH PREGNANCY RELATED
SERVICES- AND- COORDINATION OF
THOSE SERVICES I'M IN WOULD
JUST KNOW THAT WE DID NOT
PROPOSE THE CHANGES. IN THE- IN
THE INDIVIDUALS WITH NON
SATISFACTORY IMMIGRATION STATUS
BASED ON STAKEHOLDER. FEEDBACK
IN REGARDS NOT CHANGING OF THAT
POPULATION SO WE HAVE ENGAGED
WITH A LARGE NUMBER OF
STAKEHOLDERS REGARDING- THE
ITEM AND YOU HAPPY TO CONTINUE
THOSE CONVERSATIONS BUT AGAIN.
I'M NOT LOOKING TO DISRUPT
INDIVIDUALS WHO ARE CURRENTLY
PREGNANT I SETTING POLICY FOR
FUTURE ENROLLMENTS INDIVIDUALS
JOINING- THAT. MEASURE BROWN.
OKAY WELL I APPRECIATE HEARING
THAT IT TAKE IT I DON'T THINK
IT WAS ENTIRELY CLEAR- WITH OUR
STATE CALLED THE STAKEHOLDERS
WHO WERE COMMENTING SO- SO THIS
IS QUESTION- THAT- MY CAR MIGHT
SEEM A LITTLE OFF THE WALL
BECAUSE IT'S NOT THERE'S
NOTHING DO PREGNANCY BUT IS THE
QUESTION IS THAT WHAT'S THE
STATUS OF THE FOSTER USE
MANAGED. CARE WORKGROUP. SURE
WE HAVE THE- MET A NUMBER OF
TIMES THAT WE CURRENTLY ARE
SCHEDULED TO CONTINUE MEETING
FOR JUNE OF TWENTY TWENTY ONE-
THEN WE WOULD TAKE BACK THE
RECOMMENDATIONS CONVERSATIONS-
LEARNINGS FROM THAT. A FOSTER
CARE WORKGROUP AND DEVELOP A
PROPOSAL THAT WE WOULD PUT OUT-
BEFORE AGAIN HER COMIC ID RIGHT
NOW THE DEPARTMENT HASN'T PUT
OUT A PROPOSAL IN REGARDS TO
FOSTER CARE- WE ARE TRYING TO
GATHER INFORMATION WORK WITH
SUBJECT MATTER EXPERTS- AND SO
WE WOULD ENGAGE PEOPLE ON ANY
FUTURE PROPOSAL IN REGARDS. TO
ANY TRANSITIONS OR CHANGES FOR
FOSTER YOUTH IN THE FUTURE. I
JUST NOTE THAT BECAUSE THE
TRAILER BILL LANGUAGE- REQUIRES
DHS IN CONSULTATION WITH THE
DEPARTMENT SOCIAL SERVICES. TO
IMPLEMENT A SPECIALIZED CARE
MODEL. BUT YOU JUST SAID THE
WORKGROUP HASN'T FINISHED
MEETING YET SO. SO THAT. THAT
THAT SPECIALIZED CARE MODEL
WILL COME AFTER THE FACT WE
WON'T REALLY SEE WHAT THAT'S
GOING TO BE. IN OTHER WORDS
WE'RE GOING TO APPROVE THIS. IT
POTENTIALLY IN THE BUDGET BUT
WE WON'T SEE WHAT THAT MODEL
LOOKS LIKE UNTIL IT'S COMPLETED
AFTER THE FACT HE SAID LATE
JUNE SO JUST TO BE CLEAR WE ARE
ALREADY WORKING DETECTS A DSS
AND DHHS HAVE PARTNERED
ALREADY. TO HAVE A FOSTER CARE
WORKGROUP WE'VE BEEN DOING THAT
JOINTLY- FOR MANY MONTHS. WE'RE
CONTINUING THE WORK GROUP FOR
THE FEEDBACK ON WHAT THAT MODEL
WOULD LOOK LIKE THROUGH JUNE OF
TWENTY TWENTY ONE- AND THAT'S
JUST GATHERING INFORMATION.
AFTER THAT WE WOULD COMPILE-
THOSE RECOMMENDATIONS DO DATA
ANALYTICS DEVELOP A PROPOSAL
FOR FOSTER CARE WHICH WE WOULD
THEN ENGAGE BOTH THE
EGISLATURE AS WELL AS
STAKEHOLDERS IN REGARDS TO ANY
PROPOSED CHANGES BEFORE WE
IMPLEMENT. ANY OF THOSE
CHANGES- WE DO NOT HAVE A
PROPOSAL AT THIS TIME AND WITH
FULLY ENGAGE WITH ALL
STAKEHOLDERS AND LEGISLATORS
REGARDING. ANY FUTURE PROPOSAL
AROUND FASTER YOU. SO WILL WE
GET A OPPORTUNITY THAT BEFORE
IT'S IMPLEMENTED THEM. YES YOU
WOULD BE ABLE TO FULLY ENGAGE
IN OUR PROPOSAL- ONCE WE
DEVELOP ONE OKAY GREAT THANK
YOU OKAY THE TO THINK. WITHOUT
I'D LIKE TO THANK THE SIX PANEL
AND ALL OF OUR PANELS WE WILL
NOW TURN TO PUBLIC COMMENT- THE
NUMBERS WERE AVAILABLE EARLIER
BUT I WILL REPEAT THEM NOW THE
TOLL FREE NUMBER IS. ONE EIGHT
SEVEN SEVEN SIX NINE TWO EIGHT
NINE FIVE SEVEN. AND THE ACCESS
CODE IS. SEVEN THREE TWO SIX
TWO FOUR TWO. WITHOUT OPERATOR
CAN WE HAVE OUR FIRST PUBLIC
COMMENT. OPERATOR ARE YOU THERE.
HELLO CAN YOU HEAR ME YES. OKAY
PERFECT- I WOULD DETAIN NOW
LADIES AND GENTLEMEN IF YOU
WISH TO PROVIDE PUBLIC COMMENT
PLEASE PRESS ONE THE ABOUT THAT
COMMAND ONE MORE TIME ONE. ZERO
IN OUR FIRST PUBLIC COMMENT
COMES FROM LINE THIRTEEN PLEASE
GO AHEAD. GOOD AFTERNOON THIS
IS SHERIN REPORT WITH THE
CORPORATION FOR SUPPORTIVE
HOUSING CAL AINSLIE'S FEDERAL
MONEY ON THE TABLE FOR
THOUSANDS OF BENEFICIARIES
EXPERIENCING HOMELESSNESS WE
AGREE WITH IN THIS WAY THAT WE
NEED A MEDIC CAL BENEFIT TO
SOME OF THE UNIQUE SERVICES
NEED TO PEOPLE EXPERIENCING
HOMELESSNESS. WITH THE BENEFIT
WE CAN INSURE MANY THOUSANDS OF
BENEFICIARIES COULD RECEIVE THE
RIGHT SERVICES OFFERED BY
ENTITIES THAT HAVE COMPETENCY
AND SERVING PEOPLE EXPERIENCING
HOMELESSNESS STATEWIDE TO
SUPPLEMENTAL PER MEMBER PER
MONTH FREE. IN LIEU OF SERVICES
WILL LIKELY ONLY BE AVAILABLE
TO SMALL PERCENTAGE OF PEOPLE
CURRENTLY HOMELESSNESS. WITH
POTENTIAL IN EQUITIES AND HOOK
IT SIR. THESE SERVICES WILL BE
OFFERED DIFFERENTLY BY PLAN AND
SOMETIMES NOT AT ALL IN ANY
COUNTY. THE BILLING AND
CONTRACTING REQUIREMENTS ARE
LIKELY TO INCLUDE MANY OF THE
ENTITIES MOST CAPABLE OF
PROVIDING THE SERVICES. AND
MANY OF THE ASSEMBLY ENTITIES
ARE CULTURALLY SPECIFICS.
FINALLY PLANTS WILL CONTINUE TO
FACE CHALLENGES AND IDENTIFYING
AND FINDING BENEFICIARIES
EXPERIENCING HOMELESSNESS.
RESTRICTING HIGH HOW IOS ROLLS
OUT. WE URGE THE COMMITTEES TO
JOIN OVER FIFTEEN OTHER STATES
TO INCLUDE A BENEFIT THAT CAN
TRULY OFFER A WHOLE PERSON
EQUITABLE APPROACH TO
BENEFICIARIES EXPERIENCING
HOMELESSNESS IN CALAIS. AND NOT
LEAST FEDERAL MONEY ON THE
TABLE FOR THIS VERY VULNERABLE
POPULATIONS THANK YOU. THANK
YOU MA'AM NEXT CALLER PLEASE.
LINE FIFTEEN YOUR MY GET UP.
GOOD AFTERNOON ASSEMBLY MEMBERS
MIGHT EXACTLY WARM UP PUBLIC
AFFAIRS AT THE DOWNTOWN WOMEN'S
CENTER LOCATED SKINNER LOS
ANGELES AS THE NATION'S FIRST
PROVIDER OF PERMITS BUT
ACCOUNTING FOR WOMEN DO YOU
HAVE YOU SEEN KNOWS FIRST HAND
THAT SERVICES THAT ASSIST
HOUSING PEOPLE AND THEN KEEPING
THEM HOUSED FOR CENTRAL TO
ACHIEVING ANY STABILITY BUT
PERSONAL HEALTH. ENHANCING
FUNDING FOR THE HEALTH OF THE
PORT SERVICES IS ALSO A
CRITICAL COMPONENT TOWARD
SOLVING HOMELESSNESS COUNTY
PRESENTS A UNIQUE OPPORTUNITY
TO FUNDING SERVICES THROUGH A
BENEFIT STATE OF THREE WITH THE
SERVICES IT BENEFIT WOULD ALLOW
OFTEN HUNDREDS OF OTHER
PROVIDERS TO SCALE UP FUNDING
FOR HOUSING SUPPORT SERVICES
BUT MOST OF THAT FUNDING COMING
FROM WASHINGTON. THE CALENDARS
INTENDED TO SERVE PEOPLE
EXPERIENCING HOMELESSNESS WE
HAVE MANY CONCERNS THE
PROVISION FOR THIS POPULATION
THE ENHANCED CARE MANAGEMENT
BENEFIT WILL ONLY COVER CARE
COORDINATION WHICH IS
COMPLETELY INEFFECTIVE WHILE
PEOPLE ARE STILL EXPERIENCING
HOPELESSNESS OR HOUSING
INSTABILITY. AND FUNDING
HOUSING SUPPORT SERVICES
THROUGH THE IN LOW SERVICES
PROVISION WILL RESULT IN VERY
FEW BENEFICIARIES THINK SIR IN
FACT UNDER TALENT WILL IT
SHOULD BE LOSING RESOURCES FOR
CRITICAL HEALTH AND SUPPORT
SERVICES FOR THESE REASONS WE
VERY MUCH HOPE THAT
CALIFORNIA'S LIKE FIFTEEN OTHER
STATES CAN OFFER A HOUSING
SUPPORT SERVICES BENEFIT.
PLEASE CONSIDER INCLUDING IN
THE COUNTING BUDGET AND AB
EIGHT SEVENTY FIVE REQUIREMENTS
FOR DH CS TO DIRECT ADDITIONAL
CALLIN RESOURCES GRADING
HOUSING SUPPORT SERVICE BENEFIT
RATHER THAN INCLUDING PEOPLE
EXPERIENCING HOMELESSNESS AND
YOU SEE A BENEFIT OR IOS THANK
YOU VERY MUCH. THANK YOU SIR
NEXT CALLER PLEASE. LINE
NINETY. YOUR AT THE- HI THIS IS
CINDY HOW ON BEHALF OF THE TO
MY ASSOCIATION I'D LIKE TO
START BY COMMON VMA. THAT THE
CALENDAR IS IN THIS AND WE
SUPPORT THE PULLED OBJECTIVES
BUT BY THE DEPARTMENT WE ARE
READY AND EAGER TO HELP
IMPLEMENT THESE VARIOUS
INITIATIVES ESPECIALLY THOSE
THAT. ARE MENTAL HEALTH AND
REDUCE HEALTH DISPARITIES IN
GENERAL YOU MAY WOULD LIKE TO
EXPRESS SOME DISAPPOINTMENT
ABOUT THE OVERALL LACK OF
PROVIDER ENGAGEMENT OUTREACH
AND INVOLVEMENT THROUGHOUT THE
PROPOSAL ENGAGEMENT HAVE
LARGELY BEEN BETWEEN
DEPARTMENTS AND PLANT THE
DEPARTMENT AND PLANS BUT NOT
THE ACTUAL PROVIDER SEEING
PATIENT. OUTREACH TRAINING
INCENTIVES ON THE BUILD OUT OF
INFRASTRUCTURE IT'S ALMOST
ENTIRELY FOCUSED ON THE PLAN
AND COMMUNITY ORGANIZATIONS NOT
THE PROVIDERS IT IS CRITICAL TO
THE SUCCESS OF CALLING FOR
THERE TO BE A RECOGNITION THAT
PATIENTS STRUGGLING WITH THEIR
HELP OFTEN CALL THEIR DOCTOR
AND DOCTORS WILL NEED SUPPORT
TRAINING AND RESOURCES YOU
READY TO MEET THIS NEW
CHALLENGE. ATTENDING THE PLAN
WILL BE THE PRIMARY LOCATION IN
ADDRESSING THESE CHALLENGES IS
LIABLE TO CREATE COURT TAKE AND
WORSE OUTCOMES MOREOVER CMA IS
GENERALLY CONCERNED ABOUT THE
TIMING BOTH THE SHORT TIMEFRAME
FOR THE ROLLOUT OF THESE
PROPOSAL ALSO HOW THE TIMING OF
THE IMPLEMENTATION OF CHALLENGE
MATCHES UP WITH OTHER LARGE
PROPOSAL SUCH A MEDIC CAL ARE
AT. AN OFFICE OF HEALTHCARE
PORTABILITY FROM ISSUE
SPECIFICALLY HIGHLIGHTED TODAY
AM I SUPPORT THE IDEA AND
HAMPSHIRE MANAGEMENT AND THE
PROPOSAL HOWEVER IT IS
IMPORTANT THAT THE DEPARTMENT
IN THE LEGISLATURE RECOGNIZED
THAT MISSION OFFICES DON'T
CURRENTLY HAVE THE RESOURCES TO
DO ECM AND THOSE ON THE FRONT
LINES AREN'T THE ONES IN LINE
TO REPEAT THE CARD FOR THESE
SERVICES EITHER TECHNICAL
ASSISTANCE NORTH DISTANCE AND
BUILDING INFRASTRUCTURE TO
PERFORM. THE INCENTIVE TO
APPEAR TO BE GEARED STRICTLY
AVENUE IN LET'S START WITH THAT
RATHER THAN ENSURING THAT
EXISTING NETWORKS FOR CURRENT
SERVICES ARE SUFFICIENT USING
INCENTIVES TO ADD NEW SERVICES
WHILE IGNORING THE BASED
PROVIDER NETWORK IS NOT
APPROPRIATE THE COMPLETE
BREAKDOWN OF THE INMATE
COMMENTS AND CONCERNS REGARDING
THE CALENDAR TOTAL. WILL BE
AVAILABLE THIS WEEK IN MY WE
APPRECIATE ALL. TO COMMENT AND
I FORWARD TO WORKING THE LET'S
AND MINISTRY- CAL IN THE FUTURE
THANK YOU. THANK YOU MA'AM.
THANKS CALLER PLEASE. HELLO
TWENTY MY COULD OPEN. GOOD
EVENING IS KELLY BROOKS
COMMENTING THIS TONIGHT ON
BEHALF OF TWO SEPARATE FIRST ON
THE AFFECT CITY OF HEALTH AND
HEALTH THIS. CALLUNA CRITICAL
FOR THE PUBLIC HEALTH CARE
SYSTEM AND COUNTY LEADING WHOLE
PERSON CARE PILOTS UNDER THE
ELEVEN FIFTEEN WAIVER AS THE
PILOTS COME TO AN END CALLIN
PURPOSES TO SUSTAIN AND EXPAND
UPON THE IMPORTANT WHOLE PERSON
CARE CARE MANAGEMENT AND
WRAPAROUND SERVICES BY OFFERING
THEM INTO MEDICAL MANAGED CARE.
ADEQUATE FINANCING AND ROBUST
COOPERATION BETWEEN PUBLIC
HEALTH CARE SYSTEMS COUNTIES
AND MANAGED CARE PLAN WILL BE
ESSENTIAL TO ENSURE A SMOOTH
TRANSITION LASTLY THE TIMELINE
IS INCREDIBLY AMBITIOUS WE MUST
CLOSELY MONITOR LOCAL-IMPLEMENTATION READINESS AND
ADOPTED NEEDED. SECOND ON
BEHALF OF THE COUNTY HEALTH
EXECUTIVE ASSOCIATION OF
CALIFORNIA IT'S LIKE TO
UNDERSCORE THAT COVETED HAVE
PLAYED ARE YOU. A PRINT OF OUR
PUBLIC HAS UNDERSCORE THE
CRITICAL ROLE THAT COUNTIES
HAVE ENTERING THE MOST
VULNERABLE AND THAT VALUE
SHOULD BE LEVERAGE AND
ACCOUNTING COBIT HAVE ALSO
HIGHLIGHTED THE CRITICAL ROLE
OF PUBLIC HEALTH AND LOCAL
HEALTH DEPARTMENTS WHO SHOULD
BE CRITICAL PARTNERS AND
BUILDING THE POPULATION HEALTH
MANAGEMENT PLANS THESE PLANS
NEED TO INCORPORATE EQUITY.
LOCAL EPIDEMIOLOGY DATA SO THAT
WE ARE NOT ONLY ADDRESSING
INDIVIDUALS HEALTH BUT ALSO
INCORPORATING WHAT WE KNOW
ABOUT THE COMMUNITY THEY LIVE
PLAY AND WORK IMPACT THEIR.
HELP THANK YOU. THANK YOU. NEXT
CALLER- LINE TWENTY YOU'RE MY
COULD HELP. THANK YOU SIR
MEMBERS BUT I THINK HE'S
REPUBLICAN ON THE OF OUR FAMILY
PER. AND PEEVES SEVERAL COM TO
DH CS REGARDING HOW LANE
HOPEFUL THAT AND EARLY TRY
HEALTH EQUITY WILL BE CONSIDER
SHORTLY UNDER POPULATION HEALTH
AND THE BENEFITS LIKE AND I. P.
BE CONSIDERED A PART OF AYE AT
ECM AND OR FURTHER INTEGRATED
IN A MEDIC CAL IS PART OF A
COMPREHENSIVE CARE. AND CARE
PLAN TO ELIMINATE THE THIRTY
THE MENTAL HEALTH CARE WE AGREE
WITH MANY OF THE COMMENTS MADE
BY ADVOCATES DAY IN TERMS OF
PLANTS NEED TO WORK WITH
COMMUNITY BASED SERVICES AND
SUPPORT AND THE PORTS PROVIDING
MORE INPUT AS WE GO ALONG THE
PROCESS THANK YOU. THANK. YOU
NEXT CALL PLEASE. LINE TWENTY.
YOU'RE MY COULD HELP. GOOD
AFTERNOON MR CHURTON NICOLE
MORLEY ON BEHALF OF THE
PARTNERSHIP. WE APPRECIATE
INCLUSION OF PH AND THE CAL
PROPOSED AND WITHIN TEN TO
IDENTIFY RISK THANK CHILDREN TO
NECESSARY AND EMOTIONAL SUPPORT.
RECOGNIZE THAT THREE FOURTHS OF
CHILDREN ENROLLED IN MEDI CAL
OR CHILDREN OF COLOR IT IS
CRITICAL THAT WE CONSIDER
OPPORTUNITIES TO CHALLENGE THE
STATUS QUO TO BETTER SERVE OUR
COMMUNITIES AND ENSURE
CHILDREN. ESPECIALLY THOSE
HISTORICALLY UNDERSERVED THIS
HAS THE POTENTIAL TO FULFILL
THE EXISTING EPS FIFTY
REQUIREMENTS FOR CHILDREN
PARTICULARLY IMPROVING THE LOW
PREVENTIVE CARE RATES FOR
MEDICAL CHILDREN. WHAT IS
MISSING AND POORLY NEEDED IS
THE EFFECTIVE ACCOUNTABILITY
MECHANISM NAMELY FINANCING.
THESE REQUIREMENTS SHOULD BE
TYPED PAYMENT. FIRST INCENTIVE
PAYMENTS SHOULD BE MADE
AVAILABLE FOR BASIC CARE
COORDINATION INFRASTRUCTURE THE
WAY INCENTIVES WERE PROPOSED
FOR ECM. SECOND THERE SHOULD BE
A MINIMUM SPEND FOR PREVENTIVE
CARE REQUIRED FOR MANAGED CARE
CAPITATION PAYMENTS ESPECIALLY
FOR CHILDREN. FINALLY RATE
SETTING SHOULD BE TIED DIRECTLY
TO QUALITY PERFORMANCE MEASURES
AND RACIAL EQUITY NOT JUST TO
EFFICIENCIES AND UTILIZATION.
WE NEED TO ADDRESS THE PROBLEM
OF UNDER UTILIZATION AND ACCESS
TO PREVENTIVE CARE NOT JUST THE
COORDINATION AND EFFICIENCY OF
CARE FOR COMPLEX CONDITION. THE
CONVERSATION ON RATE SETTING
AND INCENTIVE PAYMENTS IT'S
ESSENTIAL TO THE SUCCESS OF THE
PHM PROPOSALS HOWEVER IN THE
CONVERSATION HAVE NOT TAKEN
PLACE. ON BEHALF OF THE
CHILDREN'S PARTNER. THANK YOU
FOR YOUR CONSIDERATION. THANK
YOU MA'AM NEXT CALLER PLEASE.
LINE SEVENTEEN YOUR MIKE ABOUT.
HI MY NAME IS ERIC LUKE PERRY
AND I'M PRESIDENT OF THE
CALIFORNIA WHAT THE ASIAN
RESPECTFULLY AND WHEN IT COMES
TO THE CHARITY CARE HE AND I
MAY HAVE WAVES AROUND ABOUT THE
PROPOSAL LAST YEAR THE
LEGISLATURE MAKE A BOLD MOVE TO
PASS SB TWELVE THIRTY SEVEN
WHICH ALLOWS NURSE MIDWIVES TO
PRACTICE WITH YOUR UNNECESSARY
RESTRICTION. BUT AFTER INCREASE
AFTER TO MATERNITY CARE
OUTCOMES AND REDUCE DISPARITIES
WITH TO BRING AND SOCIAL THE
CALL. PREGNANCY RELATED WILL
MAKE IT WORK IF FOR AFTER THE
LIFFEY CARE THANK YOU FOR TRUMP
WHO THE FACT AND ELIMINATE THE-
FIRST OF ALL CHOIR FAMILY TO
ENROLL AND MANAGE CARE MAKE IT
TO. WHY MANY PLANTS DON'T
CONTRA MORE THAN MINIMUM ONE TO
FIVE YEARS METLIFE AND ONE I
THINK THAT WHAT IF THEY WITH
ANY ALL. BUT A CALL THAT THE
MANAGED CARE SYSTEM REQUIRED TO
CALL. ALL WHAT. NOT. BURKE THE
PROPOSAL MADE FIFTY TO CONNECT
WITH THE THAT THANK YOU VERY
NETWORK ACT BY CREATING PARENTS
WHY IT FAILED APART. HI WORKING
PEOPLE OF CONTINUITY OF CARE
WITH TRAFFIC THE FIRST NAME
OKAY BY YOUR BELIEVER THERE
QUIET CHILDREN. OKAY SPECIAL
THAT HIGH. MANY PEOPLE SEVEN
HAVE A LITTLE BIT OF A FACILITY
BETTER BEING MORE THAN THAT
OKAY ARE NOT BACK TO GET THAT.
THAT WITH THE NOT BE TO. AFTER
BUT HOSPITAL OKAY FINISHED AND
FINALLY MOVING OUT. AND ALLOW
PRESENT RESIDENTS INTO MANAGED
CARE. I'M THE PEOPLE ON THE
CREATING A TWO TIERED. THAT
RETAINS MAKING PROGRESS MORE
GLOBAL WE CAN FUNCTIONS ABOUT
QUALITY. THANK YOU. THANK YOU
MA'AM. NEXT CALL PLEASE- LINE
TWENTY TWO YOU'RE MY AT THE-
GOOD EVENING MY NAME IS KATIE
AT I'M A STUDENT I'M YOUR
SENIOR PA THAT BURKE AND I'M
THINK TANK IN THE BAY AREA. I
WANT TO START BY THINKING BOTH
THE COMMITTEE INTERFERING AND
TAKE YOU TO THE DEPARTMENT
HEALTHCARE SERVICES FOR THEIR
OPPOSED ROBOT CAL A PROPOSAL IN
INCLUDING MEDICALLY SUPPORTED
SAID NUTRITION IS AN ISLAND
BENEFIT MOST UPDATED TALLY
PROPOSAL. MEDICAL SUPPORT FOOD
NUTRITION COVERS A SPECTRUM OF
INTERVENTIONS LIKE FOOD
PHARMACIES PRODUCE
PRESCRIPTIONS THE MEDICALLY
TAILORED MEALS AND IS A KEY WAY
THAT WE. CAN ADDRESS THE SOCIAL
DETERMINANTS OF HEALTH. ONE
SUCH PRO. OPERATE IN BOTH LOS
ANGELES AND SAN FRAN. IF I
PREVENCI. THANK YOU FOR THE TO
THE PROGRAM THAT PROVIDE LOCAL
POPULAR. SUCH AS THOSE
SUFFERING FROM DIABETES OR
DRAFTING HIGH RISK PREGNANCY.
UP TO FORTY DOLLARS PER MONTH
TO BUY ADDITIONAL FOR
COMBUSTIBLE- THE PROGRAM
PRIMARILY THIRDS THESE
INDIVIDUALS AND 80% OF THEM ARE
PEOPLE OF COLOR. THIS PROGRAM-
ALLOWS FOR INCREASED
PARTICIPATION IMPORTANT
VEGETABLE CONSUMPTION AND
IMPROVED HEALTH HEALTH CARE
IMPROVE HEALTH CARE OUTCOMES
AND COST SAVINGS. PROGRAMS LIKE
THIS ALLOW ADDITION TO TARGET
AND CHOOSE THE CORRECT FOOD
BASED INTERVENTION TO THE
PATIENTS BY OFFERING A BROAD
SPECTRUM OF INTERVENTIONS WE
ARE ABLE TO MAKE SURE THAT EACH
INDIVIDUAL IT. IT MATCHED WITH
THE APPROPRIATE INTERVENTION WE
WOULD LIKE TO SEE THIS BROAD
SPECTRUM OF INTERVENTIONS
MEDICALLY SUPPORTED STUDENTSHIP
AND EXTRACTION INCLUDED IN THE
CAL A POLICY DOCUMENT AND THE
DOCTOR ADVISED MANY HEALTH
PLANS IF POSSIBLE. THANK YOU.
THANK YOU VERY MUCH OUR NEXT
CALLER PLEASE. LINE TWENTY ONE
YOU'RE MY COULD OPEN. GOOD
EVENING I'M JAN NORMAL FOUNDER
AND CEO OF THE BACK FACT AND
PRESIDENT OF THE CALIFORNIANS
FOR THE ADVANCEMENT OF
MIDWIFERY TONIGHT I REPRESENT
THOUSANDS OF BIRTHING FAMILIES
THROUGHOUT CALIFORNIA WHEN I
EXPRESSED CONCERN THAT CURRENT
HMO ARE NOT COMPLYING WITH
FEDERAL AND STATE ADEQUACY
REQUIREMENTS TO INCLUDE
MIDWIVES AND BIRTH CENTERS IN
NETWORK. PUTTING EVERYONE INTO
HMOS WILL UNDERMINE BENEFIT
ACCESS MANY STUDIES HAVE
DEMONSTRATED THE BENEFITS AND
IMPROVED OUTCOMES OF THE
SERVICES OF LICENSED MIDWIVES
IN THEIR COMMUNITY BASED AND
OTHER COMMUNITY BASED NETWORK.
ACCESS TO LICENSED MIDWIFE CARE
RESULT IN MORE NORMAL WEIGHT
BIRTH NEWBORN LOWER RATES OF
PRETERM BIRTH YOUR C. SECTION
AND LOWER USE OF EMERGENCY ROOM
SERVICES DURING THE FIRST YEAR
POSTPARTUM THE FEDERAL CMS IN
CENTER FOR MEDICARE AND
MEDICAID INNOVATION SPONSORED
THE STRONG START THIRTY FROM
TWENTY FOURTEEN TO TWENTY
SEVENTEEN. STRONG START
COMPARED NEWPORT OUTCOME
FOLLOWING PRENATAL CARE
DELIVERED IN THREE DIFFERENT
MODELS THE GROUP CARE THE
MEDICAL HOME MODEL ENDED WE'RE
FREE MODEL AT THE LIBERTY
FREESTANDING BIRTH CENTERS. EMS
PROVIDE GRANTS TO THE PROVIDERS
IN THE URBAN INSTITUTE STUDY
AND REPORTED THE RESULT THE
MIDWIFERY MODEL TO PASS THE
OTHER TWO MODELS ON EVERY
OUTCOME CMS EVALUATE THE
RESULTS OF THE STUDY VERY
FAVORABLY STATING WOMEN WHO
RECEIVED PRENATAL CARE AND
STRONG START BIRTH CENTERS HAD
BETTER BIRTH OUTCOMES AND LOWER
COSTS RELATIVE TO SIMILAR
MEDICAID BENEFICIARIES. NOT
ENROLLED IN STRONG START IN
PARTICULAR RATES OF PRETERM
BIRTH LOW BIRTH WEIGHT AND
SERINE SECTIONS WERE LOWER
AMONG BIRTH CENTER PARTICIPANTS
AND COSTS FOR MORE THAN TWO
THOUSAND DOLLARS LOWER PER
MOTHER INTO CARE DURING BIRTH.
AND THE FOLLOWING YEAR THANK
YOU. THANK YOU. NEXT CALLER.
LINE FIVE YOUR GET UP. GOOD
AFTERNOON MY NAME IS THERESA
YOU AND I AM A CONSUMER OF
MIDWIFERY SERVICES AND
PRESIDENT OF CALIFORNIA
FAMILIES FOR ACCESS TO MIDWIVES
A CONSUMER ADVOCACY
ORGANIZATION WITH OVER FIVE
THOUSAND SUPPORTERS THAT WORKS
TO ADVANCE ACCESS TO MIDWIFERY
AND OTHER BIRTH OPTION. WE HAVE
CONCERNS WITH THE PROPOSAL AND
ARE OPPOSED TO REQUIRING
MEDICAL CONSUMERS TO RECEIVE
CARE FROM MANAGED CARE ONLY.
THIS WILL UNDERMINE ACCESS TO
OPTIONS FOR PROVIDERS AND
MIDWIFERY SERVICES. ALTHOUGH WE
ARE CONSUMER ORGANIZATION WE
ARE AWARE THAT CALIFORNIA
ASSOCIATION OF LICENSED
MIDWIVES COM HAS BEEN WORKING
WITH DHS. YOURS CAN MAKE
MIDWIFERY CARE OF LIKE MIDWIFE
AND FREESTANDING BIRTH CENTERS%
ACCESSIBLE TO MEDIC CAL
INVERLEITH AS REQUIRED BY STATE
AND FEDERAL LAW. THE GREAT
MAJORITY OF MANAGED CARE PLANS
THAT CONTRACT WITH MEDICARE DO
NOT COMPLY WITH THESE LAWS.
THIS LACK OF COMPLIANCE WITH A
GREAT THAT THE DHS MEDICAL
ENFORCEMENT DIVISION. BUT
FORCED TO ISSUE A SPECIFIC CALL
PLAN LETTER CLARIFYING THAT
STATE AND FEDERAL LAW REQUIRED
NCP'S. THE PROVIDE PREGNANT
MANAGED CARE ENROLLEES WITH THE
SAME HEALTHCARE SERVICES AS
WOULD BE AVAILABLE TO PREGNANT
AND ONLY THINK THE FIRST
SERVICE NOT ACCOUNT. APL
EIGHTEEN ZERO TWO TO REQUIRE
ALL MEDICAL AND- INCLUDING EACH
OF THEIR NETWORKS AT LEAST ONE
L. M. LIKE A MIDWIFE. AND ALSO
AT LEAST ONE CNN CERTIFIED
NURSE MIDWIFE. AND ONE
FREESTANDING BIRTH CENTERS NO
SUBSTITUTIONS ARE ALLOWED YEAH
OVER TWO YEARS LATER ONLY A
HANDFUL AND THE PEAS. ARE IN
COMPLIANCE. WHEN THE END CITY
IN WHICH A CREDIT INDIVIDUAL IS
THE RELATIVE NOT PROVIDE ACCESS
TO ANY L. AND THEN THE NETWORK
THAT ENROLLEE HAS THE OPTION TO
DESCEND ROLE. FIND ANOTHER PLAN
I HAVE A HEARING COULD BE
PERMITTED TO ACCESS ELLEN
SERVICES ON THE SPEAKER CIRCUIT
CASES. OF ALL PREGNANT WOMEN
ARE FORCED INTO ENTITIES WHAT
WILL THEY DO IF THEY'RE AND
THINK HE DENIES OUR LACK
ACCESS. TO LM OR FREESTANDING
BIRTH CENTERS THIS IS A GREAT
CONCERN TO US. THANK YOU FOR
YOUR TIME. THANK. YOU MA'AM.
NEXT CALLER PLEASE. WHY TWENTY.
YOU'RE MY KIDDO. THANKS VERY
MUCH THIS IS DOUG SHOEMAKER I'M
PRESIDENT OF MERCY HOUSING
CALIFORNIA WHERE THE NATION'S
LARGEST NONPROFIT HOUSING
PROVIDER AND- WE OPERATE
DEVELOP AND MANAGE A AFFORDABLE
SERVICE RICH HOUSING THROUGHOUT
THE STATE OF CALIFORNIA- IN
MANY OF THE COUNTIES THAT I
KNOW PEOPLE ON THIS COMMITTEE
ARE CONCERNED AOUT WE HOUSING
FROM READING TO SACRAMENTO AREA
FOUND A LANSING DIEGO. I
MENTION THIS BECAUSE- WE ARE
ONE OF THE LARGER PROVIDERS OF
PERMANENT SUPPORTIVE HOUSING IN
THE STATE AND I'M CALLING TO
COMMENT TO- TESTIFY IN SUPPORT
OF THE COMMENTS TO SHARE
REPORTER CORPORATION FOR SPORT.
ABOUT HIS RT MENTION. THOSE ARE
THE ARE UNFAMILIAR WITH IT
BERMAN IMPORTANT IS. AFFORDABLE
HOUSING WITH RESEARCH TO THE
CASING- SOME VERSION OF CASE-
EACH COUNTY AND EACH CITY IN
THE STATE THAT GOES TO A
HOUSING PROVIDER LIKE MERCY TO
HELP DEVELOP. EXITS FROM
HOMELESSNESS. BASICALLY
REQUIRES US RETURN FOR LOANS TO
BUILD HOUSING TO COMMIT TO
ANYWHERE BETWEEN THIRTY AND
FIFTY FIVE YEARS OF CASE
MANAGEMENT SERVICE. FOR THE
FORMALLY HOMELESS INDIVIDUALS
THAT WE AGREE TO HOUSE. AND ONE
OF THE GREAT PROBLEMS WITH THIS
PROPOSAL AS WHERE IS TODAY
WE'RE ABLE TO WORK WITH COUNTY
DEPARTMENTS. AND OTHERS THAT
ARE COMMITTED TO THIS ISSUE
SINCE AND ARE ABLE TO ACCESS
SERVICES SERVICE DOLLARS. THE
WHOLE PERSON CARE. THE CALENDAR
BUBBLES IN FRONT OF YOU TODAY
THAT REALLY REALLY DIRECTORS
HAVE BEEN IN LIEU OF SERVICE.
CAN BE A SIGNIFICANT AMMUNITION
OF AVAILABLE RESOURCES. TO
ACTUALLY HELP BUILD THE HOUSING
AND SUPPORT THE HOUSING BILL
THE HOUSING BUT SUPPORT THE
SERVICES IN THE HOUSING. THAT
EVERYONE OF THESE COUNTIES AND
CITIES AND MAYORS AROUND THE
STATE ARE CLAMORING FOR. IT SO
I'M CALLING REALLY JUST TO STAY
LIKE I CAN'T TELL YOU HOW
IMPORTANT IT IS. TO MOVE THIS
ISSUE HOUSING SUPPORT SERVICES
FROM IN LIEU OF SERVICE TO A
BENEFIT AND I'M JUST GOING TO
END WITH ONE OTHER POINT I. I
PROBABLY SAID SHARON REFORM ACT
ON THE LAST MEDICAID MANAGED
CARE WAIT I'M THAT MEDICAID
WAIVER WORKING GROUP. I SPENT
THE NEXT FOUR YEARS. TALKING TO
ME PERVERSELY EVERY MANAGED
CARE PLAN IN THE JURISDICTIONS
IN WHICH WE WORK IN TRIED OVER
AND OVER AGAIN. TO CREATE SOME
SORT OF SYNERGY OR CONTRACTUA
ARRANGEMENT TO COME SUPPORT THE
SERVICES. THAT RESIDENTS NEED
WHEN THEY MOVE OFF THE STREETS
AND OUR AND OUR LIVING IN OUR
BUILDINGS AND I CAN JUST TLL
YOU THAT. IT IS FOR ME THAT IN
LIEU OF SERVICE THE
DISCONNECTED WILL OCCUR BETWEEN
THE TIME LINES. AND
REQUIREMENTS OF THESE PLANS.
AND THE EXPECTATIONS THAT.
LOCAL ELECTED OFFICIALS HAVE.
AND THE STATE THE STATE
DEPARTMENT OF HEALTH. EXPECTS
ABOUT THE THOUSAND PROVIDERS
FOR HELPING TO MOVE PEOPLE UP
THE STREET TO DISCONNECT WILL
BE SO. DRAMATIC THAT YOU'LL SEE
ADS I. THINK A VERY SIGNIFICANT
DROP BOB. IN THE ABILITY OF THE-
THROUGH HOW TO PROVIDERS MERCY
I. BACK PRODUCE. PERMANENT
HOUSING AT SCALE WHICH IS WHAT
THE STATE DOES. NEED SO AGAIN
JUST TO CALL AYE REAL. IN YOU
TO REALLY CONSIDER- MAKING
HOUSING SUPPORT SERVICES THE
BENEFIT INSTEAD OF IN IN THE
SERVICE THANK YOU FOR YOUR
TIME. THANK YOU SIR. NEXT
CALLER PLEASE. ONLINE TWENTY
SEVEN YOUR MIKE IT'S OPEN.
ANYTHING MY NAME IS BAD AND
WRONG AND I'M WITH AMERICAN
FAMILY HOUSING AMERICAN FAMILY
HOUSING THE HOUSING SERVICES
PROVIDER AND PROVIDE SERVICES
TO MORE THAN ONE THOUSAND SIX
HUNDRED FAMILIES AND
INDIVIDUALS EACH YEAR WE KNOW
FIRST HAND SERVICES HELP PEOPLE
EXPERIENCING HOMELESSNESS GET
HOUSE AND REMAIN DEEPLY HOUSE.
EITHER ABSOLUTELY ESSENTIAL
ACCESS HEALTH STABILITY SCALING
UP FUNDING FOR THE HOUSE
HOUSING SUPPORT SERVICES IS
ALSO INTEGRAL TO SOLVING
HOMELESSNESS CALTRAIN PRESENTS
AN OPPORTUNITY TO FUNDED
SERVICES TO BENEFIT INSTEAD. OF
THROUGH IOS. HER MANAGER
BENEFIT WILL ONLY COVER CARE
COORDINATION WHICH IS
COMPLETELY INEFFECTIVE FOUR
PEOPLE ARE STILL EXPERIENCING
HOMELESSNESS PLEASE CONSIDER
INCLUDING IN THE COUNTING
BUDGET EIGHTY EIGHT SEVENTY
FIVE REQUIREMENTS FOR DH CS.
THE FINAL FROM KALYAN RESOURCES
TO CREATE A HOUSING SUPPORT
SERVICES BENEFIT. RATHER THAN
INCLUDING PEOPLE EXPERIENCING
HOMELESSNESS IN THE ECM BENEFIT
OR I'LL HI HELLO THANK YOU.
THANK YOU MA'AM NEXT CALLER
PLEASE. ONLINE TWENTY NINE YOUR
MY GET UP. THANK YOU MISTER
CHAIR MEMBERS JOHN LINGER ON
BEHALF OF THE NATIONAL
COALITION OF ASSISTIVE AND
REHAB TECHNOLOGY WE ARE THE
PROVIDERS AND MANUFACTURERS OF
COMPLEX REHAB TECHNOLOGY WHICH
IS A VERY SMALL SUBSET OF
DURABLE MEDICAL EQUIPMENT-
ALTHOUGH WE'RE UNDER THE DME
BENEFIT WE DO- INVOLVE A VERY
LABOR INTENSIVE PROCESS. ENDING
HER QUITE A BIT TRANSPORTATION
COSTS NONE OF WHICH ARE ARE
REIMBURSED CURRENTLY UNDER THE
SYSTEM AND SO WE HAVE SOME
SIGNIFICANT REIMBURSEMENT
CHALLENGES STATE DME BENEFIT
CONTINUES TO BE UNDER THE
EIGHTEEN NINETY SEVEN TEMPLE
THAT CUT FROM TWO THOUSAND NINE
ADDITIONALLY THERE IS A STATE
PLAN AMENDMENT THAT WAS
APPROVED IN TWENTY NINETEEN
WHICH TIED IT TO THE MEDICARE
FEE SCHEDULE WHICH CONTINUES TO
DECLINE- THIS IS A VERY
DIFFICULT SITUATION FOR US THE
PEOPLE SERVICE SPACE. AND
ALTHOUGH WE'RE WE'RE NOT
OPPOSED TO MOVING SOME OF OUR
OUR FRAGILE POPULATIONS TO-
MANAGED CARE WE ARE WE ARE
CONCERNED WITH- RATE SETTING IN
THE MANAGED CARE STATE BASED ON
THE INADEQUATE BEEPER SERVICE
RATE SO AS YOU MOVE FORTY LIKE
TO HAVE FURTHER DISCUSSIONS ON
ON POTENTIAL GET NOTHING THE AB
NINETY SEVEN TEMPS THANK CUT IN
ORDER TO GET THESE RATES RIGHT.
AND HELPLESS TRANSITION BETTER
TO MANAGED CARE BECAUSE THIS IS
A VERY FRAGILE POPULATION
PATIENT BUSINESS INDIVIDUALLY
CUSTOMIZED EQUIPMENT FOR ADULTS
AND CHILDREN WITH SIGNIFICANT
DISABILITIES THAT COULD RESULT
WITH WITH. IMPROPER CARE CAN
RESULT AND INADEQUATE AND-
ADVERSE HEALTH CONSEQUENCES TO
THEM AND SO- WE LOOK FORWARD TO
FURTHER CONVERSATIONS WITH THE
DEPARTMENT AND WITH THE
COMMITTEE. AS THE REPORT THANK
YOU VERY MUCH. THANK YOU SIR
NEXT CALL PLEASE. AND MR WE
HAVE NO FOR PEOPLE WISHING TO
PROVIDE. OPERATOR DO YOU MIND
DOING ONE MORE SWEEP THROUGH
FOR ANY FINAL PUBLIC COMMENTS.
HAVE A REMINDER IF YOU WOULD
LIKE TO PROVIDE PUBLIC COMMENT
PLEASE PRESS ONE ZERO THAT
COMMAND AGAIN. ONE NINE ZERO.
AND WE HAVE NO ONE QUEUING UP
AT THIS TIME THANK YOU OPERATOR
THAT WILL CONCLUDE PUBLIC
COMMENT AT THIS TIME I'LL TURN
IT OVER TO MY- CO CHAIR DR WHAT.
YOUR DOCTOR ARAMBULA JUST WANT
TO THINK AGAIN THE WITNESSES
THAT WE HAD TODAY IN THE PUBLIC
TESTIMONY- FROM- THE PUBLIC
COMMENTS- AND ALL THE
STAKEHOLDERS INVOLVED. IS
OBVIOUSLY AN EXTREMELY.
DETAILED DETAILED- THE PROPOSAL
WITH A LOT OF MOVING PARTS AND-
I THINK IS REALLY VALUABLE THAT
WE HAVE THE DISCUSSION AND GIVE
PEOPLE AN OPPORTUNITY TO WEIGH
IN. WE ORIGINALLY PLANNED THIS
AS A AS TO HEARINGS BUT- IN IN-
REALLY LOOKING AT THIS- THERE
ARE TWO TWO MAJOR ISSUES THAT
WE WANT TO DISCUSS IN THE THIRD
HEARING SO WE WILL HAVE A THIRD
HEARING ON THIS- IT MAY BE ONE
OF THE FEW OPPORTUNITIES WE IN
THE LEGISLATURE HAVE TO ENGAGE
ON THIS. BEFORE BEFORE WE GET
TO A- MORE FINAL PROPOSAL SO I
WANT TO THANK EVERYBODY FOR
PARTICIPATING WITH US TODAY AND
I LOOK FORWARD TO OUR FINAL
THIRD AND FINAL HEARING ON
THIS- COMING UP SO THANK YOU
VERY MUCH AND HAVE A GREAT
EVENING. WE ARE ADJOURNED.