Long-Term Services and Supports Standards

Updated Draft Long-term Services and Supports Network Standards (1/24/12)  This version has gone through two iterations of public comment with previous versions being release on August 6th and November 26th, 2012. It describes the specific requirements that will be incorporated into the Health Plan Readiness Tool. Based on additional stakeholder feedback, the LTSS standards have undergone further revision and refinement.  The previous version of the LTSS standards required plans involvement and direct oversight of LTSS programs, which raised concerns that the State was somehow transferring its role as regulator to plans. There is also now a greater focus on service specific training for plan staff, in addition to, enhanced policies and procedures for communication between plans and providers, as well as beneficiaries and their representatives. These standards also will be required of health plans for the non-demonstration population receiving managed LTSS.

LTSS STandards Round 1 Comments (12/10/12)

First draft Long-term Services and Supports Readiness Standards  (Nov. 26, 2012) This document reflects significant stakeholder input received on the version released in August.  It describes the specific requirements that will be incorporated into the Health Plan Readiness Tool.

Care Coordination Standards

Updated Draft Care Coordination Standards (1/24/13) This document reflects significant stakeholder input received on the version released on November 26th, 2012. The Care Coordination standards continue to focus on the person-centered model of care, and have been streamlined from the previous version. Specific changes to this updated document include: 1) Defining the population subject to these standards; 2)Deleting of the references to National Quality Forum standards; 3) Expanding the risk stratification groups from three to four; 4) Changing the timing of the HRA assessment; 5) Clarifying who may conduct the HRA; and 6) Adding behavioral health and substance use elements.

Care Coordination Standards Comment Template (Word)

Care Coordination  Standards Round 1 Comments (12/10/12)

First Draft Care Coordination Standards (Nov. 26, 2012) 

Behavioral Health Standards

 Revised local Behavioral Health MOU template (2/20/13)

 Revised Behavioral Health Coordination Standards (2/20/13)

 Fact Sheet: Inpatient and IMD coverage (3/4/13)

 Benefit Coverage Matrix (3/4/2013)

Early Drafts

DRAFT behavioral Health MOU template: Health Plan-County Department (12/18/12)

DRAFT Behavioral Health Coordination Standards (12/20/12)

Comment Template-Behavioral Health Coordination (Word)

Care Plan Options Policy  (formerly Home and Community Based Services Policy)

 Care Plan Option Services- (CPO Services)   (pdf)   6/3/13

 HCBS-Flow-Charts  (pdf)   6/3/13

 Questions and Answers from HCBS comments  (pdf)  6/3/13  

Draft HCBS Policy Paper (1/24/13) This document explains the department’s policy to expand the availability and use of additional HCBS by allowing demonstration plans to pay for these services out of the monthly payments they receive to provide care to their enrollees. This is the first release of this paper and we encourage stakeholder comments.

Draft HCBS Enrollment Flow Charts (1/24/13) This document contains a series of six flow charts to help promote a shared understanding of how these populations may receive certain HCBS under the CCI – either because beneficiaries are currently enrolled in a HCBS program or because they are seeking such services.  The options vary depending on a number of factors, including if the beneficiary participates in the Duals Demonstration.

HCBS Policy Comments received by Feb. 6 2013 (4 MB)

March 2013 Program Readiness Report

As required by SB 1008, this report provides an update on the status of the following readiness criteria and activities:

• Contract/Funding for Consumer Counseling and Education Services
• Demonstration Beneficiary Communications
• Health Plan Capitation Rates and Contracts
• Health Plan, Provider and County Agency Agreements
• Network Adequacy Standards
• Beneficiary and Health Plan Issue Resolution Procedures
• Appeals and Grievances Tracking System
• Customer Service Training Plan
• Continuity of Care
• Quality Evaluation Measures
• Health Plan Reporting Requirements

Programmatic Transition Plan

The Department of Health Care Services developed a programmatic transition with the State Department of Social Services, Department of Aging, and Department of Managed Health Care.  The transition plan describes:

• How access and quality of service shall be maintained during and after implementation of the CCI to prevent disruption of services to beneficiaries.
• Operational steps, timelines, and key milestones for determining when and how core beneficiary protection provisions will be implemented.
• The process for addressing consumer complaints, including the roles and responsibilities of the departments and health plans and how those roles and responsibilities shall be coordinated.
• How stakeholders have been included in the various phases of the planning process and how their feedback shall be taken into consideration after transition activities begin.

Final Transition Plan (Oct. 1, 2012)

Errata 1 (Word)

Cover memo summarizing changes (Oct. 1, 2012)

Stakeholder Comments (Oct. 1, 2012)

Red-lined Transition Plan (version that shows edits) (Oct. 1, 2012) 

Draft Transition Plan (PDF, August 27, 2012)