コーディネート・ケア・イニシアティブとCal MediConnect
Cal MediConnectのメンバーですか? Cal MediConnectの将来についての詳細をご覧ください。
Passage of the Coordinated Care Initiative (CCI) in July 2012 marked an important step toward transforming California’s Medi-Cal (Medicaid) care delivery system to better serve the state’s low-income seniors and persons with disabilities. Building upon many years of stakeholder discussions, the CCI begins the process of integrating delivery of medical, behavioral, and long-term care services and provides a road map to integrate Medicare and Medi-Cal for beneficiaries of both programs, called “dual eligible” beneficiaries.
Created through a public process involving stakeholders and health care consumers, the CCI was enacted through Senate Bill 1008 (Chapter 33, Statutes of 2012) and Senate Bill 1036 (Chapter 45, Statutes of 2012).
The CCI was implemented in seven counties beginning in 2014. The seven counties are Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara.
コーディネート・ケア・イニシアティブの主要部分
- Cal MediConnect:二重の適格受益者が、単一の組織化された配信システムを通じて、調整された医療、行動健康、長期施設、および在宅およびコミュニティベースのサービスを受けるための自発的な健康保険。 Cal MediConnectは、メディケアとMedi-Calの両方の福利厚生と、追加のケアコーディネート福利厚生を組み合わせたものです。
- Managed Medi-Cal Long-Term Supports and Services(MLTSS):CCI郡のすべてのMedi-Cal受益者(二重の適格受益者を含む)は、LTSSおよびMedicareラップアラウンド給付を含むMedi-Calの給付を受けるために、Medi-Calのマネージドケア健康保険に参加する必要があります。
What’s New with Cal MediConnect
Under the California Advancing and Innovating Medi-Cal (CalAIM) initiative, starting on January 1, 2023, Cal MediConnect members will be transitioned to MMPs, or Medi-Medi Plans. MMPs is the California-specific program name for Exclusively Aligned Enrollment Dual Eligible Special Needs Plans (EAE D-SNPs). Under exclusively aligned enrollment, beneficiaries can enroll in a D-SNP for Medicare benefits and in a Medi-Cal managed care plan for Medi-Cal benefits, which are both operated by the same parent organization for better care coordination and integration. DHCS will work with health plans, stakeholders, and the Centers for Medicare & Medicaid Services (CMS) to transition and expand integrated care statewide. This policy is intended to help meet the statewide goals of improved care integration and person-centered care, under both the CalAIM initiative and the California Master Plan for Aging.
DHCS is convening the monthly public CalAIM MLTSS & Duals Integration Workgroup to work with stakeholders to support this transition. Information on how to register for the CalAIM MLTSS & Duals Integration Stakeholder Workgroup, and background materials from previous workgroup meetings is available here.
一般情報
- How to Enroll – Shares basic information about how to enroll in Cal MediConnect.
- Cal MediConnect Benefits and Services – Includes basic information about CMC’s benefits/services.
- PACE – Includes brief background on the PACE program, a link to CalPACE, and four PACE FAQs.
- Health Plan 101 – An explanation of different health plan components and a series of related questions and answers.
CCIファクトシート
- 受益者向けのリソース
- Beneficiary FAQ – Includes basic FAQs about CMC for beneficiaries.
- 受益者ツールキット (英語)
- 受益者ツールキット (スペイン語)
- 耐久性のある医療機器メンバーファクトシート
- Medi-Calニュース:無料交通費特典!
- Medi-Calによる歯科サービス
2. プロバイダー向けのリソース
3. アドボケイトのためのリソース
4. CCIの履歴情報
- Background on the CCI – Contains brief background information on the CCI and five FAQs about the CCI
- What is Cal MediConnect? – A brief overview of Cal MediConnect (CMC), including which benefits are coordinated and information about how to join.
- Managed Long-Term Services and Supports (MLTSS) page –Includes brief information about MLTSS, a link to find an MLTSS plan, and three MLTSS FAQs.
- CCI-HIVファクトシート(2015年10月)
- コーディネート・ケア・イニシアティブ:エグゼクティブサマリー(2013年3月27日更新)
- CCI Population Chart: Updated table showing groups included in and excluded from the demonstration and mandatory Medi-Cal enrollment (March 27, 2013)
- CCI Population Summary: (March 27, 2013) A summary of the participating populations
- CCI Beneficiary Protections: (August 30, 2012) A summary of all the beneficiary protections included in the CCI.
- CCI Legislative Reporting Requirements: (August 30, 2012) A summary of the legislative reporting requirements for the CCI.
- CCIステークホルダーエンゲージメント要件 : (2012年8月30日) 利害関係者再協議要件の要約。
- CCI Evaluation Strategy: (October 12, 2012) An overview of the evaluation and quality monitoring for the duals demonstration.
- CCI’s Commitment to Quality: (October 12, 2012) An overview of State efforts to advance high quality care delivery.
- Cal MediConnectレートレポート
採択された法律
- CCIトレーラー法案上院法案1008 (2012年7月)
- CCI Trailer Bill Senate Bill 1036 (July 2012)
立法言語の以前のバージョン
- Coordinated Care Initiative Trailer Bill Languageの改訂案 ( 24年5月、 2012
- CCI Trailer Bill Languageの5月改訂変更を説明するファクトシート(2012年5月24日
- 長期サポートとサービス TBLファクトシート(2012年3月26日
- Legislative Language on the Brown Administration’s Coordinated Care Initiative (March 26, 2012)
- Savings Estimates and Methodology for the Coordinated Care Initiative (February)
For more information about the Coordinated Care Initiative and Cal MediConnect, please visit the Integrated Care for Dual Eligible Beneficiaries webpage.