In partnership with the Department of Health Care Services (DHCS) and the California Health Care Foundation (CHCF), Aurrera Health Group developed a toolkit with guidance applicable to Medi-Cal Managed Care Plans (MCPs) and “community care hub" organizations (Hubs). Hubs are entities that serve as intermediaries between Medi-Cal MCPs and community-based organizations (CBOs) and Providers that deliver services to address health related social needs (HRSNs).
DHCS encourages the use of Hubs to the extent it reduces barriers for CBOs, community-based Providers, and other Providers that address HRSNs to contract with MCPs and participate in the Medi-Cal delivery system. Partnering with Hubs can create operational efficiencies for MCPs and Providers, expand Networks by enabling community-based, diverse Providers to participate in Medi-Cal, and support coordinated delivery of Medi-Cal benefits.
Toolkit User Guide
This toolkit is intended for MCPs, existing Hubs, and organizations interested in becoming Hubs to support the delivery of Medi-Cal services. It includes a series of modules that highlight opportunities, basic requirements, considerations, and provide practical tools to support MCPs and Hubs to operationalize voluntary contracting partnerships.
This toolkit includes the following sections:
Module 1: Functions of a Hub
- Section 1: Overview
- Section 2: Example Hub Functions
Section 3: Hub Spotlight
Module 2: MCP-HUB Partnerships
Module 3: Oversight & Monitoring of Hubs
- Section 1: Overview
- Section 2: MCP Oversight and Monitoring Requirements for Hubs
- MCP-Hub Compliance Requirements Checklist
- Section 3: Data and Qualilty Improvement Requirements for Hubs
- Data Reporting Requirements
- Quality Improvement Requirements
- MCP-Hub Quality Improvement Tool
- Section 4: Additional Considerations for Hubs That Assume Financial Risk or Cover Specific Medi-Cal Member Populations
- Financial Viability Requirements
- Population Needs Assessment Requirements
- Medical Loss Ratios (MLRs)
- Section 5: Summary of MCP Oversight Responsibilities
Section 6: References
Additional Information
- Flexible Housing Subsidy Pools and Hubs
After reading the toolkit, readers will understand:
- The vaue of hubs in facilitating connections between MCPs and networks of direct service provider organizations and individual providers and reducing the burden of contracting;
- General functions offered by Hubs;
- Existing requirements that MCPs must adhere to when contracting with Hubs; and
- MCP Compliance and oversight responsibilities
Notes
- DHCS encourages but does not require MCPs to contract with Hubs.
The toolkit does not include new policy or introduce new requirements for MCPs but elevates existing guidance relevant to MCPs and Hubs interested in partnering for the administration and delivery of a host of Medi-Cal services including, but not limited to, Enhanced Care Management (ECM), Community Supports, Community Health Worker (CHW) services, and Doula services.
DHCS acknowledges that it may take time for existing Hubs and MCPs with established relationships to ensure all Subcontractor, Downstream Subcontractor, and Network Provider requirements are met, as applicable. MCPs are encouraged to contact their DHCS Contract Managers to request technical assistance for ensuring prompt compliance with Subcontractor, Downstream Subcontractor, and Network Provider requirements as outlined in the MCP’s contract with DHCS (MCP Contract), as applicable. Any other related questions, please contact your DHCS Contract Manager.
Webinars
- Webinar materials will be posted here once available.
