重返雙重合資格受益人的綜合護理

您是 Cal MediConnect 會員嗎？ 了解有關 Cal MediConnect 未來的更多資訊。

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.

協調照護計劃的主要部分

• Cal MediConnect ：一項自願健康計劃，旨在讓雙重合格受益人透過單一有組織的交付系統獲得協調的醫療、行為健康、長期機構以及家庭和社區服務。 Cal MediConnect將聯邦醫療保險和加州醫療補助健康保健計劃福利與額外的護理協調福利結合起來。  
• 管理式加州醫療補助健康保健計劃長期支持和服務 (MLTSS)：CCI 縣的所有加州醫療補助健康保健計劃受益人，包括雙重合格受益人，都必須加入Medi-Cal Managed Care保健計劃，以享受加州醫療補助健康保健計劃福利，包括LTSS和聯邦醫療保險綜合福利。

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.

一般資訊

• 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 資料表

1. 受益人資源

• Beneficiary FAQ – Includes basic FAQs about CMC for beneficiaries.
• 受益人工具包 (英文)
• 受益人工具包（西班牙語）
• 耐用醫療設備成員資料單
• 加州醫療補助健康保健計劃新聞：免費交通福利！
• 您透過加州醫療補助健康保健計劃獲得的牙科服務

     二.供應商的資源

• 醫生工具包
• 醫院案例管理工具包
• CCI 提供商常見問題
• 耐用醫療設備供應商資料單

     三.為倡導者提供的資源

• CCI 律師指南
• 兩項 Cal MediConnect 資格保障：推定和援助支付待定

     4.歷史 CCI 資訊

• 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 情況說明書（2015 年 10 月）
• 協調照護計劃：執行摘要（27 月 2013 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 利害關係人參與要求：（二零一二年八月三十日）利害關係人重新諮詢要求的摘要。
• 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 費率報告 

通過的法例

• 《商業貿易委員會預告條例草案》參議院第 1008 條例草案
• CCI Trailer Bill Senate Bill 1036 (July  2012) 

立法語的較早版本

• 《協調護理倡議》預告片條例草案語言的修訂建議 (24, 2012)
• 說明 5 月修訂《CCI 預告片條例草案》語言的變更簡介 (24, 2012)
• 長期支援與服務 TBL 概覽 (26, 2012)
• 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.