Duals Project Goes to CMS for Approval

It was a big moment for officials in the Department of Health Care Services.

“We are thrilled to be getting this in,” said Jane Ogle, deputy director of DHCS. “It’s a big project. So to get this in, we’re all really excited. This is the result of a year’s planning, a year of planning and work with advocates and stakeholders and within the department. And all of that comes together in this document.”

The project is the Coordinated Care Initiative, also known as the duals demonstration project, and the document is the project’s final plan, which was submitted late last week to CMS.

“CMS is going to have it for a couple of weeks, till about mid-June, and then they’ll post it for a 30-day comment period,” Ogle said. “Then after that, we start the MOU [memorandum of understanding] process.”

Some details still need to be worked out including the department’s insistence on a one-year lock-out enrollment provision while federal officials have voiced support for an opt-out provision to the passive enrollment process.

“There’s a whole pool of things we’ll talk about,” Ogle said. In regard to the lock-out idea, she said, “We continue to think that’s the right way to go. So when we come down to the MOU that s when we’ll make a final decision on those kind of details.”

The project has evolved over the past year for stakeholders, from a general level of distrust to a greater sense of involvement, according to Kevin Prindiville, deputy director of the National Senior Citizens Law Center in Oakland.

Inclusion of stakeholder input includes a recent decision to delay implementation of the duals project by three months, from March 2013 to a June 2013 start date. “This gives more time for the system to be built,” Prindiville said. “It’s a really positive sign that the state is willing to take stakeholder input and extend the start date.”

Ogle said the change in the tenor and tone of stakeholder meetings has been a pleasure to see. “There’s a collaborative that meets regularly, and we just had a meeting last week, and I have to tell you, they were different meetings 8 to 10 months ago,” Ogle said. “Now everyone [on both sides] is engaged and thoughtful, and people felt they had enough input. That’s a step forward.”

Stakeholder committees continue to meet and plan for the transition of dual eligibles — Californians eligbile for both Medicare and Medi-Cal — to managed care. Committees focus on specific issues such as provider outreach. The plans of action developed from those workgroups will be critical, Ogle said, to minimizing coverage disruption for the eventual 1.1 million dual-eligible Californians who will be part of the switch to Medi-Cal managed care plans. 

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