September 10, 2014
Area(s) of Interest: Access to Care Advocacy Practice Management
After advocacy from the California Medical Association (CMA) in conjunction with patient advocacy groups, the California Department of Health Care Services (DHCS) has revised its “Choice Forms” that allow dual eligibles to opt-out of the Cal MedConnect duals demonstration project and remain in traditional Medicare fee for service.
The project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that transitions a large portion of the state's dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara.
The previous Choice Forms did not make it clear how a patient could opt-in or out of the program and DHCS was criticized for its lack of transparency in the documents. CMA was very vocal in requesting DHCS change the forms to clearly state the patient’s options. The state hopes the new forms provide clarity and make it easier for patients to make the choice between opting into the Cal MediConnect program or opting out of it. The Spanish language forms were also revised.
The updated forms are found here and should be included in new Plan Choice books for newly enrolled members. The plan Choice Form is located in the middle of the Plan Choice Book.
DHCS will also soon be finalizing a physician toolkit to help physicians and their patients understand the project. The toolkit has been developed in conjunction with Harbage Consulting and various stakeholder groups. The various pieces of the toolkit will be released individually as they are finalized. Watch DHCS’s weekly Coordinated Care Initiative updates for more information.