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HomeMy WebLinkAboutMINUTES - 05091995 - 1.81 1.81 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on May 9,1995, by the following vote: AYES: Supervisors Rogers, Smith, DeSaulnier, Torlakson and Bishop NOES: None ABSENT: None ABSTAIN: None SUBJECT: Correspondence Item No. 1.81 LETTER dated April 27, 1995, R. Gonzalez, Chief, Managed Care Expansion Branch, State Department of Health Services, P. O. Box 942732, Sacramento 94234-7320, responding to issues contained in the Board's letter and advising of improvements to the Medi-Cal Managed Care Program that were included in the Request for Application. "REFERRED TO HEALTH SERVICES DIRECTOR i hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervis@y�thet��J}r�wn. ATTESTED: YY �,.,�I{� of��r.h�����Bocrd PHIL BATCHELOR of Supervisors and crnuta11 administrator Oeputy CC : Correspondent Health Services Director 04/27795 THU 12:10 FAX 9166571199 ADMIN SUPPORT ATE OF CALIFORNIA-HEALTH AND WELFARE AGENCY P , ETE WILSON, Governor D8PARTMENT OF HEALTH SERVICES 7141744 P STREET P.0. Box 942732 mg SACRAMENTO, CALIFORNIA 94234-7320 (91 6) 657-9 Z/-a.a 9 APR 2 7 t9k FRECENED s, Chair Board of Supervisors Contra Costa County 651 Pine Street, Room 106 t=Favts�ns Martinez, CA 94553 ' Chq�r Dear- Thank you for your letter dated November 4, 1994 providing comments and proposed criteria pertaining to Contra Costa County, for the Medi-Cal Managed Care Request for Application (RFA). We apologize For the extended delay in our response and appreciate your patience with our process. As you know, the Department of Health Services (DHS) has been operating under significant time constraints in this procurement process. 1n order to meet the September 30th release date, the RFA was distributed without the evaluation criteria. Consequently, immediately following its release, our priority turned to developing the evaluation criteria which was subsequently released on January 6, 1995 in Medi-Cal Managed Care Administrative Bulletin No. 4 and Addendum No. 4. During that same time, the Department received hundreds of questions on the RFA from the public. Also, in January 1995, the Department held two applicant conferences which generated numerous additional questions. As we began to consider your County's recommendations and the questions submitted by the public, it became clear that it would not be possible to address the county issues separately from those submitted by the public. Therefore, all of the County's written questions were folded into the RFA question and answer process. Our first bulletin containing the Department's response to questions was released on February 24, 1995, in Medi-Cal Managed Care Administrative Bulletin No. 6 and Addendum No. 6. All of the remaining questions, including the County's recommendations, were not released until the final Medi-Cal Managed Care Administrative Bulletin No. 11 and Addendum No. 11 issued on March 20, 1995. In responding to the County recommendations, the Department found that many dealt with issues previously decided, and the Department was not presented with new information that would justify reconsideration. Some of the recommendations were already contained in the RFA and simply required clarification. Additional issues raised, although supported by the Department, were deemed inappropriate for inclusion as a requirement. Activities of that nature will be encouraged, and, where feasible, supported by the Department. The remaining category of recommendations represented improvements to the program that were deemed appropriate for inclusion in the R-FA. One example is the elimination of the single visit requiremectt for the diagnosis of sexually transmitted diseases (STD) through the Local Health 04/27/'95 THU. 12:11 FAX 9166571199 ADMIN SUPPORT 0004 I I i Mr. Tom Powers i Page Three i i Response: DHS is confident that current contractual requirements already contain adequate provisions for ensuring that Contractors obtain Medi-Cal enrollee input into the health plans. As Knox-Keene licensed plans, the Mainstream and Local Initiative (LI) Contractors will be required to maintain a standing committee responsible for participating in establishing public policy, the membership of which must consist of at least 51 percent of enrollees and at least one provider (Title 10, CCR Section 1300.69). Although DHS does not require Medi-Cal representation on that committee, Addendum No. 11 added Contractual Requirement 9.2.R.6 to the RFA which requires Contractors to include Medi-Cal enrollees in their public policy development process. Members will also have an opportunity for input through member satisfaction surveys. Contractual requirement 9.5.6.R.7 requires contractors to conduct member satisfaction surveys at least annually and demonstrate follow-up and actions taken. In addition, the Community Advisory Committee required in contractual requirement 9.10.R.5 will have Medi-Cal members participation to provide input on educational and operational issues .affecting groups who speak a primary language other than English. Dietetic Services 4. Will the Department specifically require the inclusion of registered dieticians among the provider network and those services that fall within the scope of their license, including follow-up dietetic services (whether provided by registered dietician or a physician) and the inclusion of a nutritional assessment form (approved by the American Dietetics Association or the California Dietetics Association) in the initial health assessment performed on adults and children? In addition, the State should include a registered dietician on the state medical audit team. Response: No. The state's position on nutritional services has been clarified in the RFA Administrative Bulletin No. 6 (Questions 156, 157, 158 & 159). Nutrition assessment and services are a Medi-Cal benefit as defined in Title 22, CCR Section 51301 et seq and Contractors are required to provide such services. The Contractor will be expected to follow The Guide to Clinical Preventive Services. Report of the U.S. Preventive Services Task Force, 1989, which addresses the importance of nutritional counseling. There is no requirement, however, that expressly requires a Contractor to have among it's provider network registered dieticians. The Contractor may choose to fulfill its responsibility for the provision of nutrition services through qualified providers other than a registered dietician, as long as the services provided meet quality standards and approved protocols. '04%27/•95 THU 12:12 FAX 9166571199 ADMIN SUPPORT 2005 I ' i Mr. Tom Powers Page Four I , Provision of Comprehensive Nutritional and Perinatal Services 5. Can the commercial plan be required to provide comprehensive nutritional and perinatal services equivalent to current CPSP standards and ensure that those benefits, as well as immunization and other prevention services are well publicized to all Medi-Cal beneficiaries and providers. Response: This requirement already exists. The Contractor is required to apply their provider credentialing standards to all perinatal service providers. These credentialing standards are specified in the Plan's quality improvement plan which must be approved by DHS. In addition, Contractors are required to develop risk assessment tools and intervention protocols consistent with CPSP requirements and obtain DHS' approval, Perinatal service providers are exempt from undergoing CPSP certification through the process described in Title 22, CCR, Section 51249. However, applicants will be expected to demonstrate general conformity to requirements specified in Title 22, CCR Section 51179.7 and to adhere to American College of Obstetrics and Gynecologists (AGOG) standards. This includes description of a system for delivering the multidisciplinary services that include obstetric, health education, nutrition and psychosocial services and the types of providers used for provision of these services. Provider Education 6. As part of provider education, clarify and emphasize prevention services as a benefit and make providers aware of social support services, encourage them to make referrals to these services and follow up afterward. Response: The Medi-Cal managed care program is predicated on the emphasis of primary care and preventive services. Throughout the RFA precautions have been taken to ensure that prevention is a principle standard in plan operations. Please refer to the following RFA contractual requirements: * Contractual requirement 9.6.8.18 specifies that Contractors are required to train providers regarding the Medi-Cal Managed Care program, the contract and all applicable federal and state regulations. * Contractual requirements 9.7.4,R.1 through 9,7.4.R.13 describes referral arrangements to such programs such as school linked CIDP, Early Start Program regional centers and WIC. * Clinical preventive services are covered under contractual requirements 9.7.6.R_1 through 9.7.6.R.8. b4i27/195 THU 12:13 FAX 9166571199 ADMI\ SUPPORT Z006 I - ' Mr. Tom Powers Page Five * Contractual requirements 9.5.10.8.1 requires Contractors to develop and maintain procedures for the performance of initial health assessments within 120 days of enrollment. * Contractual requirement 9.7.6.R.I holds Contractors accountable for ensuring that initial health assessments are conducted within 120 days. * Preventive services standards are also required to be adopted as part of the Contractors Quality Improvement program and are specified in contractual requirement 9.5.3-R.3. While the Department recognizes the critical nature of the many and varied social services available, DHS is without the authority to mandate referrals to additional services which are not covered benefits of the Medi-Cal program, such as Adolescent Family Life Services, and shelters for battered women. DHS will, however, strongly encourage Plans to refer members to these programs as appropriate. It should also be noted that existing law requires certain referrals of providers such as reporting to law enforcement wounds or injuries suffered by women as a result of assaultive or abusive conduct; and referring suspected child abuse cases to child protective services. In addition, regulations are being developed for the referral of infants with or at risk of disabilities for early intervention services pursuant to the federal "Individuals with Disabilities Education Act". Community Prevention and Promotion Activities 7. Can the commercial plan be required to work with local groups and the LHD to provide community-wide health education? Response: See attachment, DHS Consolidated Responses, number 2. 8. Agrees to reinvest a portion of any surplus from its Medi-Cal program into community health programs operating in Contra Costa County. Response: See attachment, DHS Consolidated Responses, number 14. Access Standards 9. In addition to the State's access standards, the Contractor should agree to abide by access standards approved by the Hoard of Supervisors for the Local Initiative; the standards may include time and distance requirements and support services such as transportation and patient education. b4,'27/95 THU 12:14 FAX 91665 71199 ADMI?" SUPPORT Z007 Mr. Tom Powers Page Six Response: The access standard for primary care physicians adopted for the two-plan model is 30 minutes or 10 miles from all members' residences. This is more stringent than the Knox-Keene 30 minute-15 mile requirement. An exception to this standard will be considered if a Contractor demonstrates that an alternative access standard is consistent with the existing community standard and that services cannot reasonably be made more accessible. DHS cannot provide an approval of a requirement for access standards approved by the Board of Supervisors without a review of the proposed standard. The proposed standards were not included as part of your recommendation. Arrangements for Snecial Populations 10. Has arrangements to accommodate members with mobility problems; those who do not speak English; those who require special mental health and/or substance abuse services equivalent to standards recommended by the MAPC and approved by Board of Supervisors for the Local Initiative. Response: Contractual requirement 9.5.7.R.9 states the Contractor's obligation to ensure access for the disabled in compliance with the requirements of Title III of the Americans with Disabilities Act of 1990. Contractual requirements in subsection 9.10 delineate Contractors' responsibilities to provide access to those who do not speak English. Mental Health services are a carved out service and explained in contractual requirement 9.7.3. Alcohol and drug treatment services are also a carved out service and the Contractor's obligation for coordination of services is explained in contractual requirement 9.7.11.4. Any standards proposed by the Board of Supervisors must be reviewed and evaluated by DHS before consideration as a county specific RFA requirement. The proposed standards were not included as part of your recommendation. Plan's Experience with Low Income Enrollees 11. The Contractor should have prior experience with Medi-Cal or programs for low income individuals. Response: The evaluation criteria rewards Applicants with prior experience in serving Medi-Cal or low-income populations. Technical Response 9.1.6 of the RFA requires the Applicant to submit a description of it's previous experience, within the past 5 years. It is the intent of this procurement to select the most qualified health plan; qualifying only those with previous Medi-Cal or low income population experience would eliminate very qualified candidates. 04/27i95 THU 12:15 FAX 9166571199 ADMIN SUPPORT Z008 Mr. Tom Powers Page Seven Contra Costa County Plan's Providers' Experience with Low Income Enrollees 12. Has traditional primary and specialty providers in those regions of Contra Costa County with the most number of Medi-Cal patients. Has or will contract with at least one safety net provider in Contra Costa County, Response: See attachment, DHS Consolidated Responses, Number 15. Safety Net Providers 13. The Contractor will agree to enter into negotiations with Merrithew Memorial Hospital and clinics for specified inpatient and outpatient services. Response: See attachment, DHS Consolidated Responses, Number 5 and 23. VolpntaiyEli ibles 14. Agrees to enroll "voluntary" eligibles up to an enrollment limit agreeable to the Board of Supervisors. Response: See attachment, DHS Consolidated Responses, Number 6. Implementation Timing 15. The Commercial plan agrees to concurrent implementation with the Local Initiative unless the Local Initiative petitions to the state for an earlier start date. Response: See attachment, DHS Consolidated Responses, Number 22. LLoock=ln 16. Is a federally qualified HMO and agrees to lock-in. Response: See attachment, DHS Consolidated Responses, Number 16: 04.27/95 THU 12:15 FAX 9166571199 ADMIN SUPPORT 2009 i Mr. Tom Powers Page Eight i Area Coyeraee 17. Have a provider network in areas of the county which are not currently serviced by the Health Services Department_ Response: Neither the Local Initiative or Mainstream Contractor will be exempted from complying with time and distance standards and serving all areas of the county unless a geographic carve out has been approved by DHS as outlined in subsection 3.7, Geographic Carve Outs. Alternative time and distance standards will be considered in areas where public transportation in rural areas is insufficient to support the time standards. DHS will consider local government recommendations before approving alternative time and distance standards. Marketin;Practices 18. The Commercial Plan must agree to abide by the marketing guidelines and code of ethics adopted by the county for the LI. Response: No. Marketing guidelines have been established in both statute and regulations. The county's concerns about marketing should be minimized by the fact that upon implementation of the two-plan model, door-to-door marketing, which is the source of most concerns, will be eliminated. See also the attachment, DHS Consolidated Responses, Number 21, We appreciate your comments and continued support of the Managed Care Expansion Project. We are currently revising the Detail Design Application to incorporate the various changes to the RFA through Addendum No. 11 and anticipate releasing it by May 1, 1995. If you have any questions or would like to discuss these matters further, you may contact Ms. Carolyn Castillo, Chief, Local Initiative Unit, at (916) 654-1469. Sincerely, u n . , o P. tef Managed Care Exp Br Enclosure cc: See next page. 0l!'27/'95 THU, 12:16 FAX 9166571199 kDRIN SUPPORT 2010 Mr. Torn Powers Page Nine cc: Ms. Denise Martin Presi,dent and CEO California Association of Public Hospitals 2000 Center Street, Suite 308 Berkeley, CA 94704 Ms. Mickey Richie Executive Officer County Health Executives Association of California (CHEAC) 1.100 K Street, Suite 101 Sacramento, CA 95814 Mr. Joseph A. Kelly, Chief Medi-Cal Managed Care Division 714 P Street, Room 650 P.O. Box 942732 Sacramento, CA 94234-7320 Ms. Ann Kuhns Assistant Division Chief Medi-Cal Managed Care Division 714 P Street, Room 650 P.O, Box 942732 Sacramento, CA 94234-7320 Ms. Mary Huttner Acting Chief Managed Care Expansion Development Section 714 P Street, Room 650 P.O. Box 942732 Sacramento, CA 94234-7320 Ms. Carolyn Castillo, Chief Local Initiative Development Unit 714 P Street, Room 1340 P.O. Box 942732 Sacramento, CA 94234-7320 OX127-a5 THU 12:09 FAX 9166571199 ADMIN SUPPORT. 1j001 STATE OF CALIFORNIA Department of Health Services Medi-Cal Managed Care Division FAX TRANSMITTAL SKEET 1 ' DATE: Y- 227-9S TO: 0 FAX Number (,510) - = . -� (, 5!� •» / 0.5 9' SUBJECT Number of pages to follow including coversheet: Confidential Urgent FROM: AO Medi-Cal Managed Care Division 7.14 P Street, Room 1340 Sacramento, CA, 95514 Contact Number: FAX Number: (916) 657-1199 Fl► X WZKORANDUM CLMM OF RKE BOARD OF SUPERVISORS CONTRA COSTA COUNTY • 651 Pine Street, Room 106 Kartinez, California 94553 Phone (415) 646-2371; FAX 646-1059 DATE: April 27 , 1995 .TO: Milt Camhi Health Services Department (FAX 5-5098) FROM.. Jeanne Maglio TOTAL PAGES INCLUDING THIS COVER 11 Comments; The attached communication from Rube;R t;nnza1Pz will be listed on the May 9 , 1995, Board Agenda with referral to the Health Services Department. If this is not satisfactory, please call me. (Ext. 6-1276) PLEASE ADVISE Z!' FOR ANY COl+SPLEZ'E! HC2 RECEIVE ISIS YTBM I�