Options Questionnaire 12 11 02

Communities Creating LTC Options: County Planning Assessment QuestionnaireStatus of LTC Program Development as of December 2002Prepared by the California Center for Long Term Care IntegrationPresented December 11, 2002: 

Communities Creating LTC Options: County Planning Assessment Questionnaire Status of LTC Program Development as of December 2002 Prepared by the California Center for Long Term Care Integration Presented December 11, 2002

Purpose: 

Purpose Sharing information across counties including plans and best practices Current status and future directions Baseline for future program evaluation Provide information for waiver planning Provide information for AB-3054

Responding Counties: 

Responding Counties 13 Completed: Alameda Contra Costa Los Angeles Monterey Orange Partnership Health Plan of California Yolo Napa San Diego San Francisco San Luis Obispo San Mateo Santa Cruz Two unable to make deadline: Riverside, Nevada Three indicated that they will not complete the questionnaire at this time: Yuba, Sonoma, Marin

Completion of Questionnaire: 

Completion of Questionnaire Contra Costa, Monterey, Orange, San Diego, San Francisco, San Mateo, and Santa Cruz were most complete Others completed at least three of the nine questions Planning process and results, Organization, Target populations

Planning Process/Organization: 

Planning Process/Organization Boards of Supervisors play varying roles Providing funding Steering committee representation Receiving regular reports No involvement at all Health plan involvement Partnership Health Plan is 1040 grantee CalOptima is only active party in Orange All Healthy San Diego (Sharp & Community most) COHS involved with task force and at program level in San Mateo & Santa Cruz /Monterey Most involve health plan on steering committee (LA & San Francisco invited but don’t come)

Planning Process/Organization: 

Planning Process/Organization 9 in Aging/Adult/Senior department within health &/or human services; 3 in COHS Five use paid consultants Staff & consultant time for LTC planning 5 @ 100%; 2 @ 75%; 1 @ 50%; 5 @ 0-25% Steering committees Range in size from 12 to 400+ Roles vary from policy to working to advisory groups Where committees are large, there are subcommittees doing the follow-through type of work Wide range of time in existence 3 months (Partnership) to 10 years (San Mateo) 3 since 1996-1999; 7 since 2000-2002 Committees evolve over the years as opportunities & challenges change Meeting on a monthly or bi-monthly basis Much work done by subcommittees

Mission, Vision, Values: 

Mission, Vision, Values All but two counties had developed mission, vision, and values statements

Target Populations: 

Target Populations LA, Alameda, & Partnership undecided Condition/level of care Aged (either 60+ or 65+) Disabled (18+ or 21+) SF & SLO undecided re: SNF residents, CCC & Monterey include in later phase 6 include HIV/AIDS (rest undecided) CCC, Monterey, San Mateo, SLO, SF, & Orange intend to include MR/DD & MH Eligibility status/program participation All include ABD (18+ or 21+) SSI, duals, MSSP, IHSS 300% FPL in SD & 60% FPL in SLO Medicare MCO (SF, Sta. Cruz, Monterey, SLO undecided)

Services – 1040/COHS: 

Services – 1040/COHS 1040 counties (incl. San Mateo) and Orange to capitate all state plan & usual waiver services Some (Santa Cruz, San Mateo, Monterey, Contra Costa) exclude dental, ICF-DD, or other non-medical services (legal, I & R, counseling…) Orange, San Diego, San Mateo, and Monterey plan to include Medicare Screening & intake may be retained in county agency or transferred to health plan

Services – Non-1040: 

Services – Non-1040 SF is only non-1040/COHS to have reached decision. Coordination of HCBS, no change to medical (acute, primary, etc.) In absence of financial analysis, CCC reported coordination of all services

Finance: 

Finance Unanswered questions on financing across the board How to calculate cost neutrality Estimate additional costs of extended state plan services Estimate costs of additional services to be paid by Medi-Cal Identify funding mechanism best describing this LTCI program

Models: 

Models Full Continuum Capitation, Mandatory San Mateo Santa Cruz San Diego (along with other options) Orange (no IHSS) Managed FFS Monterey HCBS waiver only San Francisco All fund case management with HCBS waivers &/or grants and other funding

Quality Assurance: 

Quality Assurance Statement of approach Adapting health plan QA program State standards from contract/waiver Most not there yet

Integrated Info Systems: 

Integrated Info Systems All plan to have IIS eventually COHS already have (Panorama, Erisco FACET) Network of Care in 13 CA counties Alameda, San Diego, Santa Cruz, Contra Costa, Monterey Info on providers + info for consumers SF GetCare – non-medical – two portals (consumer & provider) – information about HCBS providers & standards protocols Uniform assessment – some will develop, others trying to find/adapt existing one San Mateo will use MDS-HC

Vignettes: 

Vignettes PHC/Yolo/Napa: Just started in September. Alameda: Suspended pending funding LA: Just completed strategic plan & awaiting BOS approval Orange is not a community process – COHS (CalOptima) pursuing waiver to add more HCBS to package. SLO: Quarter-time consultant, monthly meeting of steering committee (40+ members). Only target population decided.

Vignettes: 

Vignettes San Diego: Actively pursuing 1040 PLUS other options under BOS mandate. San Mateo: Ready for 1040; awaiting cap rate negotiation and re-stabilization of COHS San Francisco: Pursuing HCBS-oriented waiver process. Santa Cruz/Monterey: Steady progress on COHS-based system. Contra Costa: Awaiting data for full feasibility determination.

County Goals for next 6 Months : 

County Goals for next 6 Months 11 of 12 counties listed goals for the next 6 months. County goals vary in specificity among counties. Goals range from financial analysis to agreeing on how to proceed with LTCI projects. 3 counties (Alameda, Napa, and San Diego) listed developing an action plan or having consensus on how to proceed with LTCI efforts; what strategies to take. Only one county (San Mateo) listed web-based care management systems as a goal. One county (Orange) listed working with DHS. One county (Los Angeles) listed transportation and housing issues among their goals.