L A Care Health Plan Providers and Cal

L. A. Care Health Plan Providers and Cal Medi. Connect Paul Van Duine Senior Director of Provider Network Operations www. calmediconnectla. org

L. A. Care’s Provider Network Strategy Network • Subcontracted health plans (similar to our current Medi-Cal model) • Care 1 st Health Plan • Care. More • Kaiser Permanente • IPAs with the capacity and expertise to serve this population • LA County Department of Health Services and community clinics • Hospitals, DME, and pharmacies experienced in serving this population • Long-Term Services and Supports (LTSS) providers • Mix of groups: small, large, Medi-Cal, safety net, commercial • IPAs and Medical Groups with a strong hospital affiliation Contracting • Predominantly shared risk model • IPA capitation • Facility DRGs • C-CAP potentially in the future to align risk between plan, IPA, and hospital |2

Delegation Model (DRAFT) Delegated Responsibility L. A. Care Cal Medi. Connect (CMC) Subcontracted Health Plans Medical Groups (PPGs) • UM • Care Coordination • Complex Case Mgmt • Credentialing • Partial QI • Member Rights • LTSS • Care Plan Options • Behavioral Health • UM/Partial UM • Care Coordination • Credentialing (some PPGs)/ Partial Credentialing (some PPGs) • Quality Improvement • Continuity of Care Other Services Entity • Vision • VSP • PBM • Med. Impact • Nurse 24/7 Advice Line • Mc. Kesson • HRA • APS • HCBS Coordination • APS • Specialty Mental Health/Behavioral Health • HRA (certain BH diagnoses) • Beacon • HRA (nursing facility) • Geri. Net • Care Coordination • Geri. Net |3

Timeline (Subject to Change) Activities DHCS Awarded First Four Counties Duals Demonstration Project L. A. Care & DHCS Initiated Public Education Efforts CMS-DHCS MOU Is Signed Health Plans Receive Preliminary Rates Timing April 2012 Summer 2012 March 2013 May 2013 3 -Way Contracts Dual Eligibles begin receiving notices about voluntary enrollment into Cal Medi. Connect Voluntary Cal Medi. Connect Coverage Begins TBD February 2014 April 2014 More information to come from DHCS regarding the MLTSS portion of the CCI. |4

For the Latest Information www. calmediconnectla. org |5