CalOptima Health LTSS Updates - September 13, 2023
CalOptima Health's LTSS updates include objectives such as providing LTSS structure, reviewing SNF pilot programs, discussing timely notifications, and collaborating on the PASRR process. The organization's focus is on removing barriers to healthcare access, implementing same-day treatment authorizations, and assessing social determinants of health annually. Contact details for key personnel and information on vaccination support are also provided.
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Our Mission To serve member health with excellence and dignity, respecting the value and needs of each person. Our Vision By 2027, remove barriers to health care access for our members, implement same-day treatment authorizations and real-time claims payments for our providers, and annually assess members social determinants of health. CalOptima Health LTSS Updates September 13, 2023 Scott Robinson, Director, Long Term Services & Supports 1 CalOptima Health, A Public Agency
LTSS Agenda LTSS Objectives LTSS Updates LTC organization structure SNF pilot programs Vaccination support LTSS Liaison Timely Notifications PASRR TCS 2
LTSS Objectives To provide general LTSS structure, contacts and program updates. To describe current SNF pilot programs aimed at reducing barriers to member hospital discharge to SNF and custodial levels of care. To review new DHCS requirements regarding timely notifications of member transitions to SNF and how we can collaborate. To describe the new PASRR process and how LTC and CalOptima Health can collaborate. 3
LTC Organization Cathy Osborn, LTSS Manager Kennedy Anyama, RN, Supervisor LTC facilities Karen Marin, RN, Supervisor CBAS and Complex Discharge Heather Wanket, RN, Supervisor CalAim Contacts scott.robinson@caloptima.org; cell: 714-497-9350 cosborn@caloptima.org; cell: 714-474-9066 kanyama@caloptima.org; cell: 657-236-1769 karen.marin@caloptima.org; cell: 714-923-8836 heather.Wanket@caloptima.org; cell: 657-900-1185 4
General LTSS Updates Vaccination Support CalOptima Health would like to support your organization in planning/organizing covid and influenza vaccine clinics. Please let us know how we can help! o SNF Pilot Programs o We are working on developing programs to incentivize SNF s to be able to accommodate members with complex needs: These may include: oIsolation oDialysis oAge o Let us know if you would like to learn more about participating in a pilot progra. 5
OneCare LTSS Liaison Trained by the plan to identify and understand the full spectrum of Medicare and Medi-Cal LTSS, including home and community-based services and long-term institutional care, including payment and coverage rules Serve as LTSS subject matter expert to health network OneCare Case management team LTSS liaisons participate in all OneCare Interdisciplinary Care Teams (ICTs) Include referrals and connections to LTSS in member s Individual Care Plan (ICP) Assist with transitions of care, coordination of services, referrals and the LTSS provider community Ensure that referrals and connections to LTSS are in the member s ICP Help facilitate member care transitions by ensuring linkages to appropriate LTSS to support the member 6
CalOptima Health LTSS Liaison o CalOptima Health also has a dedicated LTSS liaison o Health network LTSS liaison can also outreach to the CalOptima Health LTSS Liaison if there are any questions regarding LTSS Contact Any questions from the LTSS Liaison can be directed to the following LTSS staff: Email: (Paz Reyes) preyes@caloptima.org (Tracy Nguyen) tracy.nguyen@caloptima.org (Luisa Cirson) luisa.Cirson@caloptima.org Phone: 714-246-8600, option 6 Fax: 714-246-8843 DHCS D-SNP Policy Guide 2024 https://www.dhcs.ca.gov/provgovpart/Documents/DHCS-CalAIM-D-SNP-Policy- Guide-2024-June.pdf 7
DHCS D-SNP Information Sharing 2023 Timely Notifications CalOptima Health and our contracted facilities (Hospitals and SNFs) must be compliant with secure and timely information sharing effective 7/1/2023 for the purpose of coordinating timely Medicare and Medi-Cal covered services between settings of care for D-SNP Members. This is required by State policy (42 CFR 422.107(d)(1)). CalOptima Health will require their contracted facilities to use secure email, data exchange through a Health Information Organization, or an electronic process approved by DHCS, to inform CalOptima Health either immediately, prior to, or at the time of any admission, discharge, or transfer for all Members. E-Fax is not permitted under this new information sharing requirement. 8
DHCS D-SNP Information Sharing 2023 Timely Notifications (continued) Additionally, CalOptima Health will require our contracted SNFs to make this notification within 48 hours after any SNF admission. For SNF discharges or transfers, CalOptima Health will require their contracted SNFs to make this notification in advance if possible, or at the time of the Member s discharge or transfer from the SNF. CalOptima Health is committed to collaborating with our facility providers and partners over the next six months to ensure a smooth transition to secure email to communicate with CalOptima Health and our Health Networks prior to 7/1/23. Our goal is for all facilities to start using the secure CalOptima health portal in the near future. We will be scheduling a training webinar soon. 2023 CalAIM D-SNP Policy Guide Updated June 2023 9
New PASRR Process PASRR LEVEL I - NEGATIVE PASRR documentation is no longer required to be sent to CalOptima when a Level I Screening is negative for SMI and/or ID/DD/RC. Hospital or SNF staffs are required to show confirmation that the PASRR Level I Screening was completed to CalOptima LTC program on PASRR section V of CalOptima LTC-ARF form. PASRR LEVEL I - POSITIVE If the Level I Screening result is positive for SMI and/or ID/DD/RC and the case advances to a Level II Evaluation The CalOptima LTC program staff shall pend approval of the LTC authorization request until Hospital or SNF sends PASRR determination letter from DHCS or PASRR Summary Report from DDS/Regional Center. Once the PASRR process is completed, Hospitals and SNFs must provide the Level II Evaluation/Determination or summary Report letter for SMI and/or ID/DD/RC to CalOptima within three calendar days of issuance to obtain LTC-ARF approval from LTC program. Hospital or SNF are required to show whether the Level I Screening result is negative or positive to CalOptima LTC program on PASRR section V of LTC-ARF form. Hospital or SNF are required to provide PASRR Case Identification (CID) to CalOptima LTC program on PASRR section V of LTC-ARF form. The Level II Evaluation/Determination letters issued by DHCS can be downloaded in the PASRR Online System once available. Level II Evaluation Summary letters issued by the DDS Regional Center are sent 10
PASRR Requirement for a Member Returning to a SNF If a Member is going from a SNF to a Hospital and then returns to the same SNF, then Hospital does not need to complete a new PASRR for the Member, if the member has a valid PASRR A new PASRR is only required when a member has significant change in physical or mental condition as indicated by MDS. If a Member is going from a SNF to a Hospital and then goes to a different Medicaid-certified SNF, the admitting SNF must obtain the PASRR documentation from the original SNF, unless the original SNF sent the PASRR documentation to the Hospital. 11
PASRR Requirements - SNF to Hospital Transfer The Hospital must send the documentation to the admitting SNF. The Hospital must include a note in the prior authorization request for SNF placement indicating Member returning to a SNF; previous PASRR on file. If the admitting SNF later determines that the Member has a significant change in condition, they must submit a Level I Screening as a Resident Review https://www.dhcs.ca.gov/services/MH/Pages/PASRR.aspx 12
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