Housing Supportive Services in Californias Whole Person Care Pilots - - PowerPoint PPT Presentation

Housing Supportive Services in California’s Whole Person Care Pilots and ACA 2703 Health Home Program

Brian Hansen Health Program Specialist II - Health Care Delivery Systems California Department of Health Care Services

July 24, 2017

Presentation Overview

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California Department of Health Care Services

• 1. Whole Person Care (WPC) Pilot

Program Overview

• 2. ACA 2703 Health Home

Program (HHP) Overview

WPC Program Overview

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California Department of Health Care Services

Program Duration

• Five-year program

authorized under the Medi-Cal 2020 1115 Demonstration Waiver Goal

• To test locally-based

initiatives that will coordinate physical health, behavioral health, and social services for beneficiaries who are frequent users of multiple health care systems Funding

• $1.5 billion in federal

funds available to match local public funds

• ver five years
• Up to $300 million

annually is available

• Based on semi-annual

reporting of activities/interventions

• Non-federal share

provided via IGTs

Participating Entities

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California Department of Health Care Services

Allowable Lead Entities

• County
• City
• A health or hospital authority
• A designated public hospital
• A district/municipal public

hospital

• A federally recognized tribe/

tribal health program

• A consortium of any of the

above entities Participating Entities must include at least:

• One (1) Medi-Cal managed

care health plan

• One (1) Health services

agency/department

• One (1) Specialty mental

health agency/department

• One (1) Public

agency/department

• Two (2) Community partners

Target Populations

WPC pilots identify high-risk, high-utilizing Medi-Cal beneficiaries in their geographic area.

• Pilots work with participating entities to determine the best target

population(s) and areas of need.

Target population(s) may include, but are not limited to, individuals:

• With repeated incidents of avoidable emergency use, hospital

admissions, or nursing facility placement;

• With two or more chronic conditions;
• With mental health and/or substance use disorders;
• Who are currently experiencing homelessness, or at risk of homelessness.

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California Department of Health Care Services

Expected Pilot Size - Population

Larger: Over 100,000

Los Angeles

Large: Between 10,000 and 100,000

Alameda Contra Costa Riverside Santa Clara San Francisco

Medium: Between 1,000 and 5,000

Kern Orange San Bernardino San Diego San Joaquin San Mateo Ventura

Small: Between 250 and 800

Monterey Napa Placer Shasta Solano

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WPC Pilot Activities/Services

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California Department of Health Care Services

• Build Infrastructure: To integrate services among local entities that serve

the target population through collaboration procedures, governance, and information sharing data systems and processes.

• Provide Services: To cover activities (not otherwise reimbursed by

Medicaid) to improve care for the target population. All populations receive intensive, whole-person case management.

• Operate Plan-Do-Study-Act: For quarterly rapid-cycle quality

improvement.

WPC Tenancy Supportive Services

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California Department of Health Care Services

• Individual Housing Transition Services: Services to assist beneficiaries

with obtaining housing, such as individual outreach and assessments, searching for housing, communicating with landlords, and coordinating moves.

• Individual Housing & Tenancy Sustaining Services: Services to support

individuals in maintaining tenancy once housing is secured, such as tenant and landlord education and tenant coaching.

WPC Additional Supports

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California Department of Health Care Services

• Transportation that is not covered by Medicaid.
• Environmental accommodations for accessibility.
• Other one-time supports, such as security deposits, utility set-up fees,

first month coverage of utilities, one-time cleaning prior to occupancy, etc.

WPC Innovative Services

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California Department of Health Care Services

:

• Recuperative Care/Medical Respite: Up to 90 days of residential care after

an acute discharge to allow recovery in a stable environment.

• Sobering Centers: Up to 24 hours of residential care to avoid ED or Jail

utilization.

• Field-based Care: Case managers, therapists, or nurses delivering services
• n the streets or at shelters.
• Benefits Advocacy and Legal Assistance: To enroll in benefits, such as SSI,

and remove barriers to benefit enrollment, health care, and housing.

Health Homes Program (HHP)

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California Department of Health Care Services

• The HHP will begin a staged rollout in 2018 and will be available in most

areas of California in 2019.

• Like most Medi-Cal benefits, the HHP will be administered through

managed care plans (MCPs).

• Plans will contract with community providers, such as FQHCs, for most

services.

• State legislation requires program cost neutrality. There will be a focus on

evaluating savings in inpatient, ED, etc.

• Eligibility includes specific physical and behavioral health conditions.
• State Health Homes legislation was cosponsored by the Corporation for

Supportive Housing and includes frequent utilizers who are experiencing homelessness.

• Eligibility is focused on the top 2-4% of the highest risk members who are

living in the community.

SPA Supportive Housing Services

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California Department of Health Care Services

• California’s draft Health Home SPA is under CMS review.
• The draft Health Home SPA services include tenancy supports referenced

in CMS’s June 26, 2015, bulletin “Coverage of Housing Related Activities and Services for Individuals with Disabilities:”

• Individual Housing Transition Services; and
• Individual Housing and Tenancy Sustaining Services.
• These services fit the definition of Health Home case management and

the needs of our target population.

• Coverage is not available for one-time set up services, such as housing

modifications, first month rent and deposit, etc.

HHP Service Requirements

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California Department of Health Care Services

• MCPs have the flexibility to organize the provision of service with their

community providers to maximize effectiveness:

• For example, services like engagement of homeless members can be

subcontracted to providers with specific expertise in the community.

• The Health Home service team will include a Housing Navigator for

members experiencing chronic homelessness.

• MCPs will provide services to members in the community, including at

home and on the streets as needed.

• MCPs will to use local community based providers with experience

serving homeless members.

• Reporting requirements will track members who have been homeless,

their services, and housing status.

Resource Assumptions

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California Department of Health Care Services

• DHCS will develop a capitated, risk-based, add-on payment for each

enrolled HHP member, which will be paid to the MCP.

• In the development of MCP rates, DHCS will consider additional resource

needs that can impact program success for those experiencing homelessness:

• Resources needed for members with varying levels of

acuity/complexity, including behavioral health conditions;

• Engagement efforts to get members into the program; and
• Higher levels of initial resource utilization for new members.

Program Monitoring

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California Department of Health Care Services

• MCPs have the flexibility to contract for services and rates to meet the

specific needs in their area, for their providers, and to fit their model.

• DHCS will verify that MCPs have a viable model for:
• A complete network of providers to meet all service needs; and
• Provider contract requirements, a payment model, and an oversight

process to ensure higher-need members receive a higher level of service.

• Through our monitoring processes, DHCS will also compare actual MCP

resource utilization to:

• DHCS rate development assumptions, and
• DHCS program service requirements.

DHCS Web Page Links

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California Department of Health Care Services

Whole Person Care Pilots

• http://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx
• Or Google “DHCS Whole Person Care Program”

ACA 2703 Health Home Program

• http://www.dhcs.ca.gov/services/Pages/HealthHomesProgram.aspx
• Or Google “DHCS Health Home Program”