Department of Health Care Services Seeks Input From Health Plans
The Department of Health Care Services (DHCS) released a Request for Information (RFI) to solicit stakeholder input into the development of a forthcoming Medi-Cal Managed Care Plan Request for Proposal (RFP) and the updated Medi-Cal managed care contract.
The RFI contained two parts. The first is a set of questions to guide stakeholder input to the RFI related to the DHCS’s expressed goals for the Medi-Cal managed care delivery system. The second is an invitation for input specifically from health plans that may be interested in submitting a proposal in the upcoming RFP process. Responses to the latter are non-binding at this stage and meant to be informational to the DHCS in the development of the RFP. DHCS is evaluating possible model changes, such as Regional Model counties joining a County Organized Health System (COHS) and possibly reducing the number of health plans that will operate in the Geographic Managed Care (GMC) counties.
DHCS priorities for Medi-Cal Managed Care
DHCS stated ten overarching goals guiding the RFP process and update of the managed care contract. DHCS will award contracts to health plans that are able to demonstrate an ability to meet the following:
- Quality – Minimum Performance Levels (MPLs), including measures in the Managed Care Accountability Set.
- Access to Care – Comprehensive networks that provide all members timely access to appropriate, culturally competent, and high-quality care, within time and distance standards.
- Continuum of Care – The demonstrated ability to manage individuals’ care, including comprehensive person-centered health care and social services, spanning all levels of intensity of care.
- Children services – Greater emphasis on preventive and early intervention, maternal services, and care that supports social and emotional development and that addresses adverse childhood experiences.
- Behavioral health services – Expanding access to evidence-based behavioral health services, focused on earlier identification and engagement in treatment for children, youth and adults.
- Coordinated/integrated care – Coordinated, integrated care for Medi-Cal members, particularly vulnerable populations with complex health care needs, consistent with the CalAIM initiative.
- Reducing health disparities – Identifying health disparities in access, utilization, and outcomes among racial, ethnic, language, and LGBTQ groups and improving health outcomes within the groups and communities most impacted by the disparities.
- Increased oversight of delegated entities – Increased oversight of all delegated entities to ensure enrollees receive quality care and service.
- Local presence and engagement – Engaging with local community partners and resources to ensure community needs are met.
- Emergency preparedness and ensuring essential services – Ensuring continuity of business operations, delivery of essential care and services to members, and the ability to mitigate any potential harm caused by an emergency, such as a health crisis or natural disaster.
Counties impacted by Procurement
Local Initiatives (LIs) and COHS contracts are not up for bid through the RFP. However, DHCS intends to use the updated contract as the boilerplate for all Medi-Cal managed care plans, including LIs and COHS plans, once the RFP process is concluded.
Responses to the RFI are due to CSBRFP8@dhcs.ca.gov no later than 4:00 p.m. on Thursday, October 1, 2020.