Medi -Cal Managed Care and CPSP

1. Medi-Cal Managed Care and CPSP CPSP Annual Meeting November 13, 2013 Mary Wieg, PHN, MBA, Nurse Consultant III Maternal, Child and Adolescent Health Division Center for Family Health California Department of Public Health

2. Objectives Participants will: • Meet Medi-Cal Managed Care staff • Share issues regarding Medi-Cal Managed care with Medi-Cal Managed Care staff • Plan next steps 2

3. Change in Plans • On October 3, MCAH staff met with Sarah Brooks, Chief of the MMCD Program to discuss questions from PSCs and plan today’s presentation. Sarah was going to join us today. • Sarah Brooks had an emergency and is unable to join us. • Two of her staff have graciously agreed to join us to listen to concerns.

4. MCMC staff Sarah Royce, MD, Medi-Cal Managed Care Medical Program Consultant Rose Recostodio, Nurse Consultant III 4

5. Questions • How does MMCD inform contracting health plans about CPSP requirements and services? All Plan letters, contracts • How does MMCD inform new MMCD staff of CPSP requirements? All Plan Letters, employee orientation. 5

6. Questions • How does MMCD assure at the provider level and enforce the requirement that clients receive CPSP comparable services? Annual audits and follow up corrective action plans. 6

7. Questions • How does MMCD oversee perinatal quality of care? Are there differences depending on the MCMC model? Annual Audits. DMHC is involved for Knox-Keene licensees. 7

8. Questions • How does MMCD monitor perinatal quality of care and identify perinatal quality of care issues? What measures do they collect such as preterm birth rates, low birth weight, plan encounter data? HEDIS measures (Prenatal and Postpartum Care). No other quality measures at this time.

9. Questions • Does the oversight/enforcement process vary at all depending on the MCMC model (e.g. two-plan COHS, GMC)? COHS not required to be licensed. • What is the process for identifying perinatal quality of care issues among MCMC clients in each local health jurisdiction? HEDIS measures, audits

10. Questions • How should we communicate issues to MMCD and get them resolved? Refer issues to Javier Portela, who supervises the contract managers, and the Contract Managers will investigate. • How can we work together to maintain and improve the quality of perinatal services for MCMC beneficiaries in California?

11. Next Steps • Would like to hear findings from plan audits regarding CPSP • Could we have input into the audit tool or quality measures? • Possible statewide Webinar or Teleconference? What would be the topic(s)?