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California Managed Care Program Features, as of 2020 (1 of 4)FeaturesCounty Organized Health Systems(COHS) ModelRegional ModelGeographic Managed Care (GMC)ModelProgram typeComprehensive MCO MLTSSComprehensive MCOComprehensive MCO MLTSSStatewide or region-specific?Del Norte, Humboldt, Lake, Lassen,Marin, Medocino, Merced, Modoc,Monterey, Napa, Orange, San LuisObispo, San Mateo, Santa Barbara,Santa Cruz, Shasta, Siskiyou, Solano,Sonoma, Trinity, Ventura, YoloAlpine, Amador, Butte, Calaveras,Colusa, El Dorado, Glenn, Imperial,Inyo, Mariposa, Mono, Nevada, Placer,Plumas, San Benito, Sierra, Sutter,Tehama, Tuolumne, YubaSacramento, San DiegoFederal operating authority1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)Program start date10/01/199510/02/201306/01/1991Waiver expiration date (if ns enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with s enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith s enrolled: Aged, Blind orDisabled Children or AdultsMandatoryMandatoryMandatoryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)MandatoryMandatoryMandatoryPopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)MandatoryPopulations enrolled: Full DualsMandatoryVoluntaryMandatoryIf the program ended in 2020, indicatethe end date189
County Organized Health Systems(COHS) ModelRegional ModelGeographic Managed Care (GMC)ModelPopulations enrolled: Children withSpecial Health Care NeedsMandatoryMandatoryMandatoryPopulations enrolled: NativeAmerican/Alaskan NativesVoluntaryVoluntaryVoluntaryPopulations enrolled: Foster Care andAdoption Assistance ChildrenMandatoryVoluntaryVoluntaryPopulations enrolled: Enrollment choice Pre-assignedperiodOtherOtherPopulations enrolled: Enrollment brokername (if applicable)Health Care Options/MAXIMUSHealth Care Options (Maximus)Populations enrolled: Notes onenrollment choice periodApproximately 45 daysApproximately 45 daysXXXBenefits covered: Outpatient hospitalphysical healthXXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XXXBenefits covered: PhysicianXXXBenefits covered: Nurse practitionerXXXBenefits covered: Rural health clinicsand FQHCsXXXBenefits covered: Clinic servicesXXXBenefits covered: Lab and x-rayXXXBenefits covered: Prescription drugsXXXBenefits covered: Prosthetic devicesXXXFeaturesBenefits covered: Inpatient hospitalphysical healthBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)Benefits covered: Partial hospitalization190
FeaturesCounty Organized Health Systems(COHS) ModelRegional ModelGeographic Managed Care (GMC)ModelBenefits covered: EPSDTXXXBenefits covered: Case managementXXXBenefits covered: Home health services X(services in home)XXBenefits covered: Family planningXXXBenefits covered: Private duty nursingXXXBenefits covered: ICF-IDDXXXBenefits covered: Nursing facilityservicesXXXBenefits covered: Hospice careXXXBenefits covered: Non-EmergencyMedical TransportationXXXOptional benefits: podiatry, chiropracticservices, acupuncture, audiology,occupational therapy, and speechtherapy. Provisional post-partum careextension (PPCE).Optional benefits: podiatry, chiropracticservices, acupuncture, audiology,occupational therapy, and speechtherapy. Provisional post-partum careextension (PPCE).Optional benefits: podiatry, chiropracticservices, acupuncture, audiology,occupational therapy, and speechtherapy. Provisional post-partum careextension (PPCE).Benefits covered: SSA Section 1945authorized Health HomeBenefits covered: Dental services(medical/surgical)Benefits covered: Dental (preventativeor corrective)Benefits covered: Personal care (stateplan option)Benefits covered: HCBS waiver servicesBenefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)191
County Organized Health Systems(COHS) ModelRegional ModelGeographic Managed Care (GMC)ModelQuality assurance and improvement:HEDIS data required?YesYesYesQuality assurance and improvement:CAHPS data required?YesYesYesQuality assurance and improvement:Accreditation required?NoNoNoHealth Services Advisory GroupHealth Services Advisory GroupHealth Services Advisory GroupXXXXFeaturesQuality assurance and improvement:Accrediting organizationQuality assurance and improvement:EQRO contractor name (if applicable)Performance incentives: Paymentbonuses/differentials to reward plansPerformance incentives: Preferentialauto-enrollment to reward plansPerformance incentives: Public reportscomparing plan performance on keymetricsXPerformance incentives: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsrequired or encouraged to pay providersfor value/quality outcomes192
FeaturesCounty Organized Health Systems(COHS) ModelRegional ModelGeographic Managed Care (GMC)ModelParticipating plans: Plans in ProgramCenCal Health/San Luis Obispo;CenCal Health/Santa Barbara; HealthPlan of San Mateo; PartnershipHealthPlan of CA/Northeast;Partnership HealthPlan ofCA/Northwest; Partnership HealthPlan/Southeast; Partnership HealthPlan/Southwest; Central CaliforniaAlliance for Health/Merced; CentralCalifornia Alliance for Health/MontereySanta Cruz; CalOptima/Orange; GoldCoast Health Plan/VenturaCalifornia Health & WellnessPlan/Imperial; California Health &Wellness Plan/Region 1; CaliforniaHealth & Wellness Plan/Region 2;Molina Healthcare of CA PartnerPlan/Imperial; Anthem Blue CrossPartnership Plan/Region 1; AnthemBlue Cross Partnership Plan/Region 2;KP Cal LLC/Amador; KP Cal LLC/ElDorado; KP Cal LLC/Placer; AnthemBlue Cross Partnership Plan/San BenitoBlue Shield of California Promise/SanDiego; Community Health GroupPartnership Plan/San Diego; HealthNet/San Diego; KP Cal LLC/San Diego;Molina Healthcare of CA PartnerPlan/San Diego; Aetna Better Health ofCA/San Diego; UnitedHealthcareCommunity Plan/San Diego; AnthemBlue Cross PartnershipPlan/Sacramento; HealthNet/Sacramento; KP CalLLC/Sacramento; Molina Healthcare ofCA Partner Plan/Sacramento; AetnaBetter Health of CA/SacramentoNotes: Program notesFull duals have the option to enroll inCal Medi-Connect in CCI counties,otherwise, they are mandatory forenrollment. Children with Special HealthCare Needs (CSHCN) are mandatory inall COHS counties except Ventura.CSHCN is voluntary in Ventura.Personal Care Services covered undermanaged care only in MLTSS EligibleBeneficiary Authorized Orange County.San Benito is voluntary due to only onecommercial plan in the county. PersonalCare Services are covered servicesunder the Regional Model, but sinceRegional does not include any of theMLTSS Counties (Alameda, LosAngeles, Orange, San Bernardino, SanDiego, San Mateo, Santa Clara, andRiverside), this benefit is not markedunder the Benefits Covered section. Innon-COHS plan model types ICF-DDand nursing facility benefits are onlycovered for a limited period of time(month of admission plus 1 month) andthen the member is disenrolled to FFS.Full duals are mandatory for managedcare enrollment in CCI Counties (SanDiego) and voluntary for all othercounties (Sacramento). In non-COHSplan model types ICF-DD and nursingfacility benefits are only covered for alimited period of time (month ofadmission plus 1 month) and then themember is disenrolled to FFS.193
California Managed Care Program Features, as of 2020 (2 of 4)Program of All-Inclusive Care for theElderly (PACE)FeaturesSenior Care Action Network (SCAN)Program typeComprehensive MCO MLTSSStatewide or region-specific?Los Angeles, Riverside, San Bernardino Alameda, Contra Costa, Fresno,Los AngelesHumboldt, Los Angeles, Orange,Riverside, Sacramento, San Bernardino,San Diego, San Francisco, Santa Clara,Kings, Tulare, Madera, San Joaquin,Stanislaus, Kern, Placer, El Dorado,Sutter, YubaFederal operating authority1915(a)PACE1915(a)/1915(i)Program start date01/01/199601/01/199804/01/1998Waiver expiration date (if applicable)12/31/2021Program of All-inclusive Care for theElderly (PACE)Dental Managed Care/Los AngelesDental only (PAHP)12/31/2020If the program ended in 2020, indicatethe end datePopulations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)VoluntaryPopulations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)VoluntaryPopulations enrolled: Aged, Blind orDisabled Children or AdultsVoluntaryVoluntaryVoluntaryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)VoluntaryPopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)VoluntaryPopulations enrolled: Full DualsVoluntaryVoluntaryVoluntary194
FeaturesSenior Care Action Network (SCAN)Program of All-Inclusive Care for theElderly (PACE)Populations enrolled: Children withSpecial Health Care NeedsDental Managed Care/Los AngelesVoluntaryPopulations enrolled: NativeAmerican/Alaskan NativesVoluntaryVoluntaryVoluntaryPopulations enrolled: Foster Care andAdoption Assistance ChildrenExemptExemptVoluntaryN/A60 daysPopulations enrolled: Enrollment choiceperiodPopulations enrolled: Enrollment brokername (if applicable)Health Care Operations (Maximus)Populations enrolled: Notes onenrollment choice periodBenefits covered: Inpatient hospitalphysical healthXBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)XXBenefits covered: Outpatient hospitalphysical healthXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XXBenefits covered: Partial hospitalization XXBenefits covered: PhysicianXXBenefits covered: Nurse practitionerXXBenefits covered: Rural health clinicsand FQHCsXBenefits covered: Clinic servicesXXBenefits covered: Lab and x-rayXXBenefits covered: Prescription drugsXXBenefits covered: Prosthetic devicesXXX195
Program of All-Inclusive Care for theElderly (PACE)Dental Managed Care/Los AngelesXXXXXBenefits covered: Home health services X(services in home)XBenefits covered: Family planningXBenefits covered: Dental services(medical/surgical)XXBenefits covered: Dental (preventativeor corrective)XXBenefits covered: Personal care (stateplan option)XFeaturesSenior Care Action Network (SCAN)Benefits covered: EPSDTBenefits covered: Case managementBenefits covered: SSA Section 1945authorized Health HomeBenefits covered: HCBS waiver servicesBenefits covered: Private duty nursingXBenefits covered: ICF-IDDXBenefits covered: Nursing facilityservicesXXBenefits covered: Hospice careXXBenefits covered: Non-EmergencyMedical TransportationXXOptional benefits: podiatry, chiropracticservices, acupuncture, audiology,occupational therapy, and speechtherapy. Provisional post-partum careextension (PPCE).PACE is responsible for covering allMedicaid servicesXBenefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)196
FeaturesSenior Care Action Network (SCAN)Program of All-Inclusive Care for theElderly (PACE)Dental Managed Care/Los AngelesQuality assurance and improvement:HEDIS data required?NoNoYesQuality assurance and improvement:CAHPS data required?NoNoYesQuality assurance and improvement:Accreditation required?No, but accreditation considered in plan Noselection criteriaQuality assurance and improvement:Accrediting organizationNo, but accreditation considered in planselection criteriaNCQA, Private credentiallingorganizations approved by DHCSQuality assurance and improvement:EQRO contractor name (if applicable)Performance incentives: Paymentbonuses/differentials to reward plansPerformance incentives: Preferentialauto-enrollment to reward plansPerformance incentives: Public reportscomparing plan performance on keymetricsXPerformance incentives: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsrequired or encouraged to pay providersfor value/quality outcomes197
FeaturesSenior Care Action Network (SCAN)Participating plans: Plans in ProgramSCAN Health Plan/Los Angeles; SCANHealth Plan Riverside/San BernardinoProgram of All-Inclusive Care for theElderly (PACE)Dental Managed Care/Los AngelesRedwood Coast Pace/Humboldt; SanHealth Net Dental Plan/Los Angeles;Diego PACE; St. Paul's PACE/SanAccess Dental Plan/Los Angeles;Diego; Sutter SeniorCareLIBERTY Dental Plan/Los AngelesPACE/Sacramento; AltaMed SeniorBuenacare/Los Angeles; BrandmanCenters for Senior Care/Los Angeles;CalOptima PACE/Orange; Center forElders Independence/Alameda; Centerfor Elders Independence/Contra Costa;Fresno PACE; InnovAgePACE/Riverside; InnovAge PACE/SanBernardino County; On LokLifeways/Alameda; On LokLifeways/Santa Clara; On LokLifeways/San Francisco; Family HealthCenters of San Diego; Gary and MaryWest PACE of Northern San Diego;Pacific PACE/Los Angeles; StocktonPACE/San Joaquin; StocktonPACE/Stanislaus; Bakersfield PACE;Bakersfield PACE; Central ValleyPACE; Central Valley PACE; InnovAgeCalifornia PACE- El Dorado; InnovAgeCalifornia PACE- Placer; InnovAgeCalifornia PACE- Sacramento;InnovAge California PACE- SanJoaquin; InnovAge California PACESutter; InnovAge California PACEYuba; Coastline PACE; Sequoia PACE;Sequoia PACE; Sequoia PACE;Sequoia PACENotes: Program notes198
California Managed Care Program Features, as of 2020 (3 of 4)FeaturesDental Managed Care/SacramentoTwo-Plan ModelPositive Healthcare/Los AngelesProgram typeDental only (PAHP)Comprehensive MCO MLTSSComprehensive MCOStatewide or region-specific?SacramentoAlameda, Contra Costa, Fresno, Kern, Los AngelesKings, Los Angeles, Madera, Riverside,San Bernardino, San Francisco, SanJoaquin, Santa Clara, Stanislaus, TulareFederal operating authority1115(a) (Medicaid demonstrationwaivers)1115(a) (Medicaid demonstrationwaivers)1915(a)Program start date01/01/199501/01/199604/01/2002Waiver expiration date (if ns enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with s enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith s enrolled: Aged, Blind orDisabled Children or AdultsMandatoryMandatoryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)MandatoryMandatoryPopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)MandatoryPopulations enrolled: Full DualsMandatoryVariesPopulations enrolled: Children withSpecial Health Care NeedsMandatoryVoluntaryPopulations enrolled: NativeAmerican/Alaskan NativesVoluntaryVoluntaryIf the program ended in 2020, indicatethe end dateVoluntaryVoluntary199
FeaturesDental Managed Care/SacramentoTwo-Plan ModelPositive Healthcare/Los AngelesPopulations enrolled: Foster Care andAdoption Assistance ChildrenVoluntaryVoluntaryVoluntaryPopulations enrolled: Enrollment choice 60 daysperiodOtherPopulations enrolled: Enrollment broker Health Care Operations (Maximus)name (if applicable)Health Care Options/MAXIMUSPopulations enrolled: Notes onenrollment choice periodApproximately 45 daysBenefits covered: Inpatient hospitalphysical healthXXBenefits covered: Outpatient hospitalphysical healthXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XXBenefits covered: PhysicianXXBenefits covered: Nurse practitionerXXXXBenefits covered: Clinic servicesXXBenefits covered: Lab and x-rayXXBenefits covered: Prescription drugsXXBenefits covered: Prosthetic devicesXXBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)Benefits covered: Partial hospitalizationBenefits covered: Rural health clinicsand FQHCsXBenefits covered: EPSDTXXXBenefits covered: Case managementXXXBenefits covered: SSA Section 1945authorized Health Home200
FeaturesDental Managed Care/SacramentoTwo-Plan ModelPositive Healthcare/Los AngelesBenefits covered: Home health services(services in home)XXBenefits covered: Family planningXXBenefits covered: Private duty nursingXXBenefits covered: ICF-IDDXXBenefits covered: Nursing facilityservicesXXBenefits covered: Hospice careXXXXOptional benefits: podiatry, chiropracticservices, acupuncture, audiology,occupational therapy, and speechtherapy. Provisional post-partum careextension (PPCE).Optional benefits: podiatry, chiropracticservices, acupuncture, audiology,occupational therapy, and speechtherapy. Provisional post-partum careextension (PPCE).Benefits covered: Dental services(medical/surgical)XBenefits covered: Dental (preventativeor corrective)XBenefits covered: Personal care (stateplan option)Benefits covered: HCBS waiver servicesBenefits covered: Non-EmergencyMedical TransportationXBenefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)Quality assurance and improvement:HEDIS data required?YesYesYesQuality assurance and improvement:CAHPS data required?YesYesYesQuality assurance and improvement:Accreditation required?No, but accreditation considered in plan Noselection criteriaNo201
FeaturesDental Managed Care/SacramentoQuality assurance and improvement:Accrediting organizationNCQA, Private credentiallingorganizations approved by DHCSQuality assurance and improvement:EQRO contractor name (if applicable)Two-Plan ModelPositive Healthcare/Los AngelesHealth Services Advisory GroupPerformance incentives: Paymentbonuses/differentials to reward plansPerformance incentives: Preferentialauto-enrollment to reward plansPerformance incentives: Public reportscomparing plan performance on keymetricsXXXPerformance incentives: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsrequired or encouraged to pay providersfor value/quality outcomes202
FeaturesDental Managed Care/SacramentoTwo-Plan ModelParticipating plans: Plans in ProgramHealth Net Dental Plan/Sacramento;Access Dental Plan/Sacramento;LIBERTY Dental Plan/SacramentoHealth Net/Kern; Health Net/LosPositive Healthcare/Los AngelesAngeles; Health Net/San Joaquin;Health Net/Stanislaus; HealthNet/Tulare; CalViva Health/Fresno;CalViva Health/Kings; CalVivaHealth/Madera; Anthem Blue CrossPartnership Plan/Fresno; Anthem BlueCross Partnership Plan/Kings; AnthemBlue Cross Partnership Plan/Madera;Anthem Blue Cross PartnershipPlan/Alameda; Anthem Blue CrossPartnership Plan/Contra Costa; AnthemBlue Cross Partnership Plan/SanFrancisco; Anthem Blue CrossPartnership Plan/Santa Clara; AnthemBlue Cross Partnership Plan/Tulare;Kern Family Health Care; L.A. CareHealth Plan/Los Angeles; Contra CostaHealth Plan; Alameda Alliance forHealth; Inland Empire HealthPlan/Riverside; Inland Empire HealthPlan/San Bernardino; Molina Healthcareof CA Partner Plan/Riverside; MolinaHealthcare of CA Partner Plan/SanBernardino; San Francisco Health Plan;Health Plan of San Joaquin/SanJoaquin; Health Plan of SanJoaquin/Stanislaus; Santa Clara FamilyHealth PlanNotes: Program notesFull duals are mandatory for managedcare enrollment in CCI Counties (LosAngeles, Riverside, San Bernardino,and Santa Clara) and voluntary for allother counties (Alameda, Contra Costa,Fresno, Kern, Kings, Madera, SanFrancisco, San Joaquin, Stanislaus, andTulare). In non-COHS plan model typesICF-DD and nursing facility benefits areonly covered for a limited period of time(month of admission plus 1 month) andthen the member is disenrolled to FFS.Positive Healthcare/Los AngelesAHF was formerly a Primary Care CaseManagement (PCCM) model andbecame a full-risk plan effective July2019, however, their enrollment remainslimited to specific populations.203
California Managed Care Program Features, as of 2020 (4 of 4)Family Mosaic Program/SanFranciscoRady Children’s Hospital San Diego(RCHSD)Program typeBehavioral Health Organization (BHO)only (PIHP and/or PAHP)Comprehensive MCOStatewide or region-specific?San FranciscoSan DiegoFederal operating authority1915(a)1115(a) (Medicaid demonstrationwaivers)Program start date12/01/199208/01/2018FeaturesWaiver expiration date (if applicable)12/31/2021If the program ended in 2020, indicatethe end datePopulations enrolled: Low-incomeadults not covered under ACA SectionVIII (excludes pregnant women andpeople with disabilities)Populations enrolled: Low-incomeadults covered under ACA Section VIII(excludes pregnant women and peoplewith disabilities)Populations enrolled: Aged, Blind orDisabled Children or AdultsVoluntaryVoluntaryPopulations enrolled: Non-DisabledChildren (excludes children in fostercare or receiving adoption assistance)VoluntaryVoluntaryPopulations enrolled: Children withSpecial Health Care NeedsVoluntaryVoluntaryPopulations enrolled: NativeAmerican/Alaskan NativesVoluntaryVoluntaryPopulations enrolled: Individualsreceiving Limited Benefits (excludespartial duals)Populations enrolled: Full Duals204
FeaturesPopulations enrolled: Foster Care andAdoption Assistance ChildrenFamily Mosaic Program/SanFranciscoRady Children’s Hospital San Diego(RCHSD)VoluntaryVoluntaryPopulations enrolled: Enrollment choiceperiodPopulations enrolled: Enrollment brokername (if applicable)Populations enrolled: Notes onenrollment choice periodBenefits covered: Inpatient hospitalphysical healthBenefits covered: Inpatient hospitalbehavioral health (MH and/or SUD)XXBenefits covered: Outpatient hospitalphysical healthBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XXXBenefits covered: Partial hospitalization XBenefits covered: PhysicianXXBenefits covered: Nurse practitionerXXBenefits covered: Rural health clinicsand FQHCsBenefits covered: Clinic servicesXXXBenefits covered: Lab and x-rayXBenefits covered: Prescription drugsXBenefits covered: Prosthetic devicesXBenefits covered: EPSDTXBenefits covered: Case managementXXBenefits covered: SSA Section 1945authorized Health Home205
FeaturesFamily Mosaic Program/SanFranciscoBenefits covered: Home health services(services in home)Benefits covered: Family planningRady Children’s Hospital San Diego(RCHSD)XXXBenefits covered: Dental services(medical/surgical)Benefits covered: Dental (preventativeor corrective)Benefits covered: Personal care (stateplan option)Benefits covered: HCBS waiver servicesBenefits covered: Private duty nursingXBenefits covered: ICF-IDDXBenefits covered: Nursing facilityservicesBenefits covered: Hospice careXBenefits covered: Non-EmergencyMedical TransportationXBenefits covered: Institution for MentalDisease inpatient treatment for peopleages 21-64 defined by 42 CFR§438.6(e) as an 'in lieu of' benefitBenefits covered: Other (e.g., nursemidwife services, freestanding birthcenters, podiatry, etc.)Optional benefits: podiatry, chiropracticservices, acupuncture, audiology,occupational therapy, and speechtherapy. Provisional post-partum careextension (PPCE).Quality assurance and improvement:HEDIS data required?YesNoQuality assurance and improvement:CAHPS data required?NoNo206
FeaturesQuality assurance and improvement:Accreditation required?Family Mosaic Program/SanFranciscoRady Children’s Hospital San Diego(RCHSD)NoNoQuality assurance and improvement:Accrediting organizationNCQAQuality assurance and improvement:EQRO contractor name (if applicable)Performance incentives: Paymentbonuses/differentials to reward plansPerformance incentives: Preferentialauto-enrollment to reward plansPerformance incentives: Public reportscomparing plan performance on keymetricsPerformance incentives: Withholds tiedto performance metricsPerformance incentives: MCOs/PHPsrequired or encouraged to pay providersfor value/quality outcomesParticipating plans: Plans in ProgramFamily Mosaic Project/San FranciscoRady Children’s Hospital San Diego(RCHSD)Notes: Program notesFMP is run by San FranciscoDepartment of Public Health for at-riskyouth and their families.RCH was a pilot program which beganin August 2018 serving special needschildren and this contract will beterminating December 2021. The fiveeligible conditions for participation areCystic Fibrosis, Hemophilia, Sickle Cell,Acute Lymphoblastic Leukemia, andDiabetes.207
Stanislaus, Kern, Placer, El Dorado, Sutter, Yuba Los Angeles Federal operating authority 1915(a) PACE 1915(a)/1915(i) Program start date 01/01/1996 01/01/1998 04/01/1998 Waiver expiration date (if applicable) 12/31/2021 12/31/2020 If the program ended in 2020, indicate the end date Populations enrolled: Low-income
