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California Managed Care Program Features, as of 2016FeaturesProgram typeHealth Plan of San Mateo CCS Demo/SanMateoComprehensive MCOStatewide or region-specific?San MateoBehavioral Health Organization (BHO) only (PIHP Other Prepaid Health Plan (PHP) (limited benefits)and/or PAHP)San FranciscoLos AngelesFederal operating authority1115(a) (Medicaid demonstration waivers)1915(a)1937 Alt Benefit PlanProgram start date06/01/201212/01/199204/01/2002Waiver expiration date (if applicable)04/01/2018blankblankIf the program ended in 2016, indicate the end blankdateblankblankPopulations enrolled: Low-income adults notcovered under ACA Section VIII (excludespregnant women and people with disabilities)blankblankVoluntaryPopulations enrolled: Low-income adultscovered under ACA Section VIII (excludespregnant women and people with disabilities)blankblankVoluntaryPopulations enrolled: Aged, Blind or Disabled blankChildren or AdultsblankblankPopulations enrolled: Non-Disabled Children(excludes children in foster care or receivingadoption assistance)blankblankVoluntaryPopulations enrolled: Individuals receivingLimited Benefits (excludes partial duals)blankblankblankPopulations enrolled: Full DualsblankblankblankPopulations enrolled: Partial DualsblankblankblankPopulations enrolled: Children with SpecialHealth Care NeedsMandatoryVoluntaryblankPopulations enrolled: NativeAmerican/Alaskan NativesExemptVoluntaryVoluntaryPopulations enrolled: Foster Care andAdoption Assistance ChildrenVoluntaryVoluntaryVoluntaryPopulations enrolled: Enrollment choiceperiodPre-assignedblankblankPopulations enrolled: Enrollment brokername (if applicable)blankblankblankPopulations enrolled: Notes on enrollment blankchoice periodBenefits covered: Inpatient hospital physicalhealthblankblankBenefits covered: Inpatient hospital behavioralhealth (MH and/or SUD)Family Mosaic Project/ San FranciscoPositive Healthcare/Los Angelesblankblankblankblankblankblank1
California Managed Care Program Features, as of 2016FeaturesHealth Plan of San Mateo CCS Demo/SanMateoBenefits covered: Outpatient hospital physicalXhealthFamily Mosaic Project/ San FranciscoPositive Healthcare/Los AngelesblankXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)blankXblankBenefits covered: Partial hospitalizationblankblankblankXXXBenefits covered: PhysicianBenefits covered: Nurse practitionerXXXBenefits covered: Rural health clinics andFQHCsXblankXBenefits covered: Clinic servicesXXXBenefits covered: Lab and x-rayXXXBenefits covered: Prescription drugs andprosthetic devicesXXXBenefits covered: EPSDTXXXBenefits covered: Case managementXXXBenefits covered: SSA Section 1945authorized health homeblankblankblankBenefits covered: Health home care (servicesin home)XblankblankBenefits covered: Family planningXblankXBenefits covered: Dental services(medical/surgical)blankblankblankBenefits covered: Dental (preventative orcorrective)blankblankblankBenefits covered: Personal care (state planoption)blankblankblankBenefits covered: HCBS waiver servicesblankblankblankBenefits covered: Private duty nursingblankblankblankBenefits covered: ICF-IDDblankblankblankBenefits covered: Nursing facility servicesblankblankblankBenefits covered: Hospice careXblankXBenefits covered: Non-Emergency MedicalTransportationXXXblankblankblankBenefits covered: Institution for MentalDisease inpatient treatment for people ages21-64 defined by 42 CFR §438.6(e) as an 'inlieu of' benefit2
California Managed Care Program Features, as of 2016FeaturesBenefits covered: Other (e.g., nurse midwifeservices, freestanding birth centers, podiatry,etc.)Health Plan of San Mateo CCS Demo/SanMateoPediatric specialties and subspecialies, pediatricsurgical specialtiesFamily Mosaic Project/ San FranciscoPositive Healthcare/Los AngelesblankblankQuality assurance and improvement: HEDISdata required?YesYesYesQuality assurance and improvement: CAHPSdata required?NoNoYesQuality assurance and improvement:Accreditation required?NoNoNoQuality assurance and improvement:Accrediting organizationblankblankblankQuality assurance and improvement: EQROcontractor name (if applicable)blankblankblankPerformance incentives: Paymentbonuses/differentials to reward plansblankblankblankPerformance incentives: Preferential autoenrollment to reward plansblankblankblankPerformance incentives: Public reportscomparing plan performance on key metricsblankblankblankPerformance incentives: Withholds tied toperformance metricsblankblankblankPerformance incentives: MCOs/PHPs requiredor encouraged to pay providers forvalue/quality outcomesblankblankblankParticipating plans and regions served: Plansin ProgramHealth Plan of San Mateo CCS DemoFamily Mosaic Project/San Francisco3Multiple Primary Care Providers
California Managed Care Program Features, as of 2016FeaturesNotes: Program notesHealth Plan of San Mateo CCS Demo/SanMateoblankFamily Mosaic Project/ San FranciscoPositive Healthcare/Los AngelesblankblankEnd of worksheet4
California Managed Care Program Features, as of 2016FeaturesDental Managed Care/Los AngelesDental Managed Care/SacramentoProgram typeDental only (PAHP)Dental only (PAHP)Statewide or region-specific?Los AngelesSacramentoFederal operating authority1115(a) (Medicaid demonstration waivers)1115(a) (Medicaid demonstration waivers)Program of All-Inclusive Care for the Elderly(PACE)Program of All-inclusive Care for the Elderly(PACE)Alameda, Contra Costa, Fresno, Humboldt, LosAngeles, OrangeRiverside, Sacramento, SanBernardino, San Diego, San Francisco, SantaClaraPACEProgram start date04/01/199812/01/199806/01/1991Waiver expiration date (if applicable)12/31/202012/31/2020blankblankblankIf the program ended in 2016, indicate the end blankdatePopulations enrolled: Low-income adults notcovered under ACA Section VIII (excludespregnant women and people with disabilities)VoluntaryMandatoryblankPopulations enrolled: Low-income adultscovered under ACA Section VIII (excludespregnant women and people with disabilities)VoluntaryMandatoryblankPopulations enrolled: Aged, Blind or Disabled VoluntaryChildren or AdultsblankVoluntaryPopulations enrolled: Non-Disabled Children(excludes children in foster care or receivingadoption assistance)VoluntaryMandatoryblankPopulations enrolled: Individuals receivingLimited Benefits (excludes partial duals)blankblankblankPopulations enrolled: Full DualsVoluntaryMandatoryVoluntaryPopulations enrolled: Partial DualsblankblankVoluntaryPopulations enrolled: Children with SpecialHealth Care NeedsblankblankblankPopulations enrolled: NativeAmerican/Alaskan NativesMandatoryVoluntaryVoluntaryPopulations enrolled: Foster Care andAdoption Assistance ChildrenVoluntaryVoluntaryExemptPopulations enrolled: Enrollment choiceperiod60 days60 daysN/APopulations enrolled: Enrollment brokername (if applicable)Health Care Operations (Maximus)Health Care Operations (Maximus)blankblankblankPopulations enrolled: Notes on enrollment blankchoice period5
California Managed Care Program Features, as of 2016FeaturesDental Managed Care/Los AngelesDental Managed Care/SacramentoProgram of All-Inclusive Care for the Elderly(PACE)XBenefits covered: Inpatient hospital physicalhealthblankblankBenefits covered: Inpatient hospital behavioralhealth (MH and/or SUD)blankblankXBenefits covered: Outpatient hospital physicalhealthblankblankXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)blankblankXBenefits covered: Partial hospitalizationblankblankXBenefits covered: PhysicianblankblankXBenefits covered: Nurse practitionerblankblankXXXblankBenefits covered: Clinic servicesblankblankXBenefits covered: Lab and x-rayblankblankXBenefits covered: Prescription drugs andprosthetic devicesblankblankXXXXBenefits covered: Rural health clinics andFQHCsBenefits covered: EPSDTBenefits covered: Case managementXXXBenefits covered: SSA Section 1945authorized health homeblankblankblankBenefits covered: Health home care (servicesin home)blankblankXBenefits covered: Family planningblankblankXBenefits covered: Dental services(medical/surgical)XXXBenefits covered: Dental (preventative orcorrective)XXXBenefits covered: Personal care (state planoption)blankblankXBenefits covered: HCBS waiver servicesblankblankblankBenefits covered: Private duty nursingblankblankblankBenefits covered: ICF-IDDblankblankblankBenefits covered: Nursing facility servicesblankblankXBenefits covered: Hospice careblankblankXXblankXBenefits covered: Non-Emergency MedicalTransportation6
California Managed Care Program Features, as of 2016FeaturesDental Managed Care/Los AngelesBenefits covered: Institution for MentalDisease inpatient treatment for people ages21-64 defined by 42 CFR §438.6(e) as an 'inlieu of' benefitBenefits covered: Other (e.g., nurse midwifeservices, freestanding birth centers, podiatry,etc.)Dental Managed Care/SacramentoblankblankblankblankProgram of All-Inclusive Care for the Elderly(PACE)blankblankQuality assurance and improvement: HEDISdata required?YesYesNoQuality assurance and improvement: CAHPSdata required?YesYesNoQuality assurance and improvement:Accreditation required?NoNoNoQuality assurance and improvement:Accrediting organizationblankblankblankQuality assurance and improvement: EQROcontractor name (if rformance incentives: Public reportscomparing plan performance on key metricsXXblankPerformance incentives: Withholds tied toperformance metricsXXblankblankblankblankPerformance incentives: Paymentbonuses/differentials to reward plansPerformance incentives: Preferential autoenrollment to reward plansPerformance incentives: MCOs/PHPs requiredor encouraged to pay providers forvalue/quality outcomesParticipating plans and regions served: Plansin ProgramHealth Net Dental/Los Angeles; Access DentalPlan/Los Angeles; Liberty Dental Plan/LosAngelesAccess Dental Plan/Sacramento; Liberty DentalPlan/Sacramento; Health Net Dental/Sacramento7Central Valley Medical Services/Fresno; RedwoodCoast PACE/Humboldt; Sutter SeniorCarePACE/Sacramento; Center for EldersIndependence/Alameda; Alta Med Health SeniorBuenacare/Los Angeles; Center for EldersIndependence/Contra Costa; InnovagePACE/Riverside; Innovage PACE/San Bernardino;ONLOK Lifeways/San Francisco; ONLOKLifeways/Alameda; ONLOK Lifeways/Santa Clara;St. Paul's PACE/San Diego; CalOPTIMAPACE/Orange; Brandman Centers for SeniorCare/Los Angeles; San Diego PACE
California Managed Care Program Features, as of 2016FeaturesDental Managed Care/Los AngelesDental Managed Care/SacramentoNotes: Program notesblankblankEnd of worksheet8Program of All-Inclusive Care for the Elderly(PACE)blank
California Managed Care Program Features, as of 2016FeaturesSenior Care Action Network (SCAN)Two-Plan ModelProgram typeComprehensive MCO MLTSSComprehensive MCO MLTSSStatewide or region-specific?Los Angeles, Riverside, San BernardinoAlameda, Contra Costa, Fresno, Kern, Kings, LosAngeles, Madera, Riverside, San Bernardino, SanFrancisco, San Joaquin, Santa Clara, Stanislaus,TulareFederal operating authority1115(a) (Medicaid demonstration waivers)1115(a) (Medicaid demonstration waivers)Del Norte, Humboldt, Lake, Lassen, Marin,Mendocino, Merced, Modoc, Monterey, Napa,Orange, San Luis Obispo, San Mateo, SantaBarbara, Santa Cruz, Shasta, Siskiyou, Solano,Sonoma, Trinity, Ventura, Yolo1115(a) (Medicaid demonstration waivers)Program start date01/01/199601/01/199610/01/1995Waiver expiration date (if kIf the program ended in 2016, indicate the end blankdateCounty Organized Health Systems (COHS)ModelComprehensive MCO MLTSSPopulations enrolled: Low-income adults notcovered under ACA Section VIII (excludespregnant women and people with disabilities)blankMandatoryMandatoryPopulations enrolled: Low-income adultscovered under ACA Section VIII (excludespregnant women and people with disabilities)blankMandatoryMandatoryPopulations enrolled: Aged, Blind or Disabled VoluntaryChildren or AdultsMandatoryMandatoryPopulations enrolled: Non-Disabled Children(excludes children in foster care or receivingadoption assistance)blankMandatoryMandatoryPopulations enrolled: Individuals receivingLimited Benefits (excludes partial duals)blankblankMandatoryPopulations enrolled: Full DualsVoluntaryVariesVariesPopulations enrolled: Partial DualsblankblankMandatoryPopulations enrolled: Children with SpecialHealth Care NeedsblankVoluntaryMandatoryPopulations enrolled: NativeAmerican/Alaskan NativesVoluntaryVoluntaryMandatoryPopulations enrolled: Foster Care andAdoption Assistance ChildrenExemptVoluntaryVoluntaryPopulations enrolled: Enrollment choiceperiodblankOtherPre-assignedPopulations enrolled: Enrollment brokername (if applicable)blankHealth Care Operations (Maximus)blankApproximately 45 daysblankPopulations enrolled: Notes on enrollment blankchoice period9
California Managed Care Program Features, as of 2016FeaturesSenior Care Action Network (SCAN)Two-Plan ModelCounty Organized Health Systems (COHS)ModelXBenefits covered: Inpatient hospital physicalhealthXXBenefits covered: Inpatient hospital behavioralhealth (MH and/or SUD)XblankblankBenefits covered: Outpatient hospital physicalhealthXXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)XblankblankBenefits covered: Partial hospitalizationXblankblankBenefits covered: PhysicianXXXBenefits covered: Nurse practitionerXXXBenefits covered: Rural health clinics andFQHCsXXXBenefits covered: Clinic servicesXXblankBenefits covered: Lab and x-rayXXXBenefits covered: Prescription drugs andprosthetic devicesXXXblankXXBenefits covered: EPSDTBenefits covered: Case managementXXXBenefits covered: SSA Section 1945authorized health homeblankblankblankXblankblankBenefits covered: Health home care (servicesin home)Benefits covered: Family planningblankXXBenefits covered: Dental services(medical/surgical)XblankblankBenefits covered: Dental (preventative orcorrective)XblankXBenefits covered: Personal care (state planoption)XXblankBenefits covered: HCBS waiver servicesblankXblankBenefits covered: Private duty nursingblankXblankBenefits covered: ICF-IDDblankXXXXXBenefits covered: Nursing facility servicesBenefits covered: Hospice careXXXBenefits covered: Non-Emergency MedicalTransportationXXX10
California Managed Care Program Features, as of 2016FeaturesSenior Care Action Network (SCAN)Benefits covered: Institution for MentalDisease inpatient treatment for people ages21-64 defined by 42 CFR §438.6(e) as an 'inlieu of' benefitBenefits covered: Other (e.g., nurse midwifeservices, freestanding birth centers, podiatry,etc.)Two-Plan ModelblankblankblankblankCounty Organized Health Systems (COHS)ModelblankblankQuality assurance and improvement: HEDISdata required?NoYesYesQuality assurance and improvement: CAHPSdata required?NoYesYesQuality assurance and improvement:Accreditation required?NoNoNoQuality assurance and improvement:Accrediting organizationblankblankblankQuality assurance and improvement: EQROcontractor name (if applicable)blankHealth Services Advisory GroupHealth Services Advisory GroupPerformance incentives: Paymentbonuses/differentials to reward plansblankblankblankPerformance incentives: Preferential autoenrollment to reward plansblankXblankPerformance incentives: Public reportscomparing plan performance on key metricsblankXXPerformance incentives: Withholds tied toperformance metricsblankblankblankPerformance incentives: MCOs/PHPs requiredor encouraged to pay providers forvalue/quality outcomesblankblankblankCalViva Health (Fresno, Kings, Madera); AnthemBlue Cross Partnership Plan (Alameda, SanFrancisco, Contra Costa, Fresno, Kings, Madera,Santa Clara, Tulare); Health Net (Kern, LosAngeles, Tulare, San Joaquin, Stanislaus); MolinaHealthcare (Riverside, San Bernardino); AlamedaAlliance for Health; Contra Costa Health Plan;Kern Health Systems; LA Care; Inland EmpireHealth Plan (Riverside, San Bernardino); SanFrancisco Health Plan; Health Plan of San Joaquin(San Joaquin, Stanislaus); Santa Clara FamilyHealth PlanCenCal (San Luis Obispo, Santa Barbara); HealthPlan of San Mateo; Partnership HealthPlan of CA(Del Norte, Humboldt, Lassen, Lake, Marin,Mendocino, Modoc, Napa, Shasta, Siskiyou,Solano, Sonoma, Trinity, Yolo); Central CaliforniaAlliance for Health (Merced, Monterey, SantaCruz); CalOPTIMA; Gold Coast Health PlanParticipating plans and regions served: Plansin ProgramSCAN Health Plan (Los Angeles, Riverside, SanBernadino); SCAN Health Plan (Nurs hm cert)(Los Angeles, Riverside, San Bernardino)11
California Managed Care Program Features, as of 2016FeaturesSenior Care Action Network (SCAN)Notes: Program notesblankTwo-Plan ModelCounty Organized Health Systems (COHS)ModelFull duals are mandatory for managed careFull duals are mandatory for managed careenrollment in Coordinated Care Initiative (CCI)enrollment in CCI Counties (Orange and SanCounties (Los Angeles, Riverside, San Bernardino Mateo) and voluntary for all other Counties.and Santa Clara) and voluntary for all otherCounties (Alameda, Contra Costa, Fresno, Kern,Kings, Madera, San Francisco, San Joaquin,Stanislaus and Tulare).End of worksheet12
California Managed Care Program Features, as of 2016FeaturesGeographic Managed Care (GMC) ModelRegional ModelProgram typeComprehensive MCO MLTSSComprehensive MCOStatewide or region-specific?Sacramento, San DiegoFederal operating authority1115(a) (Medicaid demonstration waivers)Alpine, Amador, Butte, Calaveras, Colusa, ElDorado, Glenn, Imperial, Inyo, Mariposa, Mono,Nevada, Placer, Plumas, San Benito, Sierra,Sutter, Tehama, Tuolumne, Yuba1115(a) (Medicaid demonstration waivers)Program start date06/01/199110/01/2013Waiver expiration date (if applicable)12/31/202012/31/2020If the program ended in 2016, indicate the end blankdateblankPopulations enrolled: Low-income adults notcovered under ACA Section VIII (excludespregnant women and people with disabilities)MandatoryMandatoryPopulations enrolled: Low-income adultscovered under ACA Section VIII (excludespregnant women and people with disabilities)MandatoryMandatoryPopulations enrolled: Aged, Blind or Disabled MandatoryChildren or AdultsMandatoryPopulations enrolled: Non-Disabled Children(excludes children in foster care or receivingadoption assistance)blankMandatoryPopulations enrolled: Individuals receivingLimited Benefits (excludes partial duals)blankblankPopulations enrolled: Full DualsVariesVoluntaryPopulations enrolled: Partial DualsblankblankPopulations enrolled: Children with SpecialHealth Care NeedsVoluntaryVoluntaryPopulations enrolled: NativeAmerican/Alaskan NativesVoluntaryVoluntaryPopulations enrolled: Foster Care andAdoption Assistance ChildrenVoluntaryVoluntaryPopulations enrolled: Enrollment choiceperiodOtherOtherPopulations enrolled: Enrollment brokername (if applicable)Health Care Options (Maximus)blankPopulations enrolled: Notes on enrollment Approximately 45 dayschoice periodBenefits covered: Inpatient hospital physicalXhealthApproximately 45 daysX13
California Managed Care Program Features, as of 2016FeaturesGeographic Managed Care (GMC) ModelRegional ModelBenefits covered: Inpatient hospital behavioralhealth (MH and/or SUD)blankblankBenefits covered: Outpatient hospital physicalhealthXXBenefits covered: Outpatient hospitalbehavioral health (MH and/or SUD)blankXBenefits covered: Partial hospitalizationblankblankBenefits covered: PhysicianXXBenefits covered: Nurse practitionerXXBenefits covered: Rural health clinics andFQHCsXXBenefits covered: Clinic servicesXXBenefits covered: Lab and x-rayXXBenefits covered: Prescription drugs andprosthetic devicesXXBenefits covered: EPSDTXXBenefits covered: Case managementXXBenefits covered: SSA Section 1945authorized health homeblankblankBenefits covered: Health home care (servicesin home)blankblankBenefits covered: Family planningXXBenefits covered: Dental services(medical/surgical)blankblankBenefits covered: Dental (preventative orcorrective)blankblankBenefits covered: Personal care (state planoption)XblankBenefits covered: HCBS waiver servicesXblankBenefits covered: Private duty nursingXblankBenefits covered: ICF-IDDXblankBenefits covered: Nursing facility servicesXblankBenefits covered: Hospice careXXBenefits covered: Non-Emergency MedicalTransportationXXblankblankBenefits covered: Institution for MentalDisease inpatient treatment for people ages21-64 defined by 42 CFR §438.6(e) as an 'inlieu of' benefit14
California Managed Care Program Features, as of 2016FeaturesGeographic Managed Care (GMC) ModelRegional ModelBenefits covered: Other (e.g., nurse midwifeservices, freestanding birth centers, podiatry,etc.)blankblankQuality assurance and improvement: HEDISdata required?YesYesQuality assurance and improvement: CAHPSdata required?YesYesQuality assurance and improvement:Accreditation required?NoNoQuality assurance and improvement:Accrediting organizationblankblankHealth Services Advisory GroupHealth Services Advisory GroupblankblankPerformance incentives: Preferential autoenrollment to reward plansXXPerformance incentives: Public reportscomparing plan performance on key metricsXXPerformance incentives: Withholds tied toperformance metricsblankblankPerformance incentives: MCOs/PHPs requiredor encouraged to pay providers forvalue/quality outcomesblankblankQuality assurance and improvement: EQROcontractor name (if applicable)Performance incentives: Paymentbonuses/differentials to reward plansParticipating plans and regions served: Plansin ProgramCommunity Health Group/San Diego; HealthNet/San Diego; Molina Healthcare/San Diego;Care 1st Healthplan/San Diego; Kaiser/San Diego;Molina Healthcare/Sacramento; HealthNet/Sacramento; Kaiser/Sacramento; AnthemBlue Cross Partnership Plan/SacramentoAnthem Blue Cross Partnership Plan (Alpine,Amador, Butte, Calaveras, Colusa, El Dorado,Glenn, Inyo, Mariposa, Mono, Nevada, Placer,Plumas ,San Benito, Sierra, Sutter, Tehama,Tuolumne, Yuba); California Health & Wellness(Alpine, Amador, Butte, Calaveras, Colusa, ElDorado, Glenn, Imperial, Inyo, Mariposa, Mono,Nevada, Placer, Sierra, Sutter, Tehama,Tuolumne, Yuba); Kaiser (Amador, El Dorado,Placer); Molina Healthcare (Imperial)15
California Managed Care Program Features, as of 2016FeaturesGeographic Managed Care (GMC) ModelRegional ModelNotes: Program notesFull duals are mandatory for managed careenrollment in CCI Counties (San Diego) andvoluntary for all other Counties (Sacramento).blankEnd of worksheet16
Program start date ; 06/01/2012 12/01/1992: 04/01/2002: Waiver expiration date (if applicable) 04/01/2018 blank: blank: If the program ended in 2016, indicate the end date; blank blank: blank: Populations enrolled: Low-income adults not ; covered under ACA Section VIII (excludes pregnant women and people with disabilities) blank blank: Voluntary
