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Update on CCI and Overview of Managed Care Data Sharing Department of Health Care Services November 30, 2012.

Published byCollin Earl Park Modified over 8 years ago

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Presentation on theme: "Update on CCI and Overview of Managed Care Data Sharing Department of Health Care Services November 30, 2012."— Presentation transcript:

1 Update on CCI and Overview of Managed Care Data Sharing Department of Health Care Services November 30, 2012

2 Update on CCI Implementation 1.MOU between CMS and DHCS is being finalized. 2.Readiness Review Tool and Process 3.Demonstration 3-Way Contracts 4.Recently released for stakeholder review: Assessment and Care Coordination Standards LTSS Standards

3 Current Data Exchanges between DHCS and Managed Care Plans DHCS Data to Health Plans: Upon enrollment into managed care, DHCS sends the health plan up to 12 months of Fee-for-Service claim and treatment authorization data for each member. Health Plan Data to DHCS: After members are enrolled, health plans submit encounter data to DHCS. For example, Encounter Data Element Dictionary (35C-File) used by the COHS: http://www.dhcs.ca.gov/provgovpart/Document s/PdClms_S35C_FileDED.pdfhttp://www.dhcs.ca.gov/provgovpart/Document s/PdClms_S35C_FileDED.pdf

4 Health Plan Data Sharing with Counties Health Plans use a member and/or care coordination database. To provide counties access to health plan databases, Plans are considering whether county social service agencies are “Business Associates” for HIPAA purposes. Business Associate is the standard process for provider access to health plan data.

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