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June 13, 2013 /PRNewswire/ -- With the implementation of the Affordable Care Act in
California and a spotlight on managed care, Independent Living Centers (ILCs) have an opportunity to further the Olmstead Decision by providing cost-effective, coordinated care for dual eligible beneficiaries or individuals who qualify for health care services through both Medicare and Medi-Cal programs. According to the California Department of Health Care Services (DHCS), there are approximately 1.1 million dual eligible beneficiaries in
California. Through the Coordinated Care Initiative (CCI) and Cal MediConnect,
California's efforts to transform the Medi-Cal delivery system for home and community-based (HCBS) long-term services and supports, ILCs have the chance to work with managed care plans to expand access to HCBS services. This would be accomplished by including them in the benefit package for dual eligibles and contracting with managed care organizations to deliver these services in a community setting.
"We believe ILCs can play a crucial role in the implementation of managed care," said State Independent Living Council Executive Director
Liz Pazdral. "ILCs have established and effective relationships with community-based organizations and can help managed care plans contain costs by assisting individuals living with disabilities to live independently in their homes rather than in institutions."
The CCI and Cal MediConnect will be implemented in eight counties, including
Santa Clara County, which Silicon Valley Independent Living Center's (SVILC) Director of Programs
Todd Teixeira has been actively tracking. With the state and health plans still negotiating the rates to provide services to dual eligible beneficiaries, SVILC is determining the best way to package its services. For Teixeira, it will be important to help health plans see the value of ILCs as a "link or bridge" between medically necessary and socially necessary services as part of the plans' overall strategy to provide comprehensive, integrated care for dual eligible beneficiaries, including individuals with disabilities.
"In the past, ILCs have never had to demonstrate to health plans the benefit of the services we provide and how those services can effect positive outcomes such as reducing re-hospitalization or providing in-home support services that keep individuals out of emergency rooms," said Teixeira. "Given the role we can play in keeping costs down while providing quality services, it will be critical for ILCs to collect data and track outcomes that demonstrate our value to the managed care plans."