The DHCS “strongly encouraged” managed care plans to elect to offer some or all of the 14 pre-approved community supports under CalAIM, formerly known as In Lieu of Services. Aetna Better Health of California has announced they will be covering all of them.
The community supports will be authorized by DHCS starting Jan. 1, 2022. They are listed as follows:
- Housing Transition Navigation Services
- Housing Deposits
- Housing Tenancy and Sustaining Services
- Short-Term Post-Hospitalization Housing
- Recuperative Care (Medical Respite)
- Respite Services
- Day Habilitation Programs
- Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for the Elderly (RCFE) and Adult Residential Facilities (ARF)
- Community Transition Services/Nursing Facility Transition to a Home;
- Personal Care and Homemaker Services
- Environmental Accessibility Adaptations (Home Modifications)
- Meals/Medically Tailored Meals
- Sobering Centers
- Asthma Remediation
Verne Brizendine, CEO of Aetna Better Health of California, said health plans have wanted these services for a long time, and now they have the opportunity to offer them.
“I think all the health plans have been wanting to provide the services … We wanted to really show that we’re trying to be a great partner with the Department of Health Services, and they were looking for us to provide those services. There was some debate about whether we could do all 14, and some of my staff were like, ‘Oh, man, that’s a lot to take on’ … I don’t anticipate that everything’s going to be perfect on day one, but whatever we run into, we’ll fix immediately and move forward.”
From housing to food programs, Brizendine said the community supports would address the diverse individual needs of their beneficiaries.
“Someone without a home has a different experience than someone with a home … And if I said I had a patient that kept coming up in the emergency room because they kept slipping in their bathtub, and all we needed was to … do a home modification that might help them, that person will certainly benefit from doing that home modification. So I think it’s very important to that person if it keeps them stable or from tripping over something on the floor. So I think that’s an individual need. I think they all have a benefit to the right person.”
Brizendine also mentioned the challenges of bringing together providers, community organizations, and health plans to collaborate.
“We’re bringing in providers [and community organizations] that have never operated in this health arena before, they’ve just been providing to the community. So there are a lot of things happening–they’ve never worked with a health plan, they’ve never billed for services. So we’re trying to put the things in place to make that all work very smoothly … [in CalAIM], I’m talking about the transition for the population of the [Health Home Program] and the [Whole Person Care] into the [Enhanced Care Management (ECM)], which includes social determinants of health and the community support services.”
In particular, he emphasized the importance of understanding how community-based services have functioned differently than traditional health plan providers.
“I think it’s important for us to understand that these community based services that are not traditional health plan providers have functioned in a different way, that it’s been through … their community grants or federal grants … [It’s important] that we don’t jeopardize what they already do, that we’re using them without putting them in danger of losing their other financial resources. I want to make sure that they’re preserved, that in the services they do, they don’t get harmed in any way.”