SNF Diversion/Transition to RCFE

network Setup and Care coordination

The California Coordinated Care Initiative (CCI) and the two program components: Cal MediConnect (CMC) and Managed Long Term Support and Services (MLTSS) provide CCI Managed Care Organizations (CCI MCOs) the ability to rebalance long term support and services (LTSS) from skilled nursing to community based care. Allowing dual-eligibles to self direct their care to community based rather than institutional care is one of the primary goals of CCI. More about LTSS rebalancing at our articles.

Residential Care Facilities for the Elderly (RCFEs) are community based, provide 24-hour custodial care, have high to staff ratios and are more affordable than Medi-Cal reimbursed SNFs. Small RCFEs with 4-6 residents and two full time staff are ideal for patients at risk of premature institutionalization.

CCI MCOs are free to design their own SNF Diversion/Transition to RCFE programs (see the ALW/CCI Fact Sheet) and are not dependent on the state's Assisted Living Waiver program which has significant liabilities.

The CCI MLTSS and Cal Medi-Connect blended capitated rates provide strong fiscal incentives for MCOs to encourage the use of affordable RCFEs rather than expensive SNFs for eligible SNF Diversion/Transition to RCFE candidates.  For every 100 people who benefit from SNF Diversion/Transition to RCFE the annual Medi-Cal cost savings is approximately $3,360,000.

Our services:

25+ year RCFE placement specialists

SNF diversion/transition to RCFE set-up

RCFE network set-up

RCFE/CCI MCO contract set-up

Inservices to CCI MCO care coordinators

Inservices to hospital social workers/case managers for flagging SNF diversion/transition candidates

Monthly face to face client follow-up to measure patient satisfaction

Frequent licensing checks to monitor RCFE network integrity

Customization of RCFEs to accept younger dual-eligibles

2015-2016 data analysis of needed RCFE supply vs. expected SNF diversion/transition to RCFE demand

Incentives:

Allows dual-eligibles to self direct their care
LTSS rebalancing
Saves Medi-Cal dollars
Satisfies quality withhold requirements

Cal Medi-Connect Fast Facts:

456,000 dual-eligibles in CMC (maximum enrollment)

$5,300 average SNF Medi-cal reimbursement

$2,600 average cost for a RCFE shared room

$2,800 Medi-cal cost savings for each SNF diversion/transition to RCFE

$33,600 annual Medi-cal cost savings for each SNF diversion/transition to RCFE candidate

Potential SNF diversion/transition candidates*:

10,727 SNF residents on LTSS have low level care needs that could be met in community based care settings

11,785 new users of Medi-Cal LTSS would first receive services in the community rather than in a SNF

4,682 more people entering SNFs would be able to return to the community within 100 days.

4,678 more people who have been in a SNF for 90 days or more would be able to move back to the community.

*Source: 2014 AARP/SCAN Long Term Support and Services (LTSS) report card for California.

SNF DIVERSION/TRANSITION CANDIDATES:

Allowable health conditions:

1) Dressing, bathing and incontinence
2) Help out of bed or assistance in transferring
3) Catheter or colostomy
4) Dementia or Alzheimers
5) Wanderers
6) Ambulatory
7) Wheelchair or walker dependent
8) Stage 1 and 2 ulcers

NOT ALLOWABLE health conditions:

1) Stage 3 and 4 pressure ulcers
2) Nasogastric tubes
3) Ventilators
4) Bi-pad (without ability to self administer)
5) Wound vac therapy
6) Continuous IV/TPN
7) Active communicable tuberculosis
8) Restraints

For more information about our SNF Diversion/Transition to RCFE Set-up and Coordination Services call us at 800-330-5993.

For articles we've written about CCI and Cal MediConnect please see publications.