January 27, 2020
The California Endowment, Sacramento
9:30 a.m. – 4:30 p.m.

Welcome to the Implementing the Long-Term Care Benefit program resources web page. Below are information and materials you may find helpful when preparing for and attending the event.

Overview

Effective January 2021, the Department of Health Care Services will be carving in coverage of long-term care (LTC) — including skilled nursing facilities, subacute facilities, pediatric subacute facilities and intermediate care facilities — to all managed care health plans. For plans that will newly manage the LTC benefit, thoughtful planning and preparation will be key to successful implementation.  

Taking on a new benefit is a complex and challenging task. This day-long seminar will provide the opportunity to learn from seasoned local plan leaders and industry experts who will present the critical elements of implementation, and share best practices and insights from their lessons learned in building a new LTC benefit. Attendees will take away important information and guidance to help inform plan strategies and approaches for implementing and administering the LTC benefit.

Designed specifically for local health plans that are newly acquiring the LTC benefit, the program will include discussion on the following topics:

• Developing and maintaining an LTC network
• Managing the LTC benefit
• Operational readiness
• Areas of concern and best practices
• And more …

Course Schedule

*May be subject to change

9:30 – 9:55 a.m. | Welcome & Introductions

9:55 – 10:40 a.m. | Overview of the LTC Benefit
Bradley Gilbert, MD, Consultant and former CEO of Inland Empire Health Plan

Participants will receive an overview of the LTC benefit, including who’s impacted, types of providers and levels of care. Health plan implications, and challenges and opportunities, such as developing provider rates and State rate setting will also be discussed.

10:40 – 10:55 a.m. | Break 

10:55 – 11:50 a.m. | Developing & Maintaining Your LTC Provider Network
Irene Walsh, Providers Network Associate, Santa Clara Family Health Plan and Samantha Huang, Manager, Provider Contracting Service Team, Inland Empire Health Plan

Plan experts will describe their approaches to building and maintaining their plan’s LTC provider networks. Faculty will cover a range of issues, such as contracting, outreach to facilities, curating strong working relationships with providers, provider trainings, addressing issues and disputes with providers, and important lessons learned.

11:50 a.m. – 12:40 p.m. | Hosted Lunch

12:40 – 1:25 p.m. | Preparing for Day One: Understanding Member Needs and the Provider Community
Peggy Hoover, Senior Director, Health Care Services, Partnership HealthPlan of California and Judy Cua-Razonable, Director, MLTSS, L.A. Care Health Plan

Hear firsthand accounts from fellow local plans about how they identified and profiled their LTC populations, as well as strategies for identifying their members’ needs. Learn what worked well and what to consider doing differently.

1:25 – 2:25 p.m. | Managing the Benefit and Member Care
Peggy Hoover, Senior Director, Health Care Services, Partnership HealthPlan of California, Alma Palafox, Claims Manager, Community Health Group, Donna Garrison, RN, UM, DC Planning Nurse, Santa Clara Family Health Plan

In this session, attendees will learn about Treatment Authorization Requests (TAR), including what they are, how the process works and strategies for the process based on members’ needs. Faculty will also address the components of and critical issues around the claim process, as well as considerations related to transitions of care.

2:25 – 2:40 p.m. | Break

2:40 – 3:25 p.m. | Operational Areas of Concern and Best Practices
Bradley Gilbert, MD, Consultant and former CEO of Inland Empire Health Plan, Richard Golfin, III, Compliance & Privacy Officer, CenCal Health

Kicking off this session is a former plan CEO who will outline concerns around claims payment, provider transitions, eligibility challenges and transitions of care. Also learn about LTC monitoring and reporting from a plan compliance leader.

3:25 – 4:25 p.m. | Ask the Experts — Strategies for Approaching Implementation

Join in this interactive discussion on strategies for implementation. Bring your questions as plan leaders address key implementation planning milestones, team members and functional areas to include in LTC benefit development, and key takeaways and lessons learned.

4:25 – 4:30 p.m. | Wrap-Up & Closing Remarks

Materials

Program materials: 

Download materials for viewing
Download materials for print
Download materials for note-taking

Supplemental materials:

IEHP SNF Training Guide
IEHP UM Forms
IEHP Blast Communication Example
IEHP Annual SNF Meeting Packet
LTC TAR Completion – Explanation of Form Items

Glossary of Health Care Terms and Acronyms

Please refer to your registrant reminder email for the password to access the program materials.

Faculty

Judy Cua-Razonable
Director, MLTSS
L.A. Care Health Plan

Donna Garrison, RN
UM, DC Planning Nurse, Long-Term Services and Supports
Santa Clara Family Health Plan

Donna Garrison is a Utilization Management and Discharge Planning Nurse at Santa Clara Family Health Plan (SCFHP) on the Long-Term Services and Supports (LTSS) team. In this role, Donna serves as the clinical liaison between skilled-nursing facilities and SCFHP’s internal departments. Donna works to assist providers and members with utilization management and safely transitions SCFHP members out of long-term care and into the community. She brings more than 25 years of experience as a Registered Nurse in the acute, sub-acute and skilled-nursing settings. 

Bradley Gilbert, MD
Consultant and former CEO of Inland Empire Health Plan

Dr. Bradley Gilbert has more than 30 years of experience in public health and managed care leadership. He most recently served as Chief Executive Officer at Inland Empire Health Plan (IEHP), a managed care plan serving 1.24 million members in California’s Riverside and San Bernardino Counties. Prior to IEHP, Dr. Gilbert served as the Director of Public Health/Health Officer for San Mateo and Riverside Counties, leading positive changes for public health care in those communities. He also has clinical and leadership experience in jail medicine and substance use disorder treatment center, as well as with Kaiser Permanente and private practice.

Richard Golfin, III
Compliance & Privacy Officer
CenCal Health

Richard currently serves as Compliance & Privacy Officer at CenCal Health/Santa Barbara San Luis Obispo Regional Health Authority. Most recently, Richard served as the Director of Delegation Oversight at Molina Healthcare of California, where he managed delegation to First-Tier and Downstream Related Entities across California in Medicaid and Medicare State Sponsored Programs, and the California Health Exchange. Richard is a lifelong teacher and learner, having served on the faculty in the College of Political Science at Ashford University, and as guest lecturer at the University of Southern California, Sol Price School of Public Policy. Richard is a sought after public speaker on health care compliance, delegation and public integrated delivery systems. Richard is committed to the fulfillment and successes of national public health initiatives, and honored by the opportunity to serve and provide Californians quality health care and improved access to services in Safety Net programs.

Peggy Hoover, RN
Senior Director, Health Services
Partnership HealthPlan of California

Peggy Hoover is a Registered Nurse with over 35 years of experience as an administrator in the managed care industry and in medical, surgical and pediatric nursing. As Senior Director of Health Services at Partnership HealthPlan of California (PHC), Ms. Hoover is responsible for development and administrative oversight of PHC’s Care Coordination, Utilization Management and Cultural, Linguistics, and Health Education programs. Her leadership was instrumental in the preparation and success of the Health Services program through three PHC geographical expansions – from just three counties to a current 14-county service area. Most recently, she led PHC’s implementation of the Whole Child Model, the state-mandated transition of the provision of California Children’s Services care to designated managed care plans.

Samantha Huang
Manager, Provider Contracting Service Team
Inland Empire Health Plan

Samantha Huang manages the Provider Contracting Service Team within the Network Operations division of Inland Empire Health Plan. Samantha and her team are responsible for management and maintenance of the ancillary providers network, which includes but is not limited to hospitals, SNFs, DME and Home Health. The Team develops training materials, facilitates training and supports all ancillary provider needs. Samantha also oversees provider-initiated claim review requests and claim special projects. Samantha has 19 years of health care experience with both commercial and Medicaid plans, ranging from UM to provider services and contracting.

Alma Palafox
Director of Claims Administration
Community Health Group

Alma Palafox is the Director of Claims Administration at Community Health Group (CHG) and has nearly 15 years of experience in the health care industry on both the provider and health plan side. Prior to her work at CHG, Alma served in the hospital setting in the revenue cycle department where she worked on billing and reimbursement issues. She has experience in both the Medi-Cal and Medicare lines of business.

Irene Walsh
Provider Network Associate
Santa Clara Family Health Plan

Irene Walsh is a Provider Network Associate at Santa Clara Family Health Plan (SCFHP) and is part of the Long-Term Services and Supports (LTSS) team. In this capacity, she serves as the primary liaison between skilled nursing facilities, SCFHP internal departments and community partners. She offers LTSS providers support with operations, provider relations, troubleshooting and outreach. Irene brings more than 25 years of experience in health plan operations, quality, training and program development.

Site/Parking

The California Endowment Sacramento
1414 K Street, Suite 100
Sacramento, CA 95814

Meeting Room: Adelante Room (Suite 100)

Download driving directions
Download parking information

Feedback Survey

Thank you for attending! 

At the conclusion of the program, we are kindly requesting your feedback on the course via a brief online survey, which should take only a few minutes to complete. We truly value your thoughts and opinions, and we will use the feedback we receive to shape and develop future programs.

Complete the survey

For questions or comments, please contact the LHPC Institute at institute@lhpc.org.