Managed Care Training Assessment

Staff throughout L.A. Care need to have a solid foundation in L.A. Care's Managed Care philosophy and operations. To better focus future orientations and training, please indicate the topics you think should be included for yourself and others. Check each item to be included in the training whether you need to learn more about it or not. At the end of the survey, please add any additional topics you would like to see covered.
Name: 


  1. Please indicate where you work at L.A. Care.
    Finance
    Member Services
    Executive Services
    Legal or Board Services; HR or Regulatory Affairs
    Medical Administration
    Quality Management or Healthcare Outcomes
    Operations - Marketing, Community Outreach, C&L
    Operations - PNO, Claims, Credentialling
    Operations - UM, Pharmacy, FSR, HP&E
    Other


  1. Important definitions and concepts of managed care
    Fee for service
    Health Maintenance Organization ( HMO)
    Medical Groups
    IPA
    PPG
    Member of an HMO
    PCP
    Provider
    Member access to Specialists
    Out of Plan or Out of Network
    Member's Rights when enrolled in Managed Care
    Member's Responsibilities when enrolled in Managed Care


  1. Key concepts and definitions of how L.A. Care Health Plan (LACHP)operates
    LACHPs' mission, vision and values
    Plan Partners
    Two Plan Model
    Government regulators of LACHP
    Threshold languages
    RCACs and Community Outreach efforts
    PNO functions
    Claims functions


  1. Key concepts and definitions regarding Member Services (MS)
    MS mission
    Units in MS
    Functions of Membership Information Unit
    Functions of Member Relations Specialists
    Handling of Administrative Grievances
    State Fair Hearings
    MS Call Center Mission, responsibility
    MS Call Center functions
    Types of calls made by MS Call Center


  1. CSIM, MHC system information
    "Call Type" field and codes
    "Call Status" field and codes
    "LAC#" field and codes
    "Language" field and codes
    "Call Text" field
    AEVS


  1. Key concepts and defintions regarding Medi-Cal
    Medi-Cal
    Department of Health Services ( DHS)
    Health Care Options ( HCO)
    How to qualfiy for Medi-Cal
    LACHP's product lines - LA County's restrictions
    Federal Poverty Level
    AIDS codes
    Share of cost
    SSI
    Voluntary enrollment ( Medi-Cal)
    Mandatory enrollment ( Medi-Cal)
    Fee for Service Medi-Cal
    DPSS
    Eligibility worker
    Beneficiary
    Eligibility verification for Medi-Cal beneficiaries
    Co-payments for Medi-Cal Services
    Choosing a provider
    Formulary
    Carved out services
    Monthly Premiums for Medi-Cal
    BIC
    Changes to plan by Medi-Cal beneficiary
    Plan Partner Transfer
    Retro enrollment
    Hold status and Release from Hold
    Disenrollments ( voluntary and emergency)
    Evidence of Coverage


  1. Key concpets and defintions of non-Medi-Cal programs at LACHP
    Healthy Families
    Healthy Families eligibility, coverage, premiums and co-pays
    California Kids
    California Kids eligibility, coverage, premiums and co-pays
    AIM
    AIM eligibility, coverage, premiums and co-pays
    IHSS
    IHSS eligibility, coverage, premiums and co-pays
    CHP
    CHP eligibility, coverage, premiums and co-pays
    Healthy Kids
    Healthy Kids eligibility, coverage, premiums and co-pays


  1. Please add any other topics that should be included in the training.





Mark Strunin