HOME & COMMUNITY-BASED SERVICES 

BROKERAGE DESIGN GUIDE 

A ROAD MAP FOR ESTABLISHING A BROKERAGE FOR

HOME AND COMMUNITY-BASED SERVICES

Brenda Schmitthenner 

Renée Sherrill 

County of San Diego, Aging & Independence Services 
A I S 

CALL CENTER/ADRC 

RSVP, Veterans 

Health Promotion 

Info & Assistance 

Outreach & Education 

Senior Dining 

& 

HomeDelivery 

Care Mgmt 

Adult Day Care 

Caregiver Support 

Care Transitions 

IHSS APS

Ombudsman 

Project Care 

PA/PG/PC 

Senior Team 

INTERGENERATIONAL 

COUNTY OF SAN DIEGO, AGING & 

INDEPENDENCE SERVICES 
FRAGMENTED SYSTEM OF CARE 
COORDINATED, PERSON-CENTERED SYSTEM OF CARE 
LONG TERM CARE INTEGRATION 

PROJECT 

 Began 1999 

 Today over 800 stakeholders 

 Established mission, vision, goals 

 Three strategies TEAM SAN DIEGO 
SAN DIEGO CARE TRANSITIONS PARTNERSHIP 

TRANSFORMING CARE ACROSS THE CONTINUUM 

A partnership between HHSA/AIS and 

Palomar Health, Scripps Health, Sharp HealthCare and UC San Diego Health System 

(13 hospitals) 
CARE ENHANCEMENT PROGRAM 

 FROM THIS.... TO THIS...

In-Home 

Services 

CBAS 

Acute 

Hospital 

Transit Medical 

Specialty 

Meals 

Service Patient 

Primary 

Care 

SNF 

AIS provides critical social support services through referral or direct provision 

to reduce the risk of a readmission. 
Medi-Cal Managed Long-Term 

Services and Supports (LTSS) 

What: Mandatory enrollment into a 

Medi-Cal health plan for all Medi-Cal 

benefits, including LTSS and Medicare 

wrap-around benefits. 

Who: About 64,000 Medi-Cal beneficiaries, 

including dual eligibles. 

Cal MediConnect 

 (Duals Demonstration) 

What: Optional enrollment into 3-year 

demo program for coordinated 

Medicare and Medi-Cal benefits 

through single delivery system. 

Who: About 56,000 dual eligibles in 

San Diego. 

COORDINATED CARE INITIATIVE (CCI) 
LONG TERM SERVICES & SUPPORTS

In-Home Supportive Services (IHSS) 

Multi-purpose Senior Services Program (MSSP) 

Community-Based Adult Services 

 Nursing Home Care 

COORDINATED CARE INITIATIVE (CCI) 
CCI/CAL MEDICONNECT 

THE COUNTY’S ROLE 

In-Home Supportive Services (IHSS) - 25,000 

Executed an MOU with the Health Plans 

to support the provision of IHSS as a managed care benefit. 

Drafted an IHSS Coordination Guide. 

Multipurpose Senior Services Program (MSSP) - 550 

Executed a contract with the Health Plans 

for the provision of MSSP Waiver Services to Plan Members. 

Drafted an MSSP Coordination Guide. 

Behavioral Health Services (BHS) 

Executed an MOA with the Health Plans 

for the provision of Behavioral Health Services 

(specialty mental health and alcohol and drug services not covered by Medicare). 
BEYOND THE STATE & CMS REQUIREMENTS 

CARE PLAN OPTION SERVICES 

 Case Management 

 Care Transitions 

 Home & Community-Based Services (HCBS) 
AN OPPORTUNITY 

Healthcare Provider 

1call...

Brokerage 

Can include expert assessment 

& short term service coordination 

HCBS Providers

... Numerous services

HCBS Providers 

Numerous bills...

Brokerage Healthcare Provider 

...One invoice
THE CASE STUDY 

EARLY ANALYSIS: AIS & ADRC 

 Identified the need 

 Identified users and others who would be interested or benefit 

 Designed two potential models 

 Assessed models 

 Identified requirements to ramp up 

 Identified and prioritized resolution of unknowns 
THE CASE STUDY 

SCAN FOUNDATION GRANT 

 The project was supported by a grant from The SCAN Foundation ‐

advancing a coordinated and easily navigated system of high‐quality 

services for older adults that preserve dignity and independence. 

 For more information, visit www.TheSCANFoundation.org. 
THE CASE STUDY 

THE HCBS BROKERAGE DESIGN TEAM 

 Collaborative Consulting 

 Local executive level thought leaders 

 Healthcare providers and payers 

 HCBS providers 

 Aging & Independence Services representatives 
HCBS BROKERAGE DESIGN GUIDE 

GUIDE OBJECTIVES 

 Outline potential models 

 Provide considerations for brokerage development and 

implementation 

 Use San Diego County case study to illustrate the concepts 

 Not be prescriptive 
BROKERAGE DESIGN PROCESS 

OVERVIEW 

Step 1: Design the Service Model 

Step 2: Identify the Requirements 

Step 3: Assess Viability 

Step 4: Select the Business Model 

Step 5: Resolve Unknowns 

Step 6: Implement! 
STEP 1: DESIGN THE SERVICE MODEL 

 Existing State 

 Unit of Service 

 The Customer Experience – Service Delivery 

 Model A | Model B 

 The Value Added - The Early Business Case 

 Unknowns 
STEP 2: IDENTIFY THE REQUIREMENTS 

 Start Up (workspace & infrastructure)  Audit and Compliance 

Billing 

Audit and compliance Workforce  Legal and Contracting 

Legal and contracting 

Risk management Technology  Risk Management 

 Finance  Unknowns 
STEP 3: ASSESS VIABILITY 

 Market Analysis of Community Readiness 

 Environmental Scan of Current Solutions 

 Financial Viability Assessment 

 Unknowns 
STEP 4: SELECT THE BUSINESS MODEL 

 Potential Business Structures 

 Possible Legal Entities 

 Limited Liability Company (LLC) 

 L3C

 S-Corp 

 Tax Exemption - 501 (c) (3) 

 AAA/ADRC 
STEPS 5 & 6: RESOLVE UNKNOWNS & IMPLEMENT! 

 Resolution of Uncertainties 

 Marketing Strategy 

 Implementation Plan
PROJECT OUTCOMES 

HCBS BROKERAGE DESIGN GUIDE 

 Submitted to The SCAN Foundation 

 Posted to the LTCIP website 

 Distributing widely for communities interested in improving 

HCBS access 
CASE STUDY 

WHAT WE LEARNED 

 There is strong support in San Diego County 

for an HCBS Brokerage 

 We need to assess potential demand and 

capacity to meet the demand 
QUESTIONS? 

Brenda Schmitthenner, 858-495-5853

Brenda.Schmitthenner@sdcounty.ca.gov

Renée Sherrill, 858-505-6541

Renee.Sherrill@sdcounty.ca.gov