Medi-Cal Managed Care & CalAIM

2y ago
1.54 MB
70 Pages
Last View : 1m ago
Last Download : 4m ago
Upload by : Esmeralda Toy

Medi-Cal Managed Care & CalAIM:Upcoming Program UpdatesJune 29, 20211


All participants will be on mute duringthe presentation.HousekeepingSubmit questions via the “Q&A”function.Meeting materials will be madeavailable following the webinar.3

Topics Covered1What is Medi-Cal?2How does Medi-Cal Managed Care work?3What is California Advancing and Innovating Medi-Cal (CalAIM)?4What are Enhanced Care Management (ECM) and In Lieu of Services(ILOS)?5What is the timeline and how can providers prepare?4

2Medi-Cal andMedi-Cal Managed Care45

Medi-Cal (California’s Medicaidprogram) is a public health insuranceprogram that provides health carecoverage for low-income individualsand families who meet definedeligibility requirements.6

Medi-Cal is NOT the same as:Medicare, which covers peopleover 65 or with disabilitiesCommercial or individual healthinsurance, such as employer healthinsurance or Covered California7

Medi-Cal currently serves over13 million individuals, including:Low-income seniors& people withdisabilities(some of whom also qualifyfor Medicare) (15%)Low-incomechildren& their parents(48%)Low-incomeadults(31%)Other specialcategories ofindividuals(6%)8

Medi-Cal provides a core setof health benefits, ngLongTerm 9

How does Medi-Cal Deliver Services? (1/3)Medi-CalFee-for-Service(FFS)17% Medi-CalenrollmentServicescarved outof managed careMedi-CalManagedCare83% Medi-Calenrollment10

How does Medi-Cal Deliver Services? (2/3)Medi-Cal FFS Direct relationshipand paymentbetween state andproviders No defined network Providers are paidfor each servicedeliveredMedi-Cal Managed Care The state contracts withmanaged care plans (MCPs) MCPs establish a definednetwork of providers and paythem directly (payment modelsvary) Aim is to provide coordinated,high-quality, cost-effective careServices “Carved Out” of Medi-Cal Managed Care*For more information about Medi-Cal MCPs in yourcounty, please refer to the Appendix (Slides 55 – 70).11

How does Medi-Cal Deliver Services? (3/3)Medi-Cal FFSMedi-Cal Managed CareServices “Carved Out” of Medi-Cal Managed Care Specialty Mental Health ServicesSubstance Use Disorder (SUD) TreatmentDental ServicesLong-Term Care (LTC) [in most counties]*Long Term Services and Supports (LTSS) [in mostcounties]* California Children’s Services (CCS) [in most counties]*LTC and LTSS will be carved into managed care over time as part of CalAIM.12

Medi-Cal ManagedCare Models All counties have Medi-Cal managed careplans (MCPs), but the plan models differby county. Some counties have one Medi-Cal MCP,others have two, and some have several. Additional information about which MediCal MCPs operate within your county canbe found in the Appendix (Slides 55-70) . Additional information about managedcare models can be found in theAppendix (Slide 50).13

How Plans are Paid by the StateMedi-CalManaged CarePaymentProcesses The state contracts with managed care plans(MCPs) to deliver Medi-Cal services andprovide cost-effective health care tobeneficiaries. Medi-Cal MCPs receive amonthly capitation payment, also referred to asa per-member per-month (PMPM) payment, tocover the services outlined in their contract.How Providers are Paid by Plans Each MCP has the authority and responsibilityto negotiate payment rates with providers in itscounty or service network.14

2California Advancing andInnovating Medi-Cal (CalAIM)415

What is CalAIM?CaliforniaAdvancing andInnovatingMedi-CalCalAIM is a multi-year initiative led byDHCS that aims to improve the quality oflife and health outcomes of Medi-Calbeneficiaries by implementing deliverysystem and payment reforms across theprogram.CalAIM leverages Medicaid as a tool tohelp address many of the complexchallenges facing California’s mostvulnerable residents and takes a personcentered approach that targets socialdeterminants of health and reduces healthdisparities and inequities.16

Identify and manage member risk and need throughwhole person care approaches and addressingSocial Determinants of HealthCalAIMGoalsMove Medi-Cal to a more consistent and seamlesssystem by reducing complexity and increasingflexibilityImprove quality outcomes, reduce health disparities,and drive delivery system transformation andinnovation through value-based initiatives,modernization of systems and payment reform17

Major CalAIM InitiativesMove Medi-Cal to a more consistent and seamless systemby reducing complexity and increasing flexibilityImplement changes to improve and streamline Managed Care,County-Based Services, Behavioral Health, and Dental Services.Specific initiatives in one or more of these programs include:Standardized Enrollment and BenefitsStreamlining and Integration ofAdministrative Functions and InformationPayment ReformsQuality StandardsEnhanced Oversight and MonitoringRegional Contracting or Rates18

Major CalAIM InitiativesIdentify and Manage Member Risk and Need through Whole Person CareApproaches and Addressing Social Determinants of HealthPopulation Health ManagementSerious Mental Illness (SMI) /SeriousEmotional Disturbance (SED) DemonstrationEnhanced Care ManagementMedi-Cal Enrollment Prior to Releasefrom County JailIn Lieu of ServicesCare Integration PilotsShared Risk, Shared Savings &Incentive PaymentsImprove Outcomes for Foster CareChildren and Youth19

2Enhanced CareManagement (ECM) andIn Lieu of Services (ILOS)420

Levels of Care Managementlevel of need/riskEnhanced Care Management Intended for highest risk members who need long-termcoordination for multiple chronic conditions, socialdeterminants of health issues, and utilization of multipleservice types and delivery systems.Complex Case Management Intended for high-risk members who need coordination ofservices for complex conditions or episodic need.Basic Case Management Intended for members who require support with planningand coordination that is not at the highest level ofcomplexity, intensity, or duration.21

What are ECM and ILOS? (1/2)Enhanced CareManagementA Medi-Cal managed care benefitthat will address clinical andnon-clinical needs ofhigh-need, high-cost individualsthrough the coordination of servicesand comprehensive caremanagement.In Lieu of ServicesServices that Medi-Cal managedcare plans are stronglyencouraged but not required toprovide “in lieu of”/ as substitute forutilization of other services or settingssuch as hospital or skilled nursingfacility admissions, discharge delays,or emergency department use.Building on What We Know22

What are ECM and ILOS? (2/2)Enhanced CareManagementIn Lieu of ServicesBuilding on What We KnowECM and ILOS will build on the design and learnings from California’sWhole Person Care Pilots (WPC) and Health Homes Program (HHP)and will replace both models to scale interventions to a statewide caremanagement approach.23

The Health HomesProgram (HHP)Whole Person Care(WPC)HHP is administered by 17MCPs across 12 counties.23 WPC Pilots participate inthe program.HHP and WPC Pilots will be replaced byECM/ILOS as of January 1, 2022.24

Counties Participating in HHP/WPCHHPWPCBothHHP Imperial County Sacramento County Tulare County HHP and WPCAlameda CountyKern CountyLos Angeles CountyOrange CountyRiverside CountySan Bernardino CountySan Diego CountySan Francisco CountySanta Clara County WPCContra Costa CountyKings CountyMarin CountyMendocino CountyMonterey CountyNapa CountyPlacer CountySan Joaquin CountySan Mateo CountySanta Cruz CountyShasta CountySolano CountyVentura County25

HHP/WPC Transition to ECM/ILOSCURRENT STATEWPC Pilot program FFS and managed caremembers Administrator: Local entitiesHHP Benefit (state plan service) Managed care members only Administrator: MCPsFUTURE STATEECM Benefit Managed caremembers only Administrator: MCPsILOS Optional, butstrongly encouraged Managed caremembers only Administrator: MCPs26

Enhanced Care Management (ECM) A new statewide mandatory managed care benefit, withimplementation beginning in HHP and WPC counties on 1/1/2022for certain populations. Available to eligible high-need individuals enrolled in managed care. Designed to provide person-centered care and address clinical andnon-clinical needs. Part of broader CalAIM population health system design throughwhich MCPs will offer care management interventions at differentlevels of intensity based on member need, with ECM as the highestintensity level.27

ECM Populations of Focus (1/2)AdultsChildren/Youth up to age 211. Individuals and families experiencing homelessness;2. High utilizers;2. High utilizers;3. Serious Mental Illness (SMI) /Substance Use Disorder (SUD);3. Serious Emotional Disturbance(SED), identified to be at Clinical HighRisk (CHR) for psychosis orexperiencing a First Episode ofPsychosis;4. Incarcerated and transitioning to the community;Populations havebeen definedAdditional detailsare forthcoming28

ECM Populations of Focus (2/2)Adults5. At risk for institutionalization andeligible for long-term care;6. Nursing facility residentstransitioning to the community.Populations havebeen definedChildren/Youth up to age 215. Enrolled in California Children’sServices (CCS) / Whole Child Model(WCM) with additional needs beyondCCS;6. Involved in Child Welfare(including those with a history ofinvolvement, and foster care up toage 26).Additional detailsare forthcoming29

ECM Core ServicesOutreach andEngagementMember and FamilySupportsComprehensive Assessmentand Care Management PlanHealth PromotionCoordination of and Referralto Community and SocialSupport ServicesComprehensiveTransitional CareEnhanced Coordinationof Care30

In Lieu of Services (ILOS) Focused on addressing combined medical and social determinants of healthneeds and avoiding higher levels of care and associated costs. Medically appropriate, cost-effective alternative services or settings that areprovided “in lieu of” / substitute for more costly services or settings such ashospital or skilled nursing facility admissions, discharge delays, oremergency department use. Strongly encouraged but not required for Medi-Cal MCPs to implement (notbenefits). Optional for Medi-Cal Managed Care Members to receive. Must be medically appropriate and cost-effective. Begin implementation statewide 1/1/2022.31

ILOS ServicesDHCS has pre-approved fourteen (14) potential medically appropriate and costeffective ILOS that MCPs may offer. MCPs may also submit proposals to offeradditional ILOS that are not on this menu, subject to DHCS approval. Pre-approvedDHCS ILOS options include: Housing Transition Navigation ServicesHousing DepositsHousing Tenancy and Sustaining ServicesShort-Term Post-Hospitalization HousingRecuperative Care (Medical Respite)Respite ServicesDay Habilitation ProgramsNursing Facility Transition/Diversion toAssisted Living Facilities Community Transition Services/NursingFacility Transition to a HomePersonal Care and Homemaker ServicesEnvironmental Accessibility Adaptations(Home Modifications)Meals/Medically-Tailored Meals orMedically-Supportive FoodsSobering CentersAsthma Remediation32

Roles: MCPsResponsible for establishing provider networks to deliverECM and elected ILOS. Expected to contract with existing WPC/HHP providers,as well as other medical, behavioral, and social servicesproviders, to deliver ECM/ILOS. Responsible for oversight and monitoring of ECM/ILOSservice delivery and providers.ILOS Providers ECM ProvidersMCPs33

Roles: ECM Providers (1/2)MCPs Community-based entities, with experience and expertiseproviding intensive, in-person care management services toindividuals in one or more of the populations of focus for ECM. Primary responsible entity for coordinating care acrossmultiple medical, behavioral, and social service systems. Must designate a Lead Care Manager.ILOS ProvidersECM Providers Contract with health plans and must meet specific contractualrequirements and demonstrate certain capabilities related tocare models, billing, and data sharing.34

Roles: ECM Providers (2/2)Examples of the types of ECM providers Medi-Cal MCPs maychoose to contract with, include but are not limited to: County agencies; Federally qualified health centers; Primary care providers; Behavioral health entities; Community and rural health clinics; Community mental health centers; Organizations serving individuals experiencinghomelessness or justice-involved individuals.ILOS ProvidersMCPsECM Providers35

Roles: ILOS Providers (1/2)ECM ProvidersMCPsILOS Providers Deliver critical medical and social services, such as housingnavigation, recuperative care, medically-tailored meals, orcommunity transitions, which are not typically funded byMedi-Cal. Contract with MCPs as the primary responsible entity fordelivering select medically appropriate alternatives to morecostly state plan services. Subcontract with other entities asappropriate. Must meet certain contractual requirements, such as thoserelated to care models, billing, and data sharing.36

Roles: ILOS Providers (2/2)ECM ProvidersMCPsILOS ProvidersExamples of the types of ILOS providers Medi-Cal MCPs maychoose to contract with, include but are not limited to: Social services agencies; Life skills training and education providers; Home health or respite agencies; Home delivered meals providers; Affordable housing and supportive housing providers; Sobering centers.37

2Timeline andWhat’s Coming Next438

What is the transition timeline?ECMILOSJanuary 2022 Transition all Members enrolled in a WPC Pilot or HHP who areidentified by the WPC Lead Entity or HHP CB-CME as belongingto a Population of Focus1: ECM goes live for the following ECM Populations of Focus: Individuals & Families Experiencing Homelessness; High Utilizer Adults; Adults with SMI/SUD; Adults & Children/Youth Transitioning from Incarceration².January 2022 Statewide launch of ILOS Eligible members currently served by HHP/WPC transition to ILOS.1. Includes children and youth currently served by HHP or WPC2. In WPC Pilot counties only, where the services provided in the Pilot are consistent with those described in the ECM Contract.39

What is the transition timeline?ECMILOSJuly 2022 In non-HHP/WPC counties, ECM goes live for the following ECMPopulations of Focus: Homeless; High Utilizer adults; Adults with SMI/SUD. Each MCP must show in its MOC how it will grow its networkcapacity to serve each Population of Focus over the first 12months of implementation (July 2022- July 2023).July 2022Every 6 months, MCPs may add additional pre-approved ILOS.40

What is the transition timeline?ECMILOSJanuary 2023July 2023 ECM goes live for the following ECM ECM goes live for allPopulations of Focus³:other Children and Individuals Transitioning fromYouth⁴.Incarceration (adults and children/youth); Members Eligible for LTC and at risk ofInstitutionalization; Nursing Home Residents transitioning tocommunityJanuary 2023Every 6 months, MCPs may addadditional pre-approved ILOS.3 - 4. MCPs may begin offering ECM to these Populations of Focus earlier than the indicated start dates;however, rates will not be adjusted to reflect these Populations of Focus until the indicated start dates.July 2023Every 6 months, MCPsmay add additionalpre-approved ILOS.41

What’s Coming Next? (1/3)DHCS Policy Decisions and GuidanceEarly to Mid Summer ECM and ILOS program guides ILOS pricing guidanceLate Summer to Fall ECM/ILOS reporting guidance ECM/ILOS data authorization guidanceMCP Deadlines July 1, 2021 – Model of Care part I September 1, 2021 – Model of Care part II October 1, 2021 – Model of Care part III42

What’s Coming Next? (2/3)Upcoming Webinars Additional Information about Enhanced CareManagement (ECM) and In Lieu of Services (ILOS) Intended For: Providers, counties and others interestedin participating in ECM/ILOSTopics Covered: MCP and provider roles, providerexpectations (including vetting, outreach andengagement, billing, and reporting), and questions toconsider43

What’s Coming Next? (3/3)Next Steps for Providers Learn more about ECM and ILOS: ECM/ILOS FAQsECM Key Design Implementation Decisions DHCS-MCP ECM and ILOS Contract TemplateECM and ILOS Standard Provider Terms and Conditions Review ECM and ILOS guidance documents: Reach out to the MCPs in your county if you areinterested in becoming an ECM/ILOS provider, seeSlides 55 – 70 in the Appendix for additional details.44

For more information about CalAIM, lAIM.aspxQuestions?For more information about ECM and ILOS, xSend questions or comments



Key Terms & Acronyms (1/2) Department of Health Care Services (DHCS): DHCS helps provide low-incomeand disabled Californians’ access to affordable, integrated, high-quality healthcare, including medical, dental, mental health, substance use treatment services,and long-term care. Medi-Cal Fee-for-Service (FFS): under FFS Medi-Cal, beneficiaries areresponsible for finding primary care providers and specialists who are willing toaccept Medi-Cal; beneficiaries are not matched with a primary care provider whocoordinates their care. DHCS establishes fee schedules, negotiates rates withhospitals, determines medical necessity criteria and pays provider claims forservices provided. Medi-Cal Managed Care (MC): under Medi-Cal Managed Care, each of theparticipating health plans contract with DHCS and assume full financial risk for allcovered services.48

Key Terms & Acronyms (2/2) Managed Care Plan (MCP): MCPs provide health care services for theirmembers through contracts with health care providers and medical facilities.These providers and facilities make up the plan’s network. California Advancing and Innovating Medi-Cal (CalAIM): CalAIM is a DHCSinitiative to reform the Medi-Cal program and, in turn, improve the quality of lifeand health outcomes of Medi-Cal members. Enhanced Care Management (ECM): A Medi-Cal managed care benefit that willaddress clinical and non-clinical needs of high-need, high-cost individuals throughthe coordination of services and comprehensive care management. In Lieu of Services (ILOS): Services that Medi-Cal managed care plans arestrongly encouraged but not required to provide “in lieu of”/ as substitute forutilization of other services or settings such as hospital or skilled nursing facilityadmissions, discharge delays, or emergency department use.49

Medi-Cal Managed Care Models County Organized Health System (COHS): in this model, a health plan iscreated and administered by a County Board of Supervisors. Within a COHScounty, all managed care enrollees are in the same plan (22 counties). Two-Plan Model: this model is comprised of a publicly-run entity (a “LocalInitiative”) and a commercial plan (14 counties). Geographic Managed Care (GMC): in this model, DHCS contracts with a mix ofcommercial and non-profit plans that compete to serve Medi-Cal beneficiaries (2counties). Regional Expansion Model: DHCS contracts with two commercial plans ineach county (18 counties). Imperial Model: this model only operates in Imperial County where DHCScontracts with two commercial plans. San Benito Model: this model only operates in San Benito County where DHCS50contracts with one commercial plan.

In Lieu of Services Descriptions (1/4) Housing transition navigation services: housing transition services assistbeneficiaries in obtaining housing Housing deposits: assist with identifying, coordinating, securing, or fundingone-time services and modifications necessary to enable a person to establish abasic household Housing tenancy and sustaining services: provide tenancy and sustainingservices, with a goal of maintaining safe and stable tenancy once housing issecured Short-term post-hospitalization housing: provides beneficiaries who do nothave a residence and who have high medical or behavioral health needs with theopportunity to continue their medical, physical, or substance use recoveryimmediately after exiting an inpatient facility51

In Lieu of Services Descriptions (2/4) Recuperative care (medical respite): short-term residential care for individualswho no longer require hospitalization, but still need to heal from an injury orillness (including behavioral health conditions) and whose condition would beexacerbated by an unstable living environment Respite services: short-term services provided to caregivers of participants whorequire intermittent temporary supervision to give relief to the caregiver Day habilitation programs: provide services in or out of a participant’s home toassist the participant in acquiring, retaining and improving self-help, socializationand adaptive skills necessary to reside successfully in the person’s naturalenvironment Medically tailored meals/medically-supportive food: meals/food that helpindividuals achieve their nutrition goals at critical times to help them regain andmaintain their health52

In Lieu of Services Descriptions (3/4) Nursing facility transition/diversion to assisted living facilities: services toassist individuals to live in the community and/or avoid institutionalization whenpossible by facilitating nursing facility transition back into a home-like, communitysetting and/or preventing skilled nursing admissions for beneficiaries with animminent need for nursing facility level of care Community transition services/nursing facility transition to a home: assistsindividuals to live in the community to avoid further institutionalization byproviding non-recurring set-up expenses for individuals transitioning from alicensed facility to a living arrangement in a private residence Personal care and homemaker services: provide services for individuals whoneed assistance with Activities of Daily Living (ADL) and/or Instrumental Activitiesof Daily Living (IADL)53

In Lieu of Services Descriptions (4/4) Environmental accessibility adaptations (home modifications): physicaladaptions to a home that are necessary to ensure the health, welfare, and safetyof the individual, or enable the individual to function with greater independence inthe home Sobering centers: centers used as alternative destinations for individuals whoare found to be publicly intoxicated and would otherwise be transported to theemergency department or jail Asthma remediation: physical modifications to a home environment that arenecessary to ensure the health, welfare, and safety of the individual, or enablethe individual to function in the home and without which acute asthma episodescould result in the need for emergency services and hospitalization54

MCPs by County & Contact Information (1/16)CountyAlamedaCountyAlpine CountyAmadorCountyHealth PlansContact InformationAlameda Alliance for HealthCalAIMinfo@alamedaalliance.orgAnthemBlue Cross Partnership PlanInterest FormAnthem Blue CrossPartnership PlanCalifornia Health &WellnessAnthem Blue CrossPartnership PlanCalAIM@anthem.comInterest FormCalAIM@anthem.comCaHealthWellness ECM ILOS@cahealthwellness.comInterest FormCalAIM@anthem.comCaHealthWellness ECM ILOS@caCalifornia Health & Wellnesshealthwellness.com55

MCPs by County & Contact Information (2/16)CountyButte CountyCalaverasCountyColusa CountyHealth PlansContact InformationAnthem Blue CrossPartnership PlanInterest FormCalAIM@anthem.comCaHealthWellness ECM ILOS@caCalifornia Health & Wellnesshealthwellness.comInterest FormAnthem Blue CrossPartnership PlanCalAIM@anthem.comCaHealthWellness ECM ILOS@caCalifornia Health & Wellnesshealthwellness.comInterest FormAnthem Blue CrossPartnership PlanCalAIM@anthem.comCaHealthWellness ECM ILOS@caCalifornia Health & Wellnesshealthwellness.com56

MCPs by County & Contact Information (3/16)CountyContra CostaCountyDel NorteCountyEl DoradoCountyHealth PlansContact InformationAnthem Blue CrossPartnership PlanInterest FormCalAIM@anthem.comContra Costa Health PlanSharron.Mackey@cchealth.orgPartnership Health PlanCalAIM@partnershiphp.orgAnthem Blue CrossPartnership PlanInterest FormCalAIM@anthem.comCaHealthWellness ECM ILOS@caCalifornia Health & Wellnesshealthwellness.comInterest FormAnthem Blue CrossFresno CountyPartnership PlanCalAIM@anthem.com57

MCPs by County & Contact Information (4/16)CountyHealth PlansContact InformationFresno CountyCalVivaCalViva ECM ILOS@healthnet.comAnthem Blue CrossPartnership PlanInterest FormPartnership Health PlanCalAIM@partnershiphp.orgGlenn mCaHealthWellness ECM ILOS@cahCalifornia Health & Wellnessealthwellness.comCaHealthWellness ECM ILOS@cahealthwellness.comMolina Healthcare of California MHCGovernment.Contracts@MolinaPartner Plan, Inc.HealthCare.ComCalifornia Health & Wellness58

MCPs by County & Contact Information (5/16)CountyInyo CountyKern CountyHealth PlansContact InformationAnthem Blue CrossPartnership PlanInterest FormCalAIM@anthem.comCaHealthWellness ECM ILOS@cahCalifornia Health & Wellnessealthwellness.comHealth Net CommunityECM ILOS@healthnet.comSolutions, Inc.Kern Family Health CareKings CountyLake CountyAnthem Blue CrossPartnership PlanCalViva HealthPartnership Health Plan ofCaliforniaamisha.pannu@khs-net.comInterest FormCalAIM@anthem.comCalViva ECM ILOS@healthnet.comCalAIM@partnershiphp.org59

MCPs by County & Contact Information (6/16)CountyLassen CountyLos AngelesCountyMaderaCountyMarin CountyHealth PlansPartnership Health Plan ofCaliforniaHealth Net CommunitySolutions, Inc.L.A. Care Health PlanAnthem Blue CrossPartnership PlanCalViva HealthPartnership Health Plan ofCaliforniaContact InformationCalAIM@partnershiphp.orgECM ILOS@healthnet.comECM: mzavala@lacare.orgILOS: aklurfeld@lacare.orgInterest FormCalAIM@anthem.comCalViva ECM ILOS@healthnet.comCalAIM@partnershiphp.org60

MCPs by County & Contact Information (7/16)CountyMariposaCountyHealth PlansContact InformationAnthem Blue CrossPartnership PlanInterest FormCalAIM@anthem.comCaHealthWellness ECM ILOS@cahCalifornia Health & Wellnessealthwellness.comMendocinoPartnership Health Plan ntral California Alliance nership Health Plan ofModoc CountyCalAIM@partnershiphp.orgCalifornia61

MCPs by County & Contact Information (8/16)CountyMono CountyMontereyCountyNapa CountyNevadaCountyHealth PlansContact InformationAnthem Blue Cross PartnershipPlanInterest FormCalAIM@anthem.comCaHealthWellness ECM ILOS@cCalifornia Health & Wellnessahealthwellness.comCentral California Alliance p Health Plan @ccahCentral California Alliance foralliance.orgHealthCaHealthWellness ECM ILOS@cCalifornia Health & Wellnessahealthwellness.com62

MCPs by County & Contact Information (9/16)CountyHealth PlansContact n@caloptima.orgAnthem Blue CrossPartnership PlanInterest FormInland Empire Health PlanECM@iehp.orgPlacer CaHealthWellness ECM ILOS@cahCalifornia Health & Wellnessealthwellness.comInterest FormAnthem Blue CrossPartnership PlanCalAIM@anthem.comCaHealthWellness ECM ILOS@cahCalifornia Health & Wellnessealthwellness.comMolina Healthcare of California ner Plan, Inc.

MCPs by County & Contact Information (10/16)CountySacramentoCountyHealth PlansContact InformationAetna Better HealthFlanaganBrownJ@aetna.comInterest FormAnthem Blue CrossPartnership PlanHealth Net CommunitySolutions, Inc.CalAIM@anthem.comECM .org/norKaiser .Contracts@MolinaHeMolina Healthcare ofalthCare.ComCalifornia Partner Plan, Inc.Interest FormSan BenitoAnthem Blue CrossCountyPartnership PlanCalAIM@anthem.com64

MCPs by County & Contact Information (11/16)CountyHealth PlansContact InformationInland Empire Health PlanECM@iehp.orgSanBernardino Molina Healthcare of California MHCGovernment.Contracts@MolinaCountyPartner Plan, Inc.HealthCare.ComAetna Better Health ofFlanaganBrownJ@aetna.comCaliforniaBlue Shield of CaliforniaECM-ILOS@blueshieldca.comPromise Health PlanSan DiegoCommunity Health Groupinfo@chgsd.comCountyPartnership PlanHealth Net CommunityECM ILOS@healthnet.comSolutions, Inc.Kaiser PermanenteMedi-Cal-State-Program@kp.org65

MCPs by County & Contact Information (12/16)CountyHealth PlansContact InformationMHCGovernment.Contracts@MolinaMolina Healthcare ofHealthCare.ComSan DiegoCalifornia Partner Plan, Inc.CountyUnitedHealthcare Communitymorgan perez@uhc.comPlanInterest FormAnthem Blue CrossSan FranciscoPartnership PlanCalAIM@anthem.comCountySan Francisco Health Plancalaimecmilos@sfhp.orgHealth Net CommunityECM ILOS@healthnet.comSan JoaquinSolutions, Inc.County Plan of San Joaquin LuisCenCal Health-us/Obispo County66

MCPs by County & Contact Information (13/16)CountySan MateoCountySanta BarbaraCountySanta ClaraCountySanta CruzCountyShastaCountyHealth PlansContact InformationHealth Plan of San Mateo HealthAnthem Blue CrossPartnership PlanSanta Clara Family HealthPlanCentral California AlliancePartnership Health Plan /Interest gram@ccahalliance.orgCalAIM@partnershiphp.org67

MCPs by County & Contact Information (14/16)CountyHealth PlansContact Informationhttps://w

Roles: MCPs MCPs Responsible for establishing provider networks to deliver ECM and elected ILOS. Expected to contract with existing WPC/HHP providers, as well as other medical, behavioral, and social services providers, to deliver ECM/ILOS. Responsible for oversight a

Related Documents:

Medi-Cal Dental Action Reason for Action Code(s) (see enclosed for explanation) You can discuss different treatment plans with your dentist to obtain the best care allowable under the Medi-Cal Dental program. If. have a question regarding this action, please contact your dentist or Medi-Cal Dental at 1-800-322-6384 for a more detailed .

55 11-13 Crisis Referral Not Medi-Cal Eligible 55 14-16 MHS Contract Admin. Not Medi-Cal Eligible 55 17-19 Discounted MH Outreach Not Medi-Cal Eligible 55 21-23 SPMP Case Management Not Medi-Cal Eligible 55 24-26 SPMP Program Planning Not Medi-Cal Eligible 55

Directorio de Proveedores y Servicios Medi-Cal Network 661.716.7270 Toll Free: 800.918.7302 Contracted with Health Net Medi-Cal Plan Contratado con el Plan de Health Net Medi-Cal . Aceptando pacientes mayores de 5 Ned Devasia, MD (m) 661.327.3747 5801 Truxtun Ave Bakersfield, CA 93309 BC: Internal Medicine LS: Spanish. 4 Medi-Cal Jae Kim, MD .

Medi-Cal Telecommunications Provider and Biller Application/Agreement (DHCS 6153) Medi-Cal Point of Service (POS) Network/Internet Agreement Note: These forms can be downloaded from the Forms page on the Medi-Cal Provider website ( When the provider or submitter has approval for electronic submission, then a .

Transitioning pharmacy services from Medi-Cal managed care to fee-for-service will, among other things: Standardize the Medi-Cal pharmacy benefit statewide, under one delivery system. Improve access to pharmacy services with a pharmacy network that includes the vast majority of the state's pharmacies and is generally more expansive

Medi-Cal Managed Care Plans ensure the provision of . Health Care Options (Health Plans/Dental Plans) Phone: 800-430-4263 / TTY: 800-430-7077. Other Languages: 800-430-4263 . Sacramento County Medi -Cal Managed Care 22 Eligibility & Enrollment Resources medi Medical Support Sdn Bhd medi representative office Asia Unit No. B-2-19, Block B, No.2, Jalan PJU 1A/7A Oasis Ara Damansara, PJU 1A, 47301 PETALING JAYA Darul Ehsan Malaysia T: 6 03 7832 3591 F: 6 03 78323921 medi Middle East P. O. Box: 109307 Abu Dhabi United Arab Emirates

Medi-Cal Managed Care External Quality Review Technical Report July 1, 2019- June 30, 2020 Main Report . Managed Care Quality and Monitoring Division . Dental Managed Care Plan Performance Improvement Projects 101 . Background 101 . Requirements 101 . Objectives 102 . Methodology 102 .