A federal waiver granted under Section 1115(a) of the Social Security Act permits mandatory enrollment of Medi-Cal only Seniors and Persons with Disabilities into Medi-Cal managed care. The Waiver allows the Department of Health Care Services to achieve care coordination, better manage chronic conditions, and improve health outcomes. Mandatory enrollment begins June 2011.
MMCD Transition: Seniors & Persons with Disabilities Frequently Asked Questions (FAQs)
Q: Does DHCS have any information out there for providers on the SPD transition?
A: Yes. DHCS developed a website specifically for this transition. The link to the website is http://www.dhcs.ca.gov/individuals/Pages/MMCDSPDEnrollment.aspx.
Q: What sort of information is provided on the Department’s website?
A: The MMCD SPD website includes important information for Medi-Cal members, providers and health plans. It includes an informative FAQ section that will answer a lot of general questions for providers.
Q: Who can providers direct their questions or comments for the Department to?
A: Providers can email the Department at mmcdpmb@dhcs.ca.gov or call the Ombudsman at
1-888-452-8609.
Q: Where is there a listing of the plans and counties affected by mandatory enrollment?
A: This information is available on the SPD transition website at http://www.dhcs.ca.gov/individuals/Pages/MMCDSPDEnrollment.aspx.
Q: Will CCS continue to be carved out in counties such as Napa, Solano, and Sonoma?
A: According to DHCS, carve-outs are still a topic of internal discussion and no decision has been made at this time.
Q: Will providers be forced to contract with the health plans in order to continue providing service to SPDs?
A: DHCS recognizes that providers cannot be forced to contract with health plans. Providers may continue servicing their SPDs even if they are not contracted with a particular health plan. The topic of out-of-network providers was addressed recently in statute (SB208). Welfare & Institutions code 14181 has been amended to read:
“…(13) Ensure that managed care health plans participating in the demonstration project provide access to out-of-network providers for new individual members enrolled under this section who have an ongoing relationship with a provider if the provider will accept the health plan’s rate for the service offered, or the applicable Medi-Cal fee-for-service rate, whichever is higher, and the health plan determines that the provider meets applicable professional standards and has no disqualifying quality of care issues…”
Q: How can CAMPS members become more involved with this transition?
A: CAMPS has a Reimbursement Subcommittee that is actively working with the Department on this transition. They meet at least once a month via conference call. Please contact Benjamin Ichimaru at bichimaru@amgroup.us or Dave Fein at dfein@shieldhealthcare.com if you are interested in participating in this subcommittee.