Contracting With Cal MediConnect Plans.docx



Background

The Coordinated Care Initiative (CCI) is an effort by California and the federal government to integrate the delivery of medical, behavioral, and long-term services and supports for persons eligible for both Medicare and Medi-Cal (i.e., dual eligibles).

California’s CCI consists of two parts:

1. Cal MediConnect: Most dual eligibles will be eligible to enroll in a new type of coordinated plan, called a Cal MediConnect plan. These plans will be responsible for administering the benefits under both Medicare and Medi-Cal. Participation is voluntary, but if an eligible person does not actively decline to participate, they will be enrolled in a Cal MediConnect plan.

2. Managed Long-Term Services and Supports (MLTSS): Simultaneously, California is requiring most dual eligibles who do not enroll in a Cal MediConnect plan to enroll in a Medi-Cal managed care plan for their Medi-Cal benefits. A dual eligible who does not enroll in Cal MediConnect will continue to receive their Medicare as they do currently, through either a Medicare Advantage plan or fee-for-service, but most Medi-Cal benefits will be administered by a Medi-Cal managed care plan. This piece of the program is also referred to as Medi-Cal managed care. Enrollment in MLTSS will not interfere with Medicare services or payment, which includes hospitalizations and physician services.

Contracting with Plans

If your patient is in Medicare FFS physician and joins a Medi-Cal plan, you do not need to contract with that plan to continue seeing your patient. If your patient joins a Cal MediConnect plan and you are out-of-network, they may request Continuity of Care to continue seeing you for 6-months, if you agree. After that, you likely will have to contract with the Cal MediConnect plan to continue seeing your patient. For more information about continuity of care and other payment issues, visit providers.

How Cal MediConnect Supports Physicians

Cal MediConnect plans will be responsible for coordinating a comprehensive assessment of enrolled dual eligibles’ medical, behavioral health, long-term services and supports, functional and social needs, and then facilitating an Interdisciplinary Care Team that will work with enrollees, caregivers and providers to develop person-centered, individualized care plans. The care plan will identify the appropriate members of the enrollee’s interdisciplinary care team including the enrollee’s primary care physician. This infrastructure is designed to give providers easy access to more comprehensive information about their patients and support in coordinating care and services for their patients, relieving the administrative burden some practices feel when helping their patients access care.

Physician Opportunities

The Cal MediConnect approach of coordinated care for high-need individuals through managed care plans continues the direction the large public health programs are headed in California. Physicians looking for opportunities to become part of this effort should contact the plans listed below, which were jointly selected by the Federal Center for Medicare and Medicaid Services and the California Department of Health Care Services to administer Cal MediConnect in California. Each of these plans have passed extensive readiness reviews to participate in this effort. Please note that most health plans contract with IPAs and medical groups. Physicians may have to join the health plan network by contracting with those groups. Each plan can provide a list of their Cal MediConnect contracted IPAs and medical groups.

To Join a Cal MediConnect Network

To find out more about how to join the network of Cal MediConnect plans in your county, please refer to the contact information below.

Alameda County: (Participation on hold until 2015)

● Alameda Alliance: Speak to an Alameda Alliance Provider Service Representative at (510) 747-4510 or visit the provider section online.

● Anthem Blue Cross: Visit the provider section online.

Los Angeles County:

● Care 1st: Speak to a Care 1st Provider Service Representative at (323)-889-6638 or visit the provider section online.

● CareMore: Visit the provider section online.

● Health Net:

○ If you are not already a Participating Provider: Click here [add link].

○ For Participating Providers: Click here [add link].

○ Health Net has also prepared a list of frequently asked questions for providers.

● L.A. Care Health Plan: Visit the provider section online.

● Molina Health: Speak to a Molina Provider Service Representative at (888)-665-4621 or visit the provider section online.

Orange County: (Participation on hold until 2015)

● CalOptima: Speak to a CalOptima Provider Relations Representative at (714) 246-8600 or visit the CalOptima website page about Cal MediConnect here.

Riverside & San Bernardino:

● Inland Empire Health Plan: Speak to an IEHP Provider Service Representative at (909) 890-2054 or visit the provider section online.

● Molina Health: Speak to a Molina Provider Service Representative at (888)-665-4621 or visit the provider section online.

San Diego:

● Care 1st: Speak to a Care 1st Provider Service Representative at (323)-889-6638 or visit the provider section online.

● Community Health Group: Speak to a Community Health Group Provider Service Representative at (619) 422-0422 or visit the provider section online.

● Health Net: Health Net has developed sections of its website for providers interested in participating in the Cal MediConnect program:

○ If you are not already a Participating Providers: Click here.

○ For Participating Providers: Click here.

○ Health Net has also prepared a list of frequently asked questions for providers.

● Molina Health: Speak to a Molina Provider Service Representative at (888)-665-4621 or visit the provider section online.

San Mateo:

● Health Plan of San Mateo: Speak to a Care Advantage Service Representative at (650)-616-2106 or visit the provider section online.

Santa Clara: (Participation on hold until 2015)

● Anthem Blue Cross: Visit the provider section online.

● Santa Clara Family Health Plan: Speak to a Santa Clara Family Health Plan Provider Service Representative at 408-376-2000 or visit the provider section online.

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