Dear Fellow CAMPS Providers:
Last November, the federal government approved California's Section 1115 Medi-Cal Waiver. This allows the State to re-design part of the Medi-Cal program by waiving certain federal rules and regulations. The Department of Health Care Services (DHCS) is using this opportunity to reduce Medi-Cal costs and prepare California for national health care reform.
A key provision of this waiver calls for seniors and persons with disabilities (SPDs) to enroll in Medi-Cal managed care plans. This applies to the 400,000 SPDs currently residing in the following two-plan or geographic managed care counties: Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, San Bernardino, San Francisco, San Joaquin, Santa Clara, Stanislaus, Tulare, Sacramento and San Diego.
Medi-Cal has scheduled this transition to begin on June 1, 2011. There will be a staggered 12-month enrollment of SPDs based on their birth month. All members will be given at least two plan options to choose from. Medi-Cal will "auto-assign" SPDs to plans if they fail to enroll in one themselves. Covered services are supposed to be the same that exist today in the two-plan and geographic managed care models.
This is going to be a significant change for California DME / HME providers and their patients. Are you ready for this transition? Click on the link below for information on the waiver and for specifics on mandatory SPD enrollment: http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx.
Here are some key areas of concern for providers:
ð Only contracted providers in the affected counties will be able to provide service to these patients.
ð Patients can switch between plans at any time without restriction.
ð Few providers, referral sources and patients even know about this change.
ð There is little consistency amongst the managed care plans in the way authorizations and claims are processed.
ð Provider reimbursement may be impacted as some plans are notoriously slow to pay
These are just a few of the issues.
What are your concerns? CAMPS wants to hear from you about this transition. Please email your questions and concerns to dfein@shieldhealthcare.com. This information will be collected and sent to Medi-Cal. CAMPS is working hand-in-hand with stakeholders across the state to make sure that your questions are answered and your voices are heard.
A Reimbursement Subcommittee has just been formed to help lead CAMPS members through this transition. There are a few spots open for motivated providers that are looking to be more involved. Please email Gloria Peterson at GPeterson@amgroup.us or Dave Fein at dfein@shieldhealthcare.com if you are interested in participating. Don't miss this opportunity to get more involved in your state association.
CAMPS will also be holding its Annual Convention on March 1-2, 2011 at the Hilton Irvine / Orange County Airport Hotel. Visit http://www.campsone.org/ohana/website/index.cfm?p=80001 for details.
Kind Regards,
Dave Fein
Board Member & Committee Chair
California Association of Medical Product Suppliers
