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Medi-Cal Managed Care

Medi-Cal Managed Care

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Medi-Cal Managed Care

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Presentation Transcript

  1. Medi-Cal Managed Care PSC Orientation November 2, 2011

  2. Medi-Cal Managed Care & CPSP • Three different Managed Care Models • Geographic Managed Care • County-Organized Health System • Two-Plan • 33 Counties have MCMC

  3. Medi-Cal Managed Care • MCMC Contracting Hierarchy • State • Health Plans • Subcontracting Health Plans (2-Plan Only) • IPAs/Medical Groups • Providers

  4. Medi-Cal Managed Care • All plans must have MOU with local MCAH describing roles & responsibilities: • Outreach • Perinatal access • Provider network • Education • Training • Information sharing

  5. Medi-Cal Managed Care: What Every Provider Needs to Know • READ THE CONTRACT! • CPSP is a managed care benefit • All managed care enrollees eligible • Reimbursement method varies by contract • Capitation or separate fee-for-service rate • Cannot bill Medi-Cal for managed care clients • May need prior authorization for high risk referrals

  6. Medi-Cal Managed Care • Client Care Problems • Office of the Ombudsman 1-888-452-8609 • Department of Managed Health Care 1-800-400-0815