The following memo was distributed to Medi-Cal Managed Care Health Plans and statewide stakeholder groups.
Department of Health Care Services
DATE: September 3, 2019
TO: ALL MEDI-CAL MANAGED CARE HEALTH PLANS
FROM: Mari Cantwell
Chief Deputy Director, Health Care Programs
SUBJECT: Announcement Pertaining to Long Term Care, Transplants, and Multipurpose Senior Services Program, Benefits
Effective January 1, 2021, the Department of Health Care Services (DHCS) will be carving in Long Term Care (LTC) including but not limited to skilled nursing facilities, subacute facilities, pediatric subacute facilities, and intermediate care facilities and coverage of transplants to all Medi-Cal managed care health plan (MCP) model types, including Two Plan, Geographic Managed Care (GMC), Imperial, Regional, and San Benito. County Organized Health Systems (COHS) currently have these benefits carved in and no changes will be made for them.
MCPs are required to submit network certification documentation to DHCS annually. Per All Plan Letter (APL) 19-002, each MCP must also provide DHCS with supporting documentation that demonstrates the MCP’s capacity to serve the anticipated membership in its service area. In order to allow MCPs adequate time to build and report their 2020 network filing to the DHCS timely, this announcement serves to inform the MCPs of these network changes.
Additionally, and also effective January 1, 2021, DHCS will be carving out the Multipurpose Senior Services Program (MSSP) benefit from the Coordinated Care Initiative (including Medi-Cal MLTSS MCPs and Cal MediConnect plans) in all seven counties of operation including Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. In these counties, beginning in 2021, MSSP will operate as a waiver benefit, as it did prior the implementation of the Coordinated Care Initiative in 2014.
Additional detail pertaining to the aforementioned announcement will be issued in the near future. DHCS recognizes that this announcement may generate questions, and is committed to answering them – MCPs should submit questions to their contract managers; other questions should be submitted to CalAIM@dhcs.ca.gov.