CAHF is dedicated to work with our members and Managed Care Plans in California to promote the value of long-term care providers, reduce the errors that can occur in the revenue cycle, and hold the plans accountable to follow all regulations that ensure providers will be reimbursed as required for services provided.
Specific deliverables include fact sheets, billing guidelines, All Plan Letters (APLs) and white papers designed to help you educate your team and members of the health insurance industry.
Medicare and DHCS have implemented a new requirement in the instances that the Medicare member is enrolled with one plan for their Medicare benefit and to another plan for their Medi-Cal benefit. The requirement necessitates that Hospitals and Skilled Nursing Facilities send notice to the Medi-Cal plan upon admission or discharge. The DSNP policy guide is the guidance from DHCS, and the contract between DHCS and DSNPs on care coordination speaks to data sharing with MediCal plans. Medicare plans would not be able to comply unless the hospitals and SNFs inform the plans of the admission or discharge. The boilerplate template and the DSNP guide is made available on the DHCS public website.
Other support includes:
CalAIM Education & Support: All long-term care fee-for -service Medi-Cal residents will transition to Medi-Cal Managed Care plans in 2023. The impact on SNF providers is geographically specific and will require all SNF providers to work with plans in their respective counties. CAHF staff is available to work with members and help identify opportunities and threats, and work with plans to promote a successful transition to managed care.
Managed Care Advisory Network: MCAN meetings are usually held the second Wednesday of each month to review issues impacting managed care at the State and Federal level, provide legal updates and review trending issues by plan.
Managed Care Contracting: CAHF works with providers to share best practices in Managed Care contracting and offers a Managed Care Contract Tool kit for guidance on health plan contracting issues.
News & Notes: CAHF publishes a brief newsletter to capture timely updates to share with members on the Managed Care Advisory Network.
Revenue Cycle Task Force: RCI Task Force focuses on meeting with plans to improve the revenue cycle, discuss specific operational issues that may impact the process and reduce errors for payors and providers. RCI Task Force was not able to meet face-to face during the pandemic, but hope to re-engage with plans before the CalAIM transition to discuss issues and develop specific recommendations for improvement.
For immediate assistance regarding issues with managed care plans, or to be included in CAHF managed care activities, contact Jenny Treis at 916-432-5204, jtreis@cahf.org.
