CSAC Bulletin Article

Health and Human Services 11/09/2012

Rural Managed Care Expansion RFA Released

The state Department of Health Care Services (DHCS) has released a Request for Application (RFA) seeking health plans and nonprofits interested in providing Medi-Cal Managed Care in 25 rural counties. 
The RFA comes in response to legislation passed this year (AB 1467) that authorized the state to seek health plans and nonprofits to provide Medi-Cal Managed Care in the majority of the remaining Medi-Cal Fee-for-Service (FFS) counties (Lake, San Benito, and Imperial Counties are exempt from this policy). The counties that will be transitioned from FFS to Managed Care are Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Inyo, Lassen, Mariposa, Modoc, Mono, Nevada, Placer, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, and Yuba Counties. The transition is slated to begin in June of 2013, and the formal RFA is the second step in the process. 

Interested parties must submit a letter of intent to apply no later than November 19, and the application deadline is January 21, 2013. To view the RFA or background on the managed care expansion to rural counties, click here.

State Releases Healthy Families Program Network Adequacy Assessment

The state Department of Health Care Services (DHCS) submitted the Phase 1 Network Adequacy Assessment Report on the transition of Healthy Families Program (HFP) children into the Medi-Cal program to the Legislature this week.

The report was required 60 days prior to the anticipated start of the transition, which is still slated for January 1, 2013. The transition of about 800,000 HFP participants to Medi-Cal in 2013 will occur in four phases, but questions about the availability of Medi-Cal providers willing to accept lower reimbursement rates for the former HFP children, as well as concerns about eligibility, enrollment, and renewals for the existing HFP clients, may delay the January 1 transition start date. 

Comments on the network adequacy report are due Friday, November 16, and may be submitted to dhcshealthyfamiliestransition@dhcs.ca.gov . Please note that this network adequacy report does not include data regarding mental health or substance abuse disorder providers, as the state is still gathering that data. For information about the HFP transition to Medi-Cal, click here.

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