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 o Capitation or separate fee-for-service rate o Cannot bill Medi-Cal for managed care clients o 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