Urgent Survey Response Requested: State Releases Plan to Move Medicare/Medi-Cal Patients into Managed Care Plans April 25, 2012 CMA, Medi Cal, Medicare, Payment, SFMS Member Medi-Cal, Reimbursement, Insurance, Medicare 0 On June 1, 2011, California began its transition of seniors and persons with disabilities (SPD) from Medi-Cal fee-for-service program into managed care plans, and will continue over the next several years until complete. Almost immediately, SFMS/CMA began receiving a wide range of complaints and reports of serious problems involving disruption of patient care. Over 50 percent of Medi-Cal patients involved in the initial phases of the transition had been automatically assigned to health plans due to failure to respond to notices during the enrollment period. Was this truly the patient’s fault? Or was this the result of poor planning, lack of communication or other language barriers? Nonetheless, CMA has received numerous reports of patients losing access to physicians who cared for them for many years, and have also received an increasing number of complaints of plans and IPAs/medical groups refusing to contract with physicians who have been long time Medi-Cal providers. While CMA has continued to work with the Department of Health Care Services (DHCS) to address those issues, the state now is seeking approval from the Centers for Medicare & Medicaid Services (CMS) to shift “dual eligibles” (persons with Medicare and Medi-Cal coverage) into Medicare and Medi-Cal managed care plans in four counties including Los Angeles, Orange, San Diego and San Mateo on January 1, 2013. If the state plan is approved by CMS, patients will begin receiving enrollment notices on October 1 through November 31 of this year. Furthermore, the state is once again seeking authority to automatically enroll individuals who do not actively enroll or opt-out within the required time frame. The state’s plan is currently in a thirty (30) day public comment period. CMA is collecting data on the extent of problems and other issue physicians and their patients have experienced thus far. Examples of delayed and/or denied medical treatment, disruption in continuity of care, and other issues that negatively impacted the financial viability of your practice can be extremely powerful. Your participation in this survey is crucial. The information you provide will be reflected in CMA’s response to the state’s proposal and will help us better advocate for solutions. Click here to take the survey. Comments are closed.
