The following FAQs are subject to change based on regulatory changes, requirements, and
additional guidance from the Department of Health Care Services (DHCS) and the
Centers for Medicare and Medicaid Services (CMS).
DHCS, in conjunction with CMS, plans to enroll beneficiaries who are covered by both Medicare and Medi-Cal (dual eligibles) into managed care health plans. This is a three-year demonstration with Medi-Cal benefits beginning March 1, 2013, and Medicare benefits beginning June 1, 2013, subject to CMS approval.
The goal of the demonstration is patient-centered care. DHCS, CMS and their plan partners want to improve access to care, coordination of services, ensure continuity of care and increase availability and access to home and community based services, so beneficiaries have better health outcomes and remain in their homes and communities as long as possible.
Health Net was selected to participate in the demonstration in Los Angeles and San Diego counties because Health Net has partnered with DHCS for more than 15 years in Los Angeles County and 17 years in San Diego County providing services to Medi-Cal beneficiaries, including the seniors and persons with disabilities (SPD) population. Health Net also provides Medicare benefits to dual eligible beneficiaries through its Dual Eligibles Special Needs Plan (SNP) in both counties. Health Net has experience providing high-quality care and services, and the expertise to successfully maximize the ability of dual eligible beneficiaries to remain in their homes and communities with appropriate services and supports.
Los Angeles County has approximately 374,000 dual eligible beneficiaries and San Diego County has approximately 75,000.
Services include, but are not limited to:
Your patients will receive quality care and enhanced benefits with one health plan responsible for coordinating your patients' medical care, behavioral health care and social and supportive service needs. Managed care removes the uncertainty you and your patients may currently experience in trying to determine which agency—Medicare or Medi-Cal—to contact to coordinate care. Additionally, patients will have access to customer services via telephone for questions and assistance, 24-hours a day, 7 days a week, 365 days a year.
Providers within a managed care network experience consistent financial stability and administrative simplification, receiving regular payments from a single payer, with one billing address and one telephone number for questions and assistance. Additionally, it is important to realize that both the federal government and state of California are moving towards a managed care model for all government-sponsored programs for higher quality of services, support and efficiencies. Providers within a managed care network are better positioned to continue treating their Medi-Cal and Medicare beneficiaries over the long term.
If you do not contract with a Health Net participating medical group or IPA, you can continue to see your dual eligible patients for approximately 6 to 12 months through Health Net's continued access to care program upon request by your patients.
Health Net is currently evaluating participating medical groups and IPAs for inclusion in the dual eligible network for Los Angeles and San Diego counties. Once the network is established, Health Net will post information on Health Net's provider website for interested providers. For additional information regarding our networks, please contact Health Net Provider Network Management at (626) 683-6325.
Currently, many details of the demonstration are unconfirmed. Health Net is committed to providing information as the demonstration moves forward and clarification is received on issues. Check Health Net's provider website at www.healthnet.com/provider for updates. Additional information on the dual eligibles demonstration is also available on the CalDuals website at www.calduals.org.
To provide you with the most accurate plans and information in your area, we need to know your location. Please enter a ZIP code for Arizona, California, Oregon, Washington.
To provide you with the most accurate plans and information in your area, we need to know your location. Please enter a ZIP code for Arizona, California, Oregon, or Washington.