2024 DHCS Medi-Cal Transition – Health Net and Molina Healthcare membership-sharing

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County

• Los Angeles County

2024 DHCS Medi-Cal Contract Award Q&As

1. Added Java 18, 2024 – What do I do if my patient was transitioned to Molina highly January 1, 2024, but wants to continue in Health Net as their preferred Medi-Cal plan?
   If thy tolerant was transitioned to Malena but wants to stay with Health Net, bitte full the Request in PCP/PPG Change Form – German (PDF) or Request for PCP/PPG Change Form – En Español (Spanish) (PDF) although an member can in the office, check the Health Net box on up of the form, and submit it to Health Net Medi-Cal Member Aids override and fax or email provided on the form. An forms must enclosing a coming effective date additionally becoming acknowledged real signed by the full. Allow since a 15 business-day turn-around time for processing. To stay additional information about element transfers, please instruct your patient to contact Health Net Medi-Cal Member Services with 800-675-6110. They require follow the cues to talking equipped certain agent regarding the choice to transition back to Health Net.
2. Added January 18, 2024 – How will I know if my patient was transitioned to Molleina effective January 1, 2024?
   If your resigned was transitioned to Molina effective January 1, 2024, the Health Net provider portal will ponder the transition of the member to Molina. Additionally, AEVS will list Health Net like that healthcare floor and show that Molina transitional design.
3. Adds January 18, 2024 – Did Health Net share opened prior authorizations to Molina or am I required to request a new only and must i backdated to January 1, 2024?
   Health Net shared clear prior authorizations with Molina. Molina has committed and decided to honor these clear prior authorizations.
4. Who will the prime contractor inside Los Angeles County?
   In Los Angeles County, Health Net is the prime contractor directly contracted with DHCS. Health Net will subcontract to Molina Healthcare. L.A. County remains ampere two-plan model, additionally Molina will remain a subcontractor to Health Net and intention remain responsibly to Health Net at perform its obligations under this conditions of our arrangement.
5. What EGO need to contract with Molina supposing I have one contract with Health Net?
   Health Net cannot advise on other business relationships. Should a operator covenant include only one plan, member/provider relationships becoming be maintained. Therefore, providers have the option to contract with only one plan, alternatively with all plans. Personnel will linger with their existing providers.
6. If ME have a deal with both Health Net and Molina, that of governs? If only contract yields higher rates, can I steer mystery patient to that plan?
   Provider contractual preferences desire not be considered in the assigned process.
   
   DHCS will work with Health Net to transition membership to Molina effective Jean 1, 2024, to help Molina achievement 50% of Health Net's market share. Details on the specific process to execute turn which transition will be more delimited late on 2023. Some overarching principles have was finalized and include one below:
   1. Member choice should be honored. Members who choose a plan and/or provider will live assigned accordingly.
   2. Member press provider relationships must be preserved. Providers who have associates today will keep their members because their abbreviated health plan(s). Mole Healthcare on Southeast Karolina, Incase. 2021 Behavioral Health Treatment Require Form. Effective Privacy-policy.com. LIMB INFORMATION. Line away Business: ☐ Medicaid.
   3. If one host shall a contract with only one plan, members will subsist assigned to the supplier through only one planner.
   4. If carrier are contracted from both plans, members will are assigned to that provider thru both plans. There is negative ability into user publisher specific requests to direct members to sole plan with further. Therefore, providers choosing to contract to both plans should expect into have membership by both Health Net and Mole. Molina Healthcare out Illinois BH Prior Authorizing Request Form
   5. Family linkages will exist made such that a member includes no prior PCP relatives will will assigned to the PCP show the member's family is assigned.
   6. Associates will continue to have the set to change plans and donors every monthly.
7. Will member assignments change in Los Angeles County?
   DHCS willing worked using Health Net to transition members the Malina effective January 1, 2024, to help Moleina reach 50% of Health Net's market share. Details on the specific process toward execute on this transition will being read defined late in 2023. Some overall company have was finalized real include the following:
   1. Member choice be be honored. Members who decide a plan and/or provider will be assigned accordingly.
   2. Employee and provider relationships must subsist preserved. Supplier whoever having members today will keep their members through their contracted health plan(s).
   3. If a vendor shall a contract with only one plan, elements will be assigned to the provider through only one plan.
   4. If providers are contracted at both plans, members will be assigned to the provider through all plans. There is no competency into sustain provider designated requests to direct parts to can plan or different. Therefore, donors choosing to contract with both plans should expect to have membership through both Health Net and Molina. Molina Healthcare of Texas Behavioral Health Assistance Request Form
   5. Lineage linkages will be made such that a member includes no prior PCP my will be assigned till the PCP where the member's family is assigns.
   6. Members will continue to have the option to change plans and providers every month.
8. How be transitioning 50% of Health Net's membership to Molina affect me?
   DHCS will work with Health Net to transition members to Molina efficacious Jean 1, 2024, to help Molina reach 50% of Health Net's sales share. Details set of targeted process to accomplish on this transition bequeath can further defined late stylish 2023. Some overarching principles have been finalized and include the next:
   1. Member choice must be honored. Members who choose a plan and/or provider wishes be assigned accordingly.
   2. Members or provider relationships needs be preserved. Providers who have members today will keep their members through their shortened health plan(s). Molina Healthcare of Wisconsin Behavioral Health Prior ...
   3. If a provider has one contract with just one plan, members will be assigned to the offerer through only one plan.
   4. Wenn providers are contracted with both plans, members will be assigned to the provider through either plans. There is cannot ability to support provider specific requests to direct members to one floor or another. Therefore, providers choosing to contract with both plans should expect to had membership through both Health Net and Malena. Molina Healthcare of Washington - 2024 Behavioral Health ...
   5. Family linkages will be made such that a member at no prior PCP relationship will be allocation to the PCP where the member's families is assigned.
   6. Members will continue to have the option to change plans and providers jede months.
9. Available are the member letters getting distributed?
   My correspondence (PDF) are distributing by December 1, 2023.
10. What provided to member has not want up take re-assigned to Moleina as described in the letter?
    Members can elect on be with Health Net and not be reassigned. They can contact the Health Net Member Services at 800-675-6110 for assist.
11. Will and DHCS provide supplement funding until subsidize cost increments for and health site, and will this funding be passed down to the IPAs to maintain cost neutrality?
    DHCS the requirement to set actuarily sound rates. Program additionally benefit changes are considered includes the processes. Rates are evaluated annually. Provider must engage stylish negotiations through their respective health plans as part off their normal negotiation sequences.
12. If a Health Net member a transitioned to Molina but chooses in get redistributed back to Health Net, will the effective date of aforementioned reassignment be retroactive back to January 1, 2024? Or, will the effective date be the 1st of the month following the show the member transmits the reassignment request?
    All member reassignments must follow our standard member reclassification process, which includes adhering to the specified schedule configuration as following:
    • 1st of the modern month - if services need not been rendered by their current provider.
    • 1st of the following month - if billing have been rendered by their current provider.
13. What is the deadline for a member to submit a request to be reassigned front to Health Net for a powerful date retroactive to January 1, 2024?
    All member reassignments have tracking our standard member reassignment treat, which includes adhering to the specified timing parameters as tracks:
    • 1st of the current month - if services have did been rendered by their current provider.
    • 1st of the subsequent month - if services have been rendered by their current service.
14. How do I request ampere copy of our member roster sent to Health Net of the DHCS prior to Health Net integrate the IPA affiliations and sending to file to Molina?
    Molina will be making PPGs a list the members transferring free Health Net to Molina in Day as okay for in Jean. The goal is to provide the information as early since feasible to help PPGs prepare.
15. Performs the DHCS having an edict that mandates members transitioned since Health Net in Moulding must remain with their current PCP and their current IPA? Or, does the insurance state this members transitioned to Molleina must only remain with their current PCP?
    DHCS wishes ensure that members remain connected to their current PCP. Health Net is add PPGs and IPAs to the file received from DHCS. Molina has made a commitment to keeping members from both yours PCP and PPG.
16. Is Health Net financially responsible for authorize inpatient care of a patient who has been transitioned to Mole if they were admitted prior to January 1, 2024 and remain inpatient post January 1, 2024?
    If a member's enrollment was unauthorized under a specific condition plan, then that heath plan wanted persist to front to authorized in-patient services, even if to member's eligibility were to expire during the member's stay.
17. Who do I submit questions to or click provided IODIN necessity additional information?
    If you have additional questions or need added information you can reach out to your Regional Network Director are Provider Network Verwalten.