2024 DHCS Medi-Cal Contract Transition – Counties transitioning from California Health & Wellness to Health Net

23-158e

Counties

• Amador
• Calaveras
• Imperial
• Inyo
• Mono
• Tuolumne

2024 DHCS Medi-Cal Contract Award Q&As

1. What happened to the RFP?
   DHCS has formally canceled the RFP and is using its authority to issue direct contracts on a county-by-county basis.
2. How long is the new contract?
   The contract will be five years, through December 31, 2028, auto-renewing at the end of each year for the next year.
3. What happens if the replacement plan in my county doesn't meet operational readiness requirements by January 1, 2024?
   Operational readiness is required effective January 1, 2024. DHCS reserves the right to extend contracts with existing plans should new plans require additional time to meet required readiness requirements.
4. What counties are transitioning from California Health & Wellness Plan (CHWP) to Health Net on January 1, 2024?
   1. Amador, Calaveras, Inyo, Mono and Tuolumne counties will transition to Health Net effective January 1, 2024.
   2. Imperial County will operate as a single plan county. Community Health Plan of Imperial Valley (CHPIV) will be the new county operated plan. Health Net will be the exclusive subcontractor to CHPIV effective
      January 1, 2024. All providers will be contracted through Health Net to serve all members assigned to CHPIV.
5. What is the status of Imperial County?
   Effective January 1, 2024, Health Net will serve members in Imperial County as a subcontractor to Community Health Plan of Imperial Valley (CHPIV), similar to the CalViva relationship. Health Net will serve the entire county under this arrangement. No other health plan will serve this county. Health Net will provide all services and administration through its network and operations, and CHPIV will maintain an oversight role, much like CalViva. This county will transition to a single plan model in 2024.
6. Do I need to cancel or amend my contract with California Health & Wellness Plan (CHWP) if CHWP no longer serves Medi-Cal members in my county?
   If California Health & Wellness Plan (CHWP) will no longer serve Medi-Cal members in your county, you don't need to do anything and your agreement can continue. If changes are needed to your agreement, your assigned Regional Network Director from CHWP will contact you.
7. Will the DHCS provide additional funding to subsidize cost increases for the health plans, and will this funding be passed down to the IPAs to maintain cost neutrality?
   DHCS is required to set actuarily sound rates. Program and benefit changes are considered in the process. Rates are evaluated annually. Provider must engage in negotiations with their respective health plans as part of their normal negotiation cycles.
8.   Added December 7, 2023 – What happens to claims that span from 2023 into 2024, specifically for inpatient hospital visits?
   The responsibility is determined by the date-of-service and authorization timeframe.
   
   If a claim has a date of service on or before December 31, 2023, California Health & Wellness will be responsible for payment of appropriate claims if prior authorization approval is in place. Please send these claims to:
   
   California Health & Wellness
   Attn: Claims
   P.O. Box 4080
   Farmington, MO 63640-3835
   Payer ID: 68069
   
   Claims with a date of service on or after January 1, 2024, will be denied by California Health & Wellness. Health Net will be responsible for payment of appropriate claims with a date-of-service on or after January 1, 2024, if prior authorization approval is in place. Please submit these claims to:
   
   Health Net Community Solutions, Inc.
   Medi-Cal Claims
   P.O. Box 9020
   Farmington, MO 63640-9020
9. Who do I submit questions to or contact if I need additional information?
   If you have additional questions or need additional information you can reach out to your Regional Network Director in Provider Network Management.