- Participating Physician Groups (PPG)
Cal MediConnect (CMC) extended contracts under the CMC demonstration through December 31, 2022. This program was developed by the Centers for Medicare & Medicaid Services (CMS) and the California Department of Health Care Services (DHCS) to coordinate medical, mental health and substance abuse care; long-term care; home- and community-based services; and assistance with social services under one plan for people eligible for both Medicare and Medi-Cal. Dual-eligible members who join Cal MediConnect have access to a care team that works with them and their primary care physicians (PCPs) to improve health outcomes and help them stay in their homes and communities as long as possible.
Health Net offers Cal MediConnect to dual-eligible beneficiaries in Los Angeles and San Diego counties. Health Net Cal MediConnect covered services are as follows:
- All services provided under Medicare Part A, Medicare Part B, Medicare Part D, and certain pharmacy products that are covered by Medi-Cal and may not be covered under Medicare Part D.
- All standard Medi-Cal fee-for-service (FFS) benefits, excluding:
- Intermediate care facility for the intellectually disabled (ICF/MR) services.
- County-administered Medi-Cal specialty mental health services and substance use disorder services. This does not include behavioral health services that became Medi-Cal managed care benefits on January 1, 2014, pursuant to Welfare and Institutions Code Section 14132.03, which are covered services under the Cal MediConnect contract.
- State and county activities to administer in-home specialty services (IHSS), including determining eligibility; assessing, approving, and authorizing each current and new member's initial and continuing need for services; enrolling providers, conducting provider orientation, and retaining enrollment documentation; conducting criminal background checks on all potential providers; providing assistance to IHSS recipients in finding eligible providers through an established provider registry.
- Medi-Cal dental services, known as Denti-Cal.
- In San Diego, unlimited non-emergency medical transportation (NEMT), unlimited non-medical transportation (NMT) and routine vision and eyewear allowance.
- In Los Angeles, routine podiatry, routine vision and increased eyewear allowance, worldwide emergency coverage, unlimited non-emergency medical transportation (NEMT), unlimited non-medical transportation (NMT) and some additional dental services not covered by Denti-Cal in Los Angeles County only.