21-496m Critical Action Needed to Comply with Decertification Notices
Date: 07/26/21
This information applies to Long-term Care Facilities.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
LTC facilities must work with the plan so members continue to receive medically necessary covered services
Long-term care (LTC) facilities that received a decertification notice from the California Department of Public Health (CDPH) must take these steps:
- Notify your Provider Network Management representative to begin your contract termination process.
- Help with the transition planning for CalViva Health members in your care.
Affected LTC facilities
These requirements apply to any of these LTC facility types:
- Skilled nursing (SNFs).
- Intermediate care.
- Congregate living health.
- Nursing.
- Pediatric day.
- Respite.
Plan responsibilities
Upon notice from the LTC facility of decertification, Health Net, on behalf of CalViva Health:
- Ends its contract with the LTC facility within five business days of the notice.
- Develops and submits a member transition plan to CalViva Health for review and submission to the Department of Healthcare Services (DHCS).
- Suspends all payments for services provided after the effective date of the decertification notice.
- Informs all affected contracted providers and CalViva Health members of the decertified LTC facility.
- Coordinates care for members as required by federal and state law, and CalViva Health’s contract with DHCS.
Immediate closure of LTC facilities by CDPH
In these cases, CDPH handles the transition of all affected members residing in the LTC facility. Health Net, on behalf of CalViva Health, tracks the transition of members and coordinates care as needed.
Learn more about decertification notice requirements – APL 21-003
On March 3, 2021, DHCS issued All Plan Letter (APL) 21-003 to Medi-Cal managed care plans (MCPs). It requires
MCPs to end contracts with network providers and subcontractors who have been decertified or whose participation has been revoked from the Medi-Cal program.
Additional information
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.