21-849 Know How to Coordinate Your D-SNP Patients' Medi-Cal Benefits
Date: 12/01/21
This information applies to Physicians and Participating Physician Groups (PPGs).
Ensure your D-SNP patients are getting the care they need
This communication applies only to Wellcare By Health Net (Health Net) providers who have Wellcare Dual Liberty (HMO D-SNP); 2022 plan name: Wellcare Dual Liberty Amber (HMO D-SNP) patients.
Per the contract with the Department of Health Care Services (DHCS), effective February 3, 2022, Health Net, its contracted providers and their downstream entities are responsible for coordination and delivery of all dual special needs plan patients’ Medicare and Medi-Cal benefits regardless of how the member receives their Medi-Cal benefits.
As a Health Net participating provider, you are required to comply with applicable laws and regulations and Health Net policies and procedures.
Who are the D-SNP members?
D-SNP members are those who are enrolled in:
- Health Net’s Wellcare Dual Liberty Amber plans AND
- Have Medi-Cal benefits either through the state fee-for-service program or a managed care plan (MCP).
These patients are NOT responsible for the coordination of their own Medi-Cal benefits.
What do I need to know starting February 3, 2022?
If…. | And/but | Then…. |
|---|---|---|
Your D-SNP patient’s Medicare and Medi-Cal Managed Care Plan are both through Health Net | And you are at risk for both Medicare and Medi-Cal | Coordinate and ensure delivery of your patient’s care as you normally would through your contracted providers. |
Your D-SNP patient’s Medicare and Medi-Cal Managed Care Plan are both through Health Net | And you are at risk for Medicare but NOT at risk for Medi-Cal | Coordination of care needs to come to Health Net. Refer to the Medi-Cal provider operations manual for applicable benefits section for additional information. |
Your D-SNP patient’s Medicare is through the Health Net Amber Plan | But their Medi-Cal benefits are through another Managed Care Plan |
|
Use these tips to help your patient
Care coordination goes beyond finding the patient’s Medi-Cal Managed Care Plan. Once you have identified the D-SNP patient’s Medi-Cal Managed Care Plan:
- Connect your D-SNP patient to their Medi-Cal Managed Care Plan.
- Make an appointment for your D-SNP patient at their Medi-Cal Managed Care Plan. Use interpreter assistance if needed.
- If necessary, help them in obtaining transportation through their transportation benefits.
- Follow up to ensure they have received the care they need (document the date they received their care).
Medi-Cal benefits not covered through managed care
The following benefits are covered by Medi-Cal directly, not through a health plan. Providers are responsible for the care coordination.
Benefit | Description | Contact |
|---|---|---|
In-home support services (IHSS) | Contact the county IHSS office. | |
Specialty mental health | Contact the member’s Medi-Cal managed care health plan and/or the county mental health plans. | |
Specialty substance abuse disorder | Contact the member’s county substance abuse disorder services. | |
Medi-Cal dental | Contact the DHCS Dental Administrative Service Organization (ASO). |
Additional information
Additional information about reporting requirements will be distributed once available.
State contact information is provided below:
Topic | Contact information |
|---|---|
Medi-Cal eligibility verification | 800-456-2387 |
Medi-Cal help desk | 800-541-5555 |
Medi-Cal website | |
CA Dept. of Public Health website | |
Automated Eligibility Verification System (AEVS) |
For more information refer to the following sites:
Name | Website |
|---|---|
CalDuals | |
DHCS |
For all other questions, contact the Health Net Provider Services Center within 60 days at 800-929-9224.