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Many MCPs have recently shifted reimbursement models to focus on the number of encounters per member each month. With limited explanation from the plans and lacking billing guidance, this shift is causing confusion among providers. Here, we’ll explore the reasons behind this change and where it may be heading. This change stems from a need…
On October 9th, the DHCS hosted a comprehensive webinar to unveil two major policy reforms aimed at enhancing the referral and authorization processes for Enhanced Care Management (ECM). These reforms are set to significantly improve access to ECM services for Medi-Cal members. Tyler Sadwith (State Medicaid Director, DHCS), along with Dr. Palav Babaria and Dr.…
California’s Department of Health Care Services (DHCS) has made significant strides with the introduction of CalAIM, a program designed to help the state’s most vulnerable populations by providing integrated care that addresses both health and social needs. This initiative aims to transform care delivery, reaching those who need support the most. Under this model, managed…