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Collaboration between MCPs and CBOs is vital for the success of the CalAIM program. However, the initiative faces challenges stemming from structural and cultural mismatches and a lack of effective technology tools. MCPs are focused on expanding CBO networks, providing training resources, ensuring compliance, and improving cost efficiency and auditing processes. Meanwhile, CBOs are struggling…
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.…