Provider Alerts - December 10, 2018

New DHCS California Regulation for All Providers – Reminder


Date: December 10, 2018
To: Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCP), Specialists
From: HPSJ Quality Management Department – REMINDER
Subject: New DHCS California Regulation for All Providers
Business: Medi-Cal FFS Enrollment Requirement to Remain in Managed Care Contract

Effective 1/10/2019 all Medi-Cal managed contracted providers will be required to also be contracted with the State Medi-Cal FFS program.

This can affect your HPSJ contract. Please review immediately.

There is a regulation from the Department of Health Care Services (DHCS) which includes the requirement for all of our current and future providers to be Medi-Cal FFS enrolled. The following is a quote from the regulation:

“All Medi-Cal providers are required to enter into a provider enrollment agreement with the State (DHCS Provider Enrollment Agreement) as a condition of participating in the Medi-Cal Program pursuant to Section 1902(a)(27) of the Social Security Act and Section 14043.1 of the Welfare and Institutions Code. As part of the enrollment process, managed care health plans (MCPs) are responsible for ensuring that all successfully enrolled providers execute and sign the DHCS Provider Enrollment Agreement. “

Individual providers are responsible for their enrollment with DHCS. HPSJ will be collecting copies of the DHCS approved certificates of enrollment from the provider after completion, as required, only. Since there is a delay with DHCS approving providers, HPSJ will accept proof of application until certification with DHCS is complete. HPSJ will not be coordinating the enrollment process between the provider and DHCS. See Attachment 2: Managed Care Provider Enrollment Disclosure” from the regulation. HPSJ has chosen Option B: Enrollment through DHCS (see attachment for details). Therefore, all of our providers will need to ensure that they are enrolled in order to continue as a contracted provider with HPSJ.

How did this get to be our issue? The regulation will go into effect on January 1, 2019 with no exceptions. All contracted HPSJ providers are required to be Medi-Cal FFS enrolled, to continue as a contracted provider. You are not required to offer medical services to Medi-Cal FFS patients. We have been notified that we will not be able to grandfather any of our providers that are not enrolled with Medi-Cal FFS. If you are not currently Medi-Cal FFS, you must show proof to HPSJ that you are in the process of enrollment. Please fax proof to 209-461-2565. Due to the immediate nature of this regulation, you will need to respond to the proof of enrollment very quickly.

If you have questions, please contact our Contracting or Provider Services Departments at 209-942-6320 and ask for Amanda, Christina or Evelyn.