New DHCS California Regulation for All Providers
| Date: | November 13, 2017 |
| To: | Health Plan of San Joaquin (HPSJ) Primary Care Providers (PCP), Specialists and Ancillary Providers |
| From: | HPSJ Quality Management Department |
| Subject: | New DHCS California Regulation for All Providers |
| Business: | Medi-Cal FFS Enrollment |
Effective January 1, 2018
This can affect your HPSJ contract. Please review immediately.
There is a new 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. Health Plan of San Joaquin will be collecting copies of the DHCS approved certificates of enrollment from the provider after completion, as required, only. HPSJ will not be coordinating the enrollment process between the provider and DHCS. HPSJ is currently assessing which of our providers are enrolled. We will follow-up with the providers that are not in the state’s “enrolled” database. 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.
Please advise your office manager and/or staff that HPSJ may be contacting our providers to get your certificate or advise you to complete the enrollment.
How did this get to be our issue? The regulation is effective January 1, 2018. 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.
Download Attachments:
If you have questions, please contact our Contracting or Provider Services Departments at 209-942-6320 and ask for Melissa, Christina or Evelyn.