Medi-Cal Implementation Enrollment to Begin in March

02/01/2016 7:11 AM | Jeanette McCulloch (Administrator)

Medi-Cal Implementation Update: Enrollment to Begin March 2, 2016

Medi-Cal provider enrollment for California licensed midwives (LMs) will begin in early March, thanks to a broad coalition of support that formed as a part of efforts to pass AB1308, sponsored by Assembly Member Susan Bonilla.

This key step toward Medi-Cal implementation would not have been possible without the efforts of CAM leadership, including President Rosanna Davis and Policy Chair Sarah Davis, the CAM board and membership, our financial supporters, and California Families for Access to Midwifery.

Starting March 2, 2016, California LMs will be eligible to enroll as fee-for-service providers. The California Department of Health Care Services (DHCS) has up to 180 days to take action on the application.
How To Apply to Become a Fee-for Service Provider

To provide guidance on the process, DHCS has published a bulletin you can find here

Midwives applying will need the following forms:

https://files.medi-cal.ca.gov/pubsdoco/Publications/masters-other/provappsenroll/03enrollment_DHCS6207.pdf

https://files.medi-cal.ca.gov/pubsdoco/Publications/masters-other/provappsenroll/02enrollment_DHCS6208.pdf

https://files.medi-cal.ca.gov/pubsdoco/Publications/masters-other/provappsenroll/07enrollment_DHCS6204.pdf

https://files.medi-cal.ca.gov/pubsdoco/Publications/masters-other/provappsenroll/08enrollment_DHCS6203.pdf

https://files.medi-cal.ca.gov/pubsdoco/Publications/masters-other/provappsenroll/14enrollment_DHCS6216.pdf

NOTE! There are some out-of-date forms on the Medi-Cal site awaiting update. If you encounter it, don't use the form DHCS 6248. Be sure to read the entire bulletin first and use the links provided above.

Start Date for Medi-Cal Clients

If midwives so choose, they can begin to provide care to clients as soon as the LM submits the complete application. However, it is important to be aware of the potential for reimbursements to take up to a year or longer (retroactive billings cannot be processed until the LM's application process is complete and the LM is enrolled, which can take up to 180 days). It is also possible that, for some reason, an individual midwife's application may be denied. In that case, the LM would not have a source of reimbursement for the retroactively billed care.

Reimbursement Rates for Medi-Cal
Pregnant Medi-Cal beneficiaries may be enrolled in fee-for-service or managed care programs. To learn more about fee-for-service reimbursement rates, visit here. To participate in Managed Care programs, LMs must negotiate a rate directly with a managed care provider. This rate will vary from provider to provider and community to community. The first step to becoming a managed care provider is to enroll as a fee-for-service provider as described above.
CPSP Update
Regulations regarding LMs becoming Comprehensive Perinatal Services Program (CPSP) practitioners (individuals who provide CPSP services) will be updated in March. The enrollment process for CPSP providers - billing entities like a health clinic or a licensed alternative birth center - will come later as a part of the ongoing regulatory process.
Malpractice Insurance
To enroll as Medi-Cal providers, licensed midwives are required to carry malpractice insurance, which is available through a variety of insurance providers. Southern Cross (learn more here) provides a 40% discount to CAM members.

Keep an eye on the CAM webpage for more implementation updates as they become available!

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