UPDATED MEDI-CAL ENROLLMENT REQUIREMENTS AND PROCEDURES FOR COMMUNITY-BASED ORGANIZATIONS, LOCAL HEALTH JURISDICTIONS, AND COUNTY CHILDREN AND FAMILIES COMMISSIONS
QUESTIONS AND ANSWERS FROM THE STAKEHOLDER HEARING HELD ON OCTOBER 8, 2024
Will the slide deck be shared to stakeholders?
The video recording and slides from the webinar can be viewed through
YouTube.
Is there work underway to allow community-based organizations (CBOs) offering Community Supports to enroll as Medi-Cal providers?
CBOs are only required to submit an application in the Provider Application and Validation for Enrollment (PAVE) portal when they are providing community health worker (CHW), asthma preventive (AP), and/or justice-involved (JI) services. Otherwise, CBOs providing Community Supports may participate as a Medi-Cal provider by contracting with a Managed Care Plan(s) (MCP) in their county. When providing Community Supports only, the CBO is not required to submit any information to the Department of Health Care Services’ (DHCS) Provider Enrollment Division or in PAVE.
I thought CBOs providing CHW services can already enroll via PAVE. What is the difference between the previous bulletin and this updated provider bulletin?
The previous provider bulletin effective January 8, 2024, allowed CBOs and local health jurisdictions (LHJs) that provide CHW and/or AP services to apply for enrollment in the Medi-Cal program. This updated provider bulletin, effective November 25, 2024, allows CBO applications to include CHWs offering JI services and licensed/unlicensed individuals rendering care management services under JI. This option will be available to both first-time CBO applicants and currently enrolled CBO providers submitting a supplemental application.
We are a county children and family commission in the process of becoming a Medi-Cal Provider through our MCP to provide CHW services. We anticipate all our billing to be through our MCP. Do we need to enroll as a Medi-Cal provider through our MCP and through the PAVE? Or can we only enroll through our MCP?
From previous conversations with DHCS, we understand that even if a county children and family commission was vetted by their MCP as a CHW supervising provider and contracted to provide services, they still need to enroll in PAVE once the county children and family commission pathway is open. Can DHCS confirm?
MCPs are not required to screen and enroll provider types not currently enrolled through the Medi-Cal FFS program, however, once there is an existing FFS state-level enrollment pathway for county children and family commission providers, MCPs must enroll the provider under their delegated authority in accordance with
APL 22-013 or refer the provider to DHCS for enrollment. For any additional Benefits-related questions, please email
chwbenefit@dhcs.ca.gov.
For county children and family commission that are currently Medi-Cal providers, will their services be paused at all while they go through this PAVE enrollment pathway? Or will they be able to continue to provide services while they go through this PAVE enrollment pathway? We don't want to interrupt sort of ongoing services what once this pathway is open?
An MCP may allow a provider to participate in its network for up to 120 calendar days, pending the outcome of the screening process, in accordance with APL 22-013 and Title 42 of the Code of Federal Regulations (CFR) Section 438.602(b)(2). While Welfare and Institutions (W&I) Code Section 14043.26 allows DHCS up to 180 calendar days to act on an enrollment application if the provider applies directly to DHCS, the provider still may only participate in the network for 120 days, even if DHCS has yet to act upon the application by that time.
This provider bulletin goes into effect on November 25, 2024. Is there a specific timeframe as to when you have to submit your application through PAVE? Do we only have six months to submit?
No, there is no specific timeframe to submit your application. You may submit your application to enroll as a Medi-Cal provider once you have met all program requirements on or after November 25, 2024. However, if you are already contracted with an MCP to provide JI services, you need to be enrolled by either DHCS or the MCP in order to continue providing services to managed care members. An MCP may allow a provider to participate in its network for up to 120 calendar days, pending the outcome of the screening process, in accordance with APL 22-013 and Title 42 of the CFR Section 438.602(b)(2).
Who can I contact at DHCS for questions related to Justice Involved (JI) Initiative, also known as Jail Health Services?
What is the processing timeframe for the Other Healthcare Business applications?
State law generally requires DHCS to take an action on an application for provider enrollment within 180 days. If an application is returned to a provider to make corrections, the provider has 60 days to resubmit the application. DHCS will have an additional 60 days to review the application once it has been resubmitted. If the application is referred for a comprehensive review, the review timeframe will be extended. Submitting a complete and correct application will reduce DHCS’ overall application processing time.
