Medi-Cal managed care plans: contracts. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services either through a fee-for-service or managed care delivery system. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, including contracts with managed care plans, and imposes requirements upon those contracted managed care plans, such as network adequacy standards.
This bill would require the Director of Health Care Services to conduct a contract procurement at least once every 5 years if the director contracts with a commercial Medi-Cal managed care plan for the provision of care of Medi-Cal beneficiaries on a state-wide or limited geographic basis, and would authorize the director to extend an existing contract for one year if the director takes specified action, including providing notice to the Legislature, at least one year before exercising that extension. The bill would require the department to perform specified duties, including establishing a stakeholder process in the planning and development of each commercial Medi-Cal managed care contract procurement process, and receiving public comment on the model contract, procurement qualifications, and evaluation criteria. The bill would authorize a county to submit to the department its preferences for any commercial Medi-Cal managed care plan to provide services in that county, and to request and receive from the department any report on specified matters, such as beneficiary health outcomes. The bill would authorize the department to contract with any commercial Medi-Cal managed care plan only if the plan can demonstrate its ability to meet specified evaluation criteria set forth by the department, including the ability of a commercial Medi-Cal managed care plan to comply with time and distance requirements, appointment time standards, and performance targets, as established by the department.
With respect to Medi-Cal managed care plan contracts generally, this bill would require those contractors to collaborate with identified stakeholders, including consumer advocates and public health experts in their respective Medi-Cal managed care plans’ service area, on identifying and achieving health priorities in that service area.