DHCS Issues Clarification on Coordination of Care with Managed Care Plans

California’s Department of Health Care Services (DHCS) has issued clarification on a previous email regarding protocols for LEAs coordinating care with Managed Care Plans (MCPs). The original email, sent on August 9, had raised questions about what appeared to be new coordination requirements.

In a clarification email sent on August 18, DHCS underscored that there is no new policy and their only intention had been to provide MCP contact information for LEAs who experienced difficulty contacting appropriate MCP staff to discuss coordination of care issues.

Existing policy on coordination of care with MCPs state that to minimize duplication of services, LEAs may contract with managed health care providers to render health care services separate and distinct from LEA services if mutually agreeable terms can be reached. Most importantly, health services provided by an LEA to students under an IEP, IFSP, or IHSP are expressly carved out from MCP care coordination requirements; MCPs are only required to provide case management and coordination of care for these services when school is not in session and if the MCP provider has determined they are medically necessary.

Read a copy of DHCS’ clarification email and attachment.