On January 24th the Centers for Medicare and Medicaid Services (CMS) announced the results of a program audit of CalOptima’s dual eligible special needs plan product. As a consequence of this audit, Cal MediConnect in Orange County will not move forward until CalOptima has taken the immediate corrective actions required by Medicare.
The Department of Health Care Services (DHCS) is concerned about the results of this audit, and deeply concerned about its implications for beneficiaries in Orange County. In fact, DHCS and the Department of Managed Health Care (DMHC) intend to conduct an audit of the Medi-Cal operations at CalOptima. Once the results of DHCS’ audit are reviewed, a decision will be made about the status of managed Medi-Cal long-term services and supports (MLTSS) in Orange County. DHCS will work closely with all of our partners to ensure that all CalOptima beneficiaries receive high quality care and full consumer protections.
The CMS announcement shows that the CCI readiness review process is working. All health plans participating in the CCI are subject to a number of reviews and audits – CMS audits, Department of Health Care Services and Department of Managed Health Care oversight and plan readiness review.
More information about the CalOptima program audit and the full CMS report will be posted here.
We will continue to keep you informed as this process moves forward, and welcome your questions to info@calduals.org