Provider Bulletin #15 – Contract Changes

Provider Bulletin #15 – Contract Changes

By: LA County Staff

Provider Bulletin #15 – Contract Changes

Provider Bulletin #15 – Contract Changes 1024 680 My Health LA

Provider Bulletin #15 has been sent out to our CPs. This bulletin provided details on the upcoming Adult Medi-Cal Expansion for ages 26 through 49 and its impact on the MHLA contract going forward. Here are the highlights of the contract changes:

  • Automatic Enrollment Extension
    • MHLA has auto-extended eligibility through January 31, 2024 for current participants, re-adds, and new applicants.
    • More details can be found in MHLA Provider Bulletin #14.
  • MHLA Audits
    • Final annual Program Monitoring and Administrative Reviews by June 30, 2023.
    • Last monthly Eligibility and Enrollment Review audits will be completed by December 31, 2023.
  • Adding Clinic or Administrative Enrollment Sites
    • Deadline to add a new and/or transfer a clinic, mobile clinic, or administrative enrollment site requiring the MHLA audit team to conduct a Facility Site Review (FSR) is May 31, 2023.
    • Deadline to add/transfer a site with a health plan FSR is September 30, 2023.
  • Medical Encounter Data and Dental Claims Submission
    • All encounter claim data must be submitted to AIA no later than March 31, 2024.
    • Dental claims will also need to be submitted to AIA within 60 days of date of service and no later than March 31, 2024.
  • Pharmacy
    • No additional pharmacy locations may be added after May 31, 2023.
    • Pharmacy claims must be submitted no later than March 31, 2024.
  • Sunsetting of MHLA Program
    • The My Health LA Program will conclude operations January 31, 2024.
  • Communications
    • Letters and flyers will be sent via U.S. mail to all MHLA participants informing them of their presumptive eligibility for Full Scope Medi-Cal on January 1, 2024, and a reminder to enroll in Restricted (Emergency) Medi-Cal by December 31, 2023. Flyers are available on the MHLA Medi-Cal Expansion resource page in various threshold languages for reference and CP use.
    • MHLA program will send out texts and robocalls periodically to all participants who provided permission to receive phone messages.

Below is a summarized timeline of important dates as laid out by Provider Bulletin #15. This timeline is also available for reference on the “Medi-Cal Expansion” page.

MHLA Timeline Final

Provider Bulletin #15 is available on the MHLA website on the “Medi-Cal Expansion” and “Provider Notices & Contracts” pages.