California § 14186.3 - A Medi-Cal managed care plan may elect to offer Medi-Cal covered services through

§ 14186.3. A Medi-Cal managed care plan may elect to offer Medi-Cal covered services through

(a) A Medi-Cal managed care plan may elect to offer Medi-Cal covered services through an in-network, contracted field medicine provider pursuant to this article. (b) A Medi-Cal managed care plan that elects to offer Medi-Cal covered services through an in-network, contracted field medicine provider shall allow a Medi-Cal member who is experiencing homelessness to receive those services directly from an in-network, contracted field medicine provider, regardless of the member’s in-network assignment, such as primary care provider (PCP) or independent practice association (IPA) assignment. (c) (1) A Medi-Cal managed care plan that elects to offer Medi-Cal covered services through an in-network, contracted field medicine provider shall allow an in-network, contracted field medicine provider enrolled in the Medi-Cal program to directly refer a member who is experiencing homelessness for covered services, including specialist, diagnostic services, medications, durable medical equipment, transportation, or other medically necessary covered services, within the appropriate network of the Medi-Cal managed care plan or in-network IPA. (2) The Medi-Cal managed care plan or IPA shall create referral and authorization mechanisms in order to facilitate the referrals described in paragraph (1). (d) Medi-Cal managed care plans contracting with field medicine providers pursuant to this section shall have appropriate mechanisms, procedures, or protocols to ensure timely communication between the in-network, contracted field medicine provider, the Medi-Cal member’s plan or IPA, and the member’s assigned primary care provider for purposes of care coordination and to prevent the duplication of services. (e) (1) A Medi-Cal managed care plan shall provide a method for a Medi-Cal member to inform the Medi-Cal managed care plan online, in person, or via telephone that the member is experiencing homelessness. (2) The department shall inform a Medi-Cal managed care plan if a Medi-Cal member has indicated that they are experiencing homelessness based on information furnished on the Medi-Cal application. (f) In the case of a Medi-Cal beneficiary who is experiencing homelessness and who receives services within the fee-for-service delivery system, the department shall reimburse a field medicine provider enrolled in the Medi-Cal program for providing Medi-Cal covered services.