February 26, 2016
Area(s) of Interest: Commercial Payors Payor Contracting Payor Issues and Reimbursement Practice Management
Aetna Better Health, Aetna’s national Medicaid subsidiary, is pursuing regulatory approval to participate in the Medi-Cal managed care program in Sacramento and San Diego counties. An actual effective date has yet to be determined, but Aetna Better Health anticipates the program may begin as early as January 2017.
In preparation, Aetna Better Health began issuing contracts to providers in San Diego and Sacramento counties in September 2015. Providers within the targeted IPAs and medical groups received a letter accompanied by an agreement requesting their participation in the Aetna Better Health Medi-Cal product. Rates and terms were included with the notice. Providers wishing to participate are required to affirmatively sign and return the agreement to Aetna agreeing to join the network.
While Aetna initially requested a response by the end of November 2015 from providers interested in participating, Aetna has advised the California Medical Association (CMA) that providers who remain interested in participating may still submit their completed agreements to Aetna Better Health.
CMA is working with Aetna to obtain clarification regarding certain contract provisions and how they may impact physician practices, and will publish an update as soon as more information is available. Physicians with questions regarding the Aetna Better Health notice or agreement can contact Aetna at (855) 772-9076.
Aetna Better Health is the second plan to seek regulatory approval to participate in the Medi-Cal managed care program in Sacramento and San Diego counties. Beginning December 15, United Healthcare mailed notices to 1,450 contracted physicians in San Diego County and 750 contracted physicians in Sacramento County. A subset of physicians in these counties received either a notice advising them that they had automatically been opted into the new Medi-Cal product or a written amendment requiring a physician signature that confirmed the physician's willingness to join the United Healthcare Community Plan before it became effective. Rates and terms were included with both notices. The effective date for United Healthcare is still pending.