January 24, 2019
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
The California Medical Association (CMA) has learned that Molina Healthcare has terminated its contract with Golden Shore Medical Group. The plan filed requests in late 2018 with the California Department of Managed Health Care (DMHC) to transfer its enrollees to other delegated groups and the request was approved by the Department on January 11, 2019.
According to Molina’s block transfer filing with DMHC, the termination was the result of the parties’ inability to agree on contractual terms. As a result of the termination, Golden Shore has announced to its network physicians that it will close its doors on January 31, 2019.
The plan filings with DMHC indicate approximately 80,000 Molina enrollees, 94 percent of which are Medi-Cal patients, will be affected in Sacramento, San Bernardino, Riverside, Orange and Los Angeles counties as follows:
|Receiving Provider Group
||Number of Enrollees
|Allied Physicians of California
|AltaMed Health Services
|Associated Dignity Medical Group
|Associated Hispanic Physicians of Southern California
|Bella Vista Medical Group IPA
|California Pacific Physicians Medical Group
|Exceptional Care Medical Group
|Global Care Medical Group IPA
|Healthcare LA, IPA
|Heritage Victor Valley Medical Group
|Inland Faculty Medical Group
|LaSalle Medical Associates
|Preferred IPA of California
|River City Medical Group
|Vantage Medical Group
*Note: there are approximately 26 receiving medical groups/IPAs. Those listed represent medical groups/IPAs that will receive 200 or more enrollees.
The plan filing indicates that only nine percent of enrollees are expected to be able to retain their current primary care physician.
Four other plans also delegated a small number of enrollees to Golden Shore—Brand New Day, Central Health Plan, Easy Choice and Aetna. CMA is gathering more information on the total number of enrollees with these four plans and which delegated groups will receive the enrollees.
Claims for services provided through January 31 should be submitted to Golden Shore for payment. If claims have been submitted to Golden Shore and are not being paid timely, physicians should contact the plan directly.
CMA encourages physicians to be diligent in obtaining updated insurance information from Golden Shore patients and to verify eligibility at the time of scheduling, if possible, to avoid unnecessary patient confusion and denials of payment for services rendered.
Patients may also be able to continue to see their physicians, even if they the physician is not contracted with the patient’s new delegated entity, under California’s continuity of care law. Under continuity of care laws, patients with an acute condition, serious chronic condition, duration of a pregnancy, duration of a terminal illness, and care of children between birth and 36 months may qualify to request continuity of care. Additionally, patients that have received an authorization for a surgery or other procedure to be performed within 180 calendar days of January 31, may be eligible to request continuity of care. To request continuity of care, patients should call the health plan number on the back of their ID cards.
For more information on continuity of care requirements, see CMA health law library document #7051, “Contract Termination By Physicians and Continuity of Care Provisions.” (Health law documents are available free to CMA members. Nonmembers can purchase documents for $2 per page.)
CMA will provide more information on Molina’s transition once we received updated information on the receiving groups. Practices that are experiencing problems with Golden Shore or issues resulting from the contract termination are encouraged to contact CMA’s Reimbursement Helpline at (888) 401-5911 or firstname.lastname@example.org.