L.A. Care
MCLA, CMC, LACC & PASC
What are the lines of business at L.A. Care?
California's Medical Assistance Program.
What is Medi-Cal?
DMHC, DHCS, and CMS.
Which are the state and federal oversight organizations that audit L.A. Care?
2013
What year were the Behavioral Health benefits expanded through ACA?
This department develops interventions to improve clinical outcomes and reports interventions annually to all major regulators
What is Quality Improvement?
Kaiser, Promise & Anthem.
Who are our Plan Partners?
A collection of doctors who have partnered with one another, contractually.
What is a PPG?
A memo from the state to direct the plan on how to implement legal and regulatory standards.
What is an APL?
One in five.
This Department supports the clinics that serve our most vulnerable client
What is Safety Net?
The LOB for in home support service workers.
Members with Medi-cal with a managed care plan and Medicare with an Advantage plan.
Who are CCI or Duals members?
Set of laws or statutes passed by the State Legislature to regulate health care service plans, including health maintenance organizations (HMOs) and Managed Care.
What is Knox-Keene?
Psychotherapy, group therapy versus psych testing.
Services that do not need prior authorizations versus those that do need prior authorizations.
The department responsible for the coordination of audits and corrective action plan submission.
What is Compliance?
Over 2,500.
The acronym used to refer to how administrative costs are calculated.
What is PMPM?
CAP.
Dementia, Eating Disorders and TBI.
This department is responsible for visiting the facilities of our contracted primary care physicians to ensure L.A. Care and our Plan Partners have providers with sufficient capacity to serve our members.
What is the Facility Site Review Department?
The largest department at L.A. Care.
What is the Customer Solution Center?
The acronym used in contracts referring to the table used to outline who is responsible for providing which services/complete which functions.
What is a DOFR?
Thomas Mapp
The anti-psychotic medications certain alcohol and heroin detoxification treatment medications
and inpatient mental health for medi-cal members.
What are parts of the carve out?
This department ensures the accuracy of revenue received by the organization, and payments distributed to our members, providers, plan partners, and ancillary service providers such as pharmacy and durable medical equipment providers.
What is the Medical Payment System & Services Department?