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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

22-1044 New Update to IPA's Delegated Agreement to Help Providers Manage Delegated Responsibilities

Date: 12/07/22

Effective February 13, 2023, delegation agreements will be issued at the start of the year

California Health & Wellness Plan (CHWP) is responsible for the oversight of all delegated physicians and other providers to ensure regulatory requirements are met in performing delegated functions. Delegated independent practice associations (IPAs) are issued an updated delegation agreement following the completion of their annual delegation oversight audit.

As of February 13, 2023, the delegation agreements will be issued as follows:

  • Delegation Oversight will issue delegation agreements separate from the annual audit. This change will allow us to review the agreement independent of the Annual audit results.
  • New delegation agreements will be issued to our delegated IPAs in the beginning of the year. They will no longer be issued at the end of the annual audit.

Off-cycle delegation agreements may also be issued by CHWP

CHWP reserve the right to issue off-cycle delegation agreements to include the change and:

  • Delegates will have 14 calendar days to review and submit with the appropriate signatures.
  • Upon receipt, CHWP will put into effect a new delegation agreement.
  • A copy of the agreement will be issued to the delegated IPA.

Revocation of delegation agreement

Delegation agreements are reviewed annually to update and include regulatory, contractual, and NCQA standard updates; and revisions and or new requirements as needed. CHWP reserve the right, upon written notice, to revoke the delegation of some or all responsibilities for CHWP members. If the delegate does not perform the responsibilities as defined in the CHWP/IPA/Provider Delineation of Delegated Responsibilities grid in accordance with CHWP, NCQA and regulatory standards:

  • Delegate will have a thirty (30) day cure period prior to revocation (except in the event of risk to members).
  • Delegation agreements shall remain in effect unless the delegate is notified by CHWP of a status change.

Additional information

Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.

 

This Information applies to Independent Practice Associations (IPAs).