Sacramento County
GMC Medi-Cal Managed Care
CARE COORDINATION GUIDE: MOLINA HEALTHCARE
January 23, 2017
Resources
Webpage
Member Services –
Health
Member Services –
Behavioral Health
Contact
www.MolinaHealthcare.com
888-665-4621
888-479-3310 TTY/TDD
888-665-4621
Substance Use
Disorders
Advice Nurse
(24 Hour)
Urgent Care Clinics
Transportation
Linguistic
888-275-8750
866-735-2929 TTY/TDD
Member Services
888-665-4621
Member Svcs. 888-665-4621
562-901-9632 Fax Request
800-479-3310 TTY/TDD
711 Relay Line
Instructions
Health Plan BH benefits serve members with mild-moderate mental health needs. Call Member
Services Behavioral Health at (888) 665-4621.
Members with serious, persistent mental health needs should be referred to the:
County Mental Health Plan
(916) 875-1055 or 1(888) 881-4881
Adult TTY (916) 874-8070, Child TTY (916) 876-8892 / FAX (916) 875-1190
Members may receive substance use services through the
County Alcohol & Drug Treatment Services:
Call Alcohol & Drug System of Care at (916) 874-9754
See “Urgent Care List” posted on Sacramento County Medi-Cal Managed Care Resources
Webpage. Urgent Care Clinics are identified for Plans and IPAs.
Routine: Call 3-7 days in advance.
Guidelines: Covered only when a member’s medical and physical condition does not allow
enrollee to take regular means of public or private transportation. This requires a written
prescription from PCP and prior approval (ex. wheelchair accessible vans).
Emergency: Emergency transportation (ambulance) provided through the “911” Emergency
response system, will be covered when Medically Necessary.
Contact Member Services Monday through Friday, 7:00 AM to 7:00 PM.
After hours and weekends, call the Nurse Advice Line at 888-275-8750 (English) or
866-648-3537 (Spanish).
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Sacramento County
GMC Medi-Cal Managed Care
CARE COORDINATION GUIDE: MOLINA HEALTHCARE
January 23, 2017
Care Management
By Enrollment
Plan Name for
Care Management
Molina Medical
Group (MMG)
Enrollees
Basic Case
Management
Molina Direct
Enrollees
EHS Enrollees
All Molina
(eff. 9-5-16)
MMG Enrollees
Non-SPD
Basic Case
Management
Basic Case
Management
Basic Case
Management
Complex Case
Management
Complexist
Program
MMG Enrollees
SPD
Complexist
Program
River City Enrollees
CARE MANAGEMENT
Responsible Party - PCP,
Contact Information
Clinic or IPA (specify)
Rowan Baird MD
MMG Clinic – Norwood
Richard Fox NP
4215 Norwood Avenue, #1
(916) 564-0521
MMG – Mack Road
Nawal Kamel MD – Peds
6339 Mack Road
Zakauddin Vera MD –
(916) 585-7912
Cardiology
MMG – Citrus Heights
Thomas Mahoney MD
7777 Sunrise Blvd., Citrus Heights, CA
Olena Hays PA-C
(916) 722-2227
PCP or Clinic
Assigned PCP or Clinic
PCP or Clinic
Assigned PCP or Clinic
PCP or Clinic
Assigned PCP or Clinic
Paul Hyppolite, Supervisor
Case Management
Kenneth Low MD
Edwin Ventocilla PA
LCSW
(888) 562-5442, ext.128563
[email protected]
MMG – 55th Street
7215 55th Street
Sacramento, CA
916 399-1100
Kulvinder Boparai MD
Ashley Yamahata FNP
LCSW
MMG – Marysville Blvd.
3234 Marysville Blvd
916 646-1200
Instruction
MMG Group is responsible.
See contact.
Contact Paul Hyppolite –
Email request for referral.
Services are provided on an
interim basis based on
complexity of conditions. This
may include non-compliance with
medications & appointments. In
the Complexist Program the
patient is always seen by MD for
appointments with extra
attention as needed.
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Sacramento County
GMC Medi-Cal Managed Care
CARE COORDINATION GUIDE: MOLINA HEALTHCARE
January 23, 2017
Category
Emergency
Department
Support
Mercy San Juan
Plan Name
for Transitions of Care
TRANSITIONS OF CARE
Responsible Party (PCP, Clinic or IPA Specify) /
Contact Information
“EDSU” – Emergency
Department Support Unit
(844) 9-MOLINA or (844) 966-5462
FAX: (877) 665-4625
*
Available 24/7 to ED employees that need
assistance with Molina members (for
authorization or alternate levels of care).
Inpatient/Discharge Planning
Care Review Clinician (CRC)
Transition of Care (TOC) Coach
Ivona Malouf (888) 562-5442, ext.126079
Leslie Veurink (916) 224-8187
Methodist Hospital
CRC
TOC Coach
Trista Friemoth (888) 562-5442 ext. 129884
Candace DeLa Calzada (916) 584-0731
Mercy General
Hospital
Mercy Folsom
CRC
TOC Coach
CRC
TOC Coach
CRC
TOC Coach
Trista Friemoth (888) 562-5442 ext. 129884
Lauren Boyer (916) 204-3792
Ivona Malouf (888) 562-5442, ext.126079
Candace De La Calzada (916) 584-0731
Sutter/UCD
Instruction
All facilities
Inpatient Review CRC
Pam Silvan (888) 562-5442, ext. 121096
Misty Hailey (916) 698-6828
Linda John (888) 562-5442, ext. 127086
Discharge Planning
– Molina
Complex D/C planner
Cherry Resurrecion 888-562-5442 ext.123044
Complex D/C planner
Robert Potter 888-562-5442 ext. 115607
Medi-Cal Only
This team works with designated facility
staff to plan and transition enrollees from
acute care.
Medicare & Medi-Medi
Medi-Cal: Tuesday through Thursday
Medicare: Monday – Friday
Medi-Cal: Monday, Friday, Weekends and
Holidays
Medicare: Weekends and Holidays
Discharge Planning
916-228-4300
RCMG Case Management
– River City
[email protected]
*
Either the CRC or the TOC Coach can be called for support. For After-hours, weekends, and holidays, please call 855-322-4075 Ext. 129557
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Sacramento County
GMC Medi-Cal Managed Care
CARE COORDINATION GUIDE: MOLINA HEALTHCARE
January 23, 2017
GMC MANAGED CARE PLAN DEFINITIONS
Basic Case Management - Collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s
health needs. Services are provided by the Primary Care Provider or Clinic. Coordination of carved out and linked services are considered basic case
management services. Services provided by the PCP in collaboration with Plan include:
1. Initial Health Assessment (IHA);
2. Individual Health Education Behavioral Assessment (IHEBA);
3. Identification of appropriate providers and facilities (medical, rehab, etc.) to meet members care needs;
4. Direct communication between the provider and member/family;
5. Member and family education (healthy lifestyle changes); and
6. Coordination of carved out and linked services and referrals to appropriate community resources and other agencies.
Complex Case Management - The systematic coordination and assessment of care and services provided to members who have experienced a critical
event or diagnosis that requires the extensive use of resources and who need help navigating the system to facilitate appropriate delivery of care and
services. For SPD – must include Person Centered Planning concepts. Plan shall develop methods to identify members who may benefit from these
services, using utilization data, the Health Information Form (HIF), Member Evaluation Tool (MET), clinical data, and any other available data, as well as
self and physician referrals. Services are provided by the Plan, in collaboration with the PCP and include, at a minimum:
1. Basic Case Management;
2. Management of acute or chronic illnesses, including emotional and social support issues by a multidisciplinary case management team;
3. Intense coordination of resources to ensure member regains optimal health or improved functioning; and
4. With member and PCP input, development of care plans specific to individual needs, and updating of these plans at least annually.
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