Medi-Cal provider portal

Enhanced Care Management (ECM): A Medi-Cal managed care benefit addresses clinical and non-clinical needs of high-need, high-cost individuals through coordinated services and comprehensive care management. ECM services are interdisciplinary, team-based, high-touch and person-centered.

Community Supports (CS): KP provides these services as a substitute to avoid utilization of other services such as hospital or skilled nursing facility admissions, discharge delays, or emergency department use.

Community Health Workers (CHW): CHWs are non-licensed frontline workers based in the member’s community and provide non-clinical support to members to help them reach a health-related goal. As an extension of the KP care team, they bring support services out of care facilities to meet members where they are in their own community.

For more information about ECM and CS, including information about how to refer members, click here: ECM, CS & CHW Information and Reference Guide.

• To download the ECM and CS referral form, click here: ECM, CS, & CHW Referral Form.

For information on how to contract with KP to become an ECM or Community Supports provider, click here: Kaiser Permanente, Network Lead Entity FAQ.

Kaiser Permanente’s Justice Involved Liaison (JIL) supports our members as they transition from incarceration into the community. The JIL coordinates care between correctional facilities, pre-release care management providers, and ECM providers. To contact our Justice Involved Liaison, email Ji-Liaison@kp.org or call 626-405-5386.

In accordance with Medi-Cal requirements, Kaiser Foundation Health Plan, Inc. (KFHP) may make Proposition (Prop) 56 payments based on eligible services provided to KFHP Medi-Cal members. Please see below communications which include information on the various Prop 56 programs and eligibility requirements for payments to non KP providers.

• Adverse Childhood Experience 
• Developmental Screening
• Family Planning Services
• Hyde Payments
• Physician Services
• Value-Based Payments

Consistent with the terms of your Agreement with Kaiser Foundation Hospitals or SCPMG, you are required to cooperate with the administration of Coordination of Benefits (COB). These include new requirements as set forth in All Plan Letter 21-002. See below communications for additional information.

• Institutional Services Providers – COB and Medi-Cal Cost Avoidance 
• Professional Services Providers – COB and Medi-Cal Cost Avoidance

In accordance with requirements imposed on KP by state law and others detailed in the Medi-Cal Program Compliance exhibit to your Healthcare Services Agreement with Kaiser Foundation Hospitals and/or Southern California Permanente Medical Group, Inc., we must ask you to submit Ownership and Control disclosure information. If you have previously provided Ownership and Control disclosure information, we ask that you notify KP of any change.

This information includes:

• Disclosure of all the provider’s officers, owners, stockholders owning more than 10 percent of the stock issued by the provider, and creditors owning more than 5 percent of the provider’s debt.

For the purpose of this request, “provider” shall be equivalent to “Contractor” as that term is defined in your Agreement. Please note failure to submit the required information may cause you to be in breach of your Agreement.

If an Ownership and Control disclosure form has already been provided or you opt to utilize the electronically editable form below, please fill out the form or allow an authorized designee to respond on behalf of your practice/ organization, sign and return it to KP by scanning and emailing it to the following email address: Medicaid-PROV-Team@kp.org.

The Department of Health Care Services (DHCS) posts All Plan Letters (APLs) informing Medi-Cal Managed Care Plans (MCPs) of new guidelines and standards required by the state of California for Medi-Cal Services. Click below for a summary of the most recent APLs released by DHCS.

DHCS All Plan Letters

In accordance with requirements imposed on KP by state law and others detailed in the Medi-Cal Program Compliance exhibit to your Healthcare Services Agreement with Kaiser Foundation Hospitals and/or Southern California Permanente Medical Group. This guide includes information about the Medi-Cal Managed Care program, and the unique benefits or processes related to serving KP's Medi-Cal Members.

Provider Medi Cal Quick Reference Guide

The Department of Health Care Services (DHCS) requires providers who see members under age 21 to be trained on Medi-Cal for Kids and Teens, also referred to as Early and Periodic, Diagnostic, and Treatment Services (EPSDT), at least every 2 years. The document linked below is a comprehensive training on EPSDT services provided by DHCS.

DHCS-EPSDT Provider Training

The Department of Health Care Services (DHCS) requires that KP, as a Medi-Cal Managed Care Plan, provide cultural competency, sensitivity, or diversity training for its contracted providers at key points of contact with KP members, such as reception staff and direct caregivers. This training helps reinforce KP’s commitment to effectively deliver health care services in a culturally competent manner that meets the social, cultural, and linguistic needs of our members. To promote access and the delivery of services in a culturally competent manner to all members, we are requesting you attest to having reviewed the Diversity, Cultural Competency, and Cultural Sensitivity Training.

If an attestation form has already been provided or you opt to utilize the electronically editable form below, please fill out the form or allow an authorized designee to respond on behalf of your practice/organization, sign and return it to KP by scanning and emailing it to the following email address: Medicaid-PROV-Team@kp.org.

• Kaiser Permanente Diversity, Cultural Competency, and Cultural Sensitivity Training
• Kaiser Permanente Diversity, Cultural Competency, and Cultural Sensitivity Training Attestation Form

Consistent with state guidance, KP will utilize the attestations to Diversity, Cultural Competency, and Cultural Sensitivity training to modify provider listings to indicate providers have completed the training.

Any questions about this request can be directed to the email noted above. Please be sure to include your question(s) and phone contact information so we can respond quickly to your question(s).