The County Medical Services Program (CMSP) provides health coverage for low-income, indigent adults in thirty-four, primarily rural, California counties. The eleven-member CMSP Governing Board provides policy direction for the program. As a part of this responsibility, the Governing Board sets program eligibility requirements, determines the scope of covered health care benefits, and sets the payment rates paid to health care providers delivering services to CMSP members.
The Governing Board contracts with Anthem Blue Cross Life & Health Insurance Company to administer CMSP. In its administration of the program, Anthem Blue Cross has contracted with a wide range of healthcare providers to form the Anthem Blue Cross/CMSP Provider Network. This Network provides non-emergency and emergency services to CMSP members.
Characteristics of CMSP program administration include:
- Healthcare providers contract with Anthem Blue Cross to participate in the Anthem Blue Cross/CMSP Provider Network. Only providers participating in the Network may receive payment for non-emergency health care services provided to CMSP members.
- CMSP provides payment for emergency health care services provided to CMSP members by Network providers and all other providers of emergency services in California and in the designated areas of the border states of Oregon, Nevada and Arizona.
- CMSP provides NO coverage for any health care services provided outside of California and the designated areas of the border states of Oregon, Nevada and Arizona.
- All treatment authorization requests for medical, dental and vision services are processed by Anthem Blue Cross or its dental and vision service subcontractors.
- Anthem Blue Cross utilizes the Milliman Practice Guidelines, supplemented by Wellpoint Practice Guidelines, to review and consider Treatment Authorization Requests.
- Payment for medical, dental and vision services is processed by Anthem Blue Cross and its dental and vision services subcontractors in accordance with current HIPAA standards. Both paper and electronic billings are processed.
- MedImpact Health Systems Inc. (MedImpact) administers the CMSP prescription drug benefit, including the processing of prior authorization requests and claims payment.
- Eligibility for CMSP is determined by the county social services departments in the thirty-four participating CMSP counties in accordance with eligibility rules set by the Governing Board.
More detailed information about the County Medical Services Program is provided in the following sections: