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A Stethoscope on a book.The County Medical Services Program (CMSP) provides limited-term health coverage for uninsured low-income, indigent adults that are not otherwise eligible for other publicly funded health care programs. Thirty-five, primarily rural, California counties participate in CMSP. 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 Advanced Medical Management to administer CMSP. In its administration of the program on the Governing Board's behalf, Advanced Medical Management has contracted with a wide range of healthcare providers to form the CMSP Provider Network. This Network provides non-emergency and emergency services to CMSP members.

Characteristics of CMSP program administration include:

  • Healthcare providers contract with Advanced Medical Management to participate in the 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 and dental services are processed by Advanced Medical Management..


  • Payment for medical and dental services is processed by Advanced Medical Management in accordance with current HIPAA & HITECH 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-five 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:

 

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