Payments for Skilled Nursing Facility (SNF) Workforce and Quality Incentive Program (WQIP)-eligible Network Providers for qualifying bed days within 45 calendar days of receiving the Per Diem Exhibits from DHCS or within 30 days of receiving a Clean Claim from the provider, whichever is later.
SNF WQIP-eligible Network Providers with questions around how to determine the responsible payer of WQIP-eligible days can reach out the CalOptima Health LTSS Liaisons.
Detailed instructions on filing a provider grievance
CalOptima Health members deserve quality long-term care, which is why we work with nearly 400 local long-term care facilities. Each facility must go through a rigorous selection and contracting process to ensure CalOptima Health members receive consistent, quality care in a comfortable and secure environment. Please call our Long-Term Care department at 714-246-8600 (option 5) with any questions or for additional information.
MSSP provides social and health care management services to delay older adults from having to go to nursing homes. MSSP care managers help CalOptima Health members get needed services from community resources while working with their families and support systems. MSSP lowers costs and allows members to stay in their homes and enjoy a higher quality of life.
For more information about MSSP or to apply for the program, please call CalOptima Health MSSP at 714-347-5780 or contact CalOptima Health’s Customer Service department at 1-888-587-8088 (TTY 711).
MSSP is funded by the California Department of Aging and is administered by CalOptima Health.
To get these services, CalOptima Health members must:
Registered nurses (RNs) and social workers provide care management services to MSSP members and their families. Some services include:
MSSP care managers coordinate a wide range of services based on the member’s needs:
Community-Based Adult Services offers assistance and services to low-income, elderly or disabled individuals. Participating seniors and disabled individuals receive services at a local community adult day care center, allowing participants to continue living at home, with the intention to minimize the need for placement in nursing homes.
Please call our Long-Term Services and Supports department at 714-246-8600 (option 5) with any questions or for additional information.
In addition to being a CalOptima Health member, to be eligible for CBAS, participants must:
CBAS participants receive the following benefits:
We want to make sure you get services you are eligible for and that we have all of the information about your health. The steps below explain how we decide if you are eligible for CBAS: