Welcome to the County Medical Services Program
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, Inc. (AMM) to administer CMSP. In its administration of the program, Advanced Medical Management, Inc. (AMM) has administered contracts 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 CMSP through Advanced Medical Management, Inc. (AMM) 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 AMM.
- AMM utilizes the Milliman Care Guidelines to review and consider Treatment Authorization Requests.
- Payment for medical and dental services is processed by AMM in accordance with current HIPAA & HITECH 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.
CMSP offers health coverage for low-income adults who:
- Are age 21-64
- Have limited income and assets
- Do not qualify for Medi-Cal
- Live in one of CMSP’s participating 35 rural counties
2014 Medicare and Medicaid Fraud and Abuse Prevention Workbook
HIPAA Privacy and Security Notice
Provider Bulletin: ICD 10 Readiness