24-034 See What News Is Online for December 2023
Date: 01/10/24
Go to the Provider Library for the latest information that can help you do business with us
The table below outlines communications posted in the Provider Library in December 2023. The table includes the posting date, material number and title, type of notice, applicable audience and counties, and a summary of the communication.
Date, number and title | Type of notice | Audience1 | Lines of business2 | Summary |
|---|---|---|---|---|
December 1, 2023 23-1416m (PDF), 2022 Provider Appointment Availability and After-Hours Access Survey Results | News & Announcements | Physicians PPGs Ancillary providers | IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO) Medicare (Wellcare By Health Net) | Informs providers of the annual Provider Appointment Availability and After-Hours Access Survey results for 2022. The survey results are used to monitor provider compliance with timely access and after-hours regulations, and evaluate the effectiveness of the network to meet the needs and preferences of Health Net members. |
December 8, 2023 23-1427m, Stay Informed: Wellness Updates for 2024 | News & Announcements | Physicians PPGs
| IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO) Medicare (Wellcare By Health Net) | Stay informed of wellness program changes for 2024. This notice also includes a list of upcoming 2024 wellness webinars for members and the community and the registration link. |
December 18, 2023 23-1434m (PDF), Medical Policies – November 2023 | Contractual | Physicians PPGs Hospitals Ancillary providers | IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO) Medi-Cal Medicare (Wellcare By Health Net) | Notifies providers about changes to existing medical policies and a retired policy for November 2023. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed online at bit.ly/HN_med_policies. As a reminder, all services must be medically necessary and member benefits, legal and regulatory mandates take precedence over content of medical policies and must be applied first. |
December 20, 2023 23-1477m, Get Assistance on How to Serve the Children and Youth Population of Focus | News & Announcements
| Physicians PPGs Hospitals Ancillary providers ECM providers CS Providers | Medi-Cal
| Informs providers of DHCS’s Enhanced Care Management (ECM) for Children and Youth Population of Focus (POF) Spotlight (PDF), designed to help contracted and prospective ECM providers serving Children and Youth. |
December 21, 2023 23-1461m, Minors Ages 16 or Older Can Consent to Narcotic Replacement Therapy | Regulatory | Physicians PPGs Hospitals Ancillary providers | IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO) Medi-Cal Molina | Informs providers that minors ages 16 or older can consent to narcotic replacement therapy without parent or guardian consent due to Assembly Bill 816. |
December 21, 2023 23-1457m (PDF), Maternal Health Equity Trainings and Resources are Available Online to Providers | News & Announcements | Physicians PPGs
| IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO) | Informs providers of available maternal health equity trainings and resources to comply with the California Dignity in Pregnancy and Childbirth Act (Senate Bill 464). |
December 21, 2023 23-1464m, Keep with Behavior Access Standards Performance Targets to Align with Plan Goals
| Regulatory
| Physicians PPGs Hospitals Ancillary providers ECM providers CS providers
| IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO) Medi-Cal Molina | Beginning in reporting year (RY) 2024, Health Net must meet or exceed an 80% Provider Appointment Availability Survey initial performance target for non-physician mental health and substance use disorder providers’ follow-up appointments. |
December 26, 2023 23-1490m, Stay in Compliance With Drug Utilization Review Requirements That Target Opioids | Regulatory | Physicians PPGs Hospitals Ancillary providers | Medi-Cal Molina
| Informs providers of their responsibilities for a drug utilization review program, per California Department of Health Care Services All Plan Letter (APL) 23-026, which supersedes a similar APL, |
December 26, 2023 23-1468m, Find Out What’s Changing: Billing Members for Ground Ambulance Transportation | Legislative | PPGs | IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO)
| Notifies PPGs that, effective January 1, 2024, Assembly Bill 716 amends prior law and prohibits noncontracting providers from charging and balance billing members for ground ambulance services at a rate above that charged by contracting providers. Claims that are PPG risk should apply the member's in-network cost share, and the provider remittance advice and member explanation of benefits must reflect that the member is not responsible for charges beyond their in-network cost share. |
December 28, 2023 23-1511m, Stay Informed for 2024: Updates for Electronic Signatures and Expiration Dates, Medical Information Definitions, and Data Exchange of Health Information | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO) Medi-Cal Molina
| Informs providers of updates related to Assembly Bills 1697, 254 and 352, including the use of electronic signatures for medical information release authorizations and expiration dates for authorization requests; medical information definitions, including reproductive and sexual health definitions; and the exchange of health information in real time. |
December 28, 2023 23-1220m, Transitions of Care Management (TRC) Worksheet Available Online | News & Announcements | Physicians PPGs Hospitals Ancillary providers
| Medicare (Wellcare By Health Net) | The Transitions of Care Management (TRC) worksheet is available online. Access this notice for instructions on when to submit the worksheet and how to access it. |
December 28, 2023 23-1483m, Update to Existing Law Adds Associates as Qualified Autism Service Professionals | Regulatory | PPGs | IFP (HMO/PPO) Employer Group (HMO/POS/HSP, EPO, PPO)
| Notifies providers about Senate Bill 805, Health Care Coverage: Pervasive Developmental Disorders or Autism, effective January 1, 2024. This bill expands the criteria for a qualified autism services professional who can provide and administer behavioral health treatment plans to include: psychological associates, associate marriage and family therapists, associate clinical social workers, and associate professional clinical counselors. Other available resources about or related to autism are provided. |
1 ECM – Enhanced Care Management; CS – Community Supports
2 Medi-Cal (all counties) indicates that the communication applies to Medi-Cal Los Angeles, Sacramento, San Joaquin, Stanislaus, and Tulare counties.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone or through the provider portal.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.
For Medi-Cal, this information applies to Los Angeles, Sacramento, San Joaquin, Stanislaus, and Tulare counties.