24-028 Provider Communications Posted Online and Operations Manual Updates for December 2024
Date: 01/08/25
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The tables below outline provider communications posted online and operations manual changes made in December 2024.
- Communications posted online: Includes the posting date, material number and title, type of notice, applicable audience and lines of business, and a summary of the communication.
- Provider operations manual changes (for physicians, participating physician groups (PPGs), hospitals, and ancillary providers): Includes the effective date of the change, document name (and path to section where document is located), audience, affected lines of business and URLs, and a summary of the change.
- Behavioral Health Provider Operations Manual: Includes the effective date of the change, operations manual section, topic and summary of the change.
Communications posted online in December 2024
Date, number and title | Type of notice | Audience | Lines of business1 | Summary |
|---|---|---|---|---|
12/10/24 24-1167m (PDF), Improve Members’ Health and Social Outcomes With Enhanced Care Management | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties)
| This quick reference guide helps providers determine whether a Medi-Cal member is eligible for Enhanced Care Management (ECM) services and aids in making a referral to ECM. |
12/10/24 24-1272m (PDF), Support Healthy Child Development and Mental Health With Dyadic Services and Family Therapy Benefits | News & Announcements | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Medi-Cal (all counties) Molina
| As a reminder, dyadic care services and family therapy benefits are available to Medi-Cal members under age 21. Review this notice for information on referrals, eligibility criteria, claims billing and submission, and training. |
12/12/24 24-1263m (PDF), Evaluating 2023 Success: Special Needs Plan Model of Care Evaluation | News & Announcements | Physicians PPGs | Medicare Advantage HMO/PPO | See how Wellcare By Health Net evaluated its 2023 Special Needs Plans to improve care quality and identify areas for improvement. |
12/16/24 24-1291m, Expanded Definition of Psychiatric Emergency Medical Condition | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | The definition of psychiatric emergency medical condition was expanded, per Assembly Bill (AB) 1316. Psychiatric emergency services are covered, regardless of whether the patient is voluntarily or involuntarily detained.
|
12/17/24 24-1302m, Register Today! Learn How to Reduce Implicit Bias and Promote Equitable Care | News & Announcements | Physicians
| IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Register for the no cost online training, Strengthening Cultural Humility, Dismantling Implicit Bias in the Healthcare Setting, to stay compliant with the California Dignity in Pregnancy and Childbirth Act (Senate Bill (SB) 464). Access the course flyer for detailed instructions on how to access the course. |
12/18/24 24-1276m, Prescribe These Medication-Assisted Treatment Drugs Without Prior Authorization | Regulatory | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group
| AB 1842 requires health plans (and delegated entities) offering outpatient prescription drug benefits to provide coverage without prior authorization, step therapy or utilization review for at least one U.S. Food and Drug Administration-approved drug for substance use treatment in each of four designated categories. The bill does not apply to Medi-Cal plans, as current Medi-Cal contracts already provide for multiple drugs in the four categories. |
12/18/24 24-1281m (PDF), 2023 Provider Appointment Availability and After-Hours Access Survey Results | News & Announcements | Physicians PPGs Ancillary providers | IFP (Ambetter HMO/PPO) Employer Group Medicare Advantage HMO/PPO | Check out Provider Appointment Availability and After-Hours Access Survey results for 2023. 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 members. |
12/19/24 24-1279m, Prevent the Spread of Tuberculosis During Regular Check-Ups | Legislative | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Review new tuberculosis (TB) screening criteria due to AB 2132. Providers must offer TB screening assessments to members ages 18 and older if certain risk factors are identified, as detailed in this notice. |
12/20/24 24-1285m, Prioritize Maternal Mental Health With Expanded Screenings | Regulatory | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group
| Effective 1/1/25, at least one mental health screening must be included during a member’s pregnancy and another within the first six weeks postpartum.
|
12/20/24 24-1307m, Find Out What’s Changing for Partial Dual Eligible Medi-Cal Members in 2025 | Legislative | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties) Medicare Advantage HMO/PPO | Effective 1/1/25, per SB 311, the state’s Medi-Cal program will pay Medicare Part A premiums for eligible individuals who are not automatically enrolled in Medicare Part A. As a result, providers may see an increase in patients in Dual Eligible Special Needs Plans (D-SNPs). |
12/30/24 24-1347m, Medical Policies – | Contractual | Physicians PPGs Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group Medi-Cal (all counties) Molina | Review changes to medical policies for procedures and services for November 2024. Medical policies, available online at Health Net Medical Policies, offer guidelines for determining medical necessity for certain procedures, equipment and services. 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. |
1Medi-Cal (all counties) indicates that the communication applies to Medi-Cal Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.
Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in December 2024
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
12/5/24 | Health Net Medicare Programs Provider Services Department (under Contacts) | Physicians PPGs Hospitals Ancillary |
| Updated phone numbers for Medicare Programs Provider Services. |
12/6/24 | Health Net Injectable Medications HCPCS/DOFR Crosswalk (PDF) (under Benefits > Injectables > Therapeutic Injections and Other Substances) | Physicians PPGs Hospitals Ancillary | HMO, PPO, Medi-Cal, Medicare (PDF)
| The Injectable Medication HCPCS/DOFR Crosswalk has been updated for the 3rd quarter of 2024. |
12/9/24
| Tuberculosis Detection and Treatment/ Tuberculosis Screening | Physicians PPGs Hospitals Ancillary | Updated TB screening criteria for members ages 18 and older if risk factors are identified, per AB 2132 requirements. | |
12/17/24 | Administration of Immunizations (under Benefits > Immunizations) | Physician PPGs Hospitals Ancillary |
| Updated document, per new regulations regarding administering immunizations. |
12/19/24 | Overview (under Provider Oversight > Delegated Medical Management) | PPGs Hospitals |
| Updated information about delegated PPGs’ responsibilities and their policies and procedures, per state requirements about use of artificial intelligence (AI) in utilization management. |
12/30/24 | Notification of Hospital Admissions (under Utilization Management) | Physicians PPGs Hospitals Ancillary |
|
Updated information to align with single point of contact requirements for post-stabilization care authorization, per APL 24-012.
|
12/30/24 | Hospital Request for Authorization to Provide Post-Stabilization Services (under Emergency Services) | PPGs |
| |
12/30/24 | Notification of Hospital Admissions (under Utilization Management) | Physicians PPGs Hospital Ancillary |
|
Behavioral Health Provider Operations Manual changes in December 2024
Effective Date | Section | Topic | Summary |
|---|---|---|---|
12/30/24 | Section 9 | 10.4 Requests for Authorization for Post-Stabilization Care | Added information to align with single point of contact requirements for post-stabilization care authorization, per APL 24-012. |
Provider Services
Line of business | Phone number | |
|---|---|---|
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
Medicare (Individual & Employer Group) (Wellcare By Health Net) | ||
Medi-Cal (including CS and ECM providers) | N/A | |
Behavioral Health providers | N/A |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.