24-156 Provider Communications Posted Online for January 2024
Date: 02/09/24
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The table below outlines provider communications posted online in the Provider Library in January 2024. It includes the posting date, material number and title, type of notice, applicable audience and lines of business, and a summary of the communication.
Communications posted online in January 2024
Date, number and title | Type of notice | Audience1 | Lines of business2 | Summary |
|---|---|---|---|---|
1/2/24 24-027m, Follow Prior Authorization Requirements to Submit Palliative Care Requests | Contractual | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | Medi-Cal (all counties) Molina | Advises providers about the requirements to submit a prior authorization request for palliative care services. It includes turnaround times to respond to requests, how to access the prior authorization request form and information to include on the form before submitting it. |
1/4/24 24-019m (PDF), Medication Trend Updates and Formulary Changes – 1st Quarter 2024 | Contractual | Physicians PPGs
| IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medicare Advantage HMO/PPO Medi-Cal (all counties) | Informs providers of formulary changes and medication safety issues for the first quarter of 2024. |
1/5/24 24-022m, Reminder: PPG Financial Survey Reporting, Filing and Oversight Requirements | Regulatory | Physicians PPGs
| IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medicare Advantage HMO/PPO Medi-Cal (all counties) | This reminds PPGs that they are responsible for and must file their financial statements in a timely manner according to each quarter’s filing deadline. |
1/5/24 24-025m (PDF), Update to Authorization Request for Sleep Studies Effective January 5, 2024 | Regulatory | Physicians PPGs Hospitals | Medi-Cal (all counties) | Informs providers about new changes to the process for requesting prior authorization for sleep studies, effective January 5, 2024. |
1/25/24 24-074m (PDF), 2022 Provider Appointment Availability and After-Hours Access Survey Results | News & Announcements | Physicians PPGs Ancillary providers | Medi-Cal (all counties) | Review results from the annual Provider Appointment Availability and After-Hours Access Survey for 2022. 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 Medi-Cal members.
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1/26/24 24-033m(PDF), Follow Prior Authorization Requirements to Submit Palliative Care Requests | Contractual | Physicians PPGs Hospitals Ancillary providers | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medicare Advantage HMO/PPO | Advises providers about the requirements to submit a prior authorization request for palliative care services. It includes turnaround times to respond to requests, how to access the prior authorization request form and information to include on the form before submitting it. |
1/26/24 24-090m (PDF), Medical Policies - December 2023 | Contractual | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medicare Advantage HMO/PPO Medi-Cal (all counties) | Review new medical policies, changes to existing policies and a retired policy for December 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. |
1/31/24 24-105m, Find Out What Changed: AB 1369 Expands Access to Care for Eligible Patients via Telehealth |
| Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medicare Advantage HMO/PPO Medi-Cal (all counties) | As of January 1, 2024, California Assembly Bill 1369 permits a physician or surgeon who is licensed in another state to provide care via telehealth to a patient who has an immediate life-threatening condition. Review this notice for additional details. |
1/31/24 24-109m, Find Out What Changed: Sedation and Anesthesia Coverage for Dental Services | Regulatory | Physicians PPGs Hospitals Ancillary providers | Medi-Cal (all counties) | Informs providers about requirements for Medi-Cal managed care plans to cover intravenous moderate sedation and deep sedation/general anesthesia services provided by a physician in conjunction with dental services for members in hospitals, ambulatory medical surgical settings or dental offices, per the Department of Health Care Services All Plan Letter 23-028. It also describes related requirements for providers. |
1/31/24 24-111m, Stay Informed With the Winter 2024 Provider Pulse Newsletter | News & Announcements | Physicians PPGs | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) | The Winter 2024 issue of the quarterly Provider Pulse newsletter is available online, including instructions on how to access it. Highlights from this issue include the Medi-Cal expansion to ages 26-49 regardless of immigration status, articles about quality efforts, and several stories about the company’s philanthropic activities across the state. |
1/31/24 24-114m, Stay Informed With the Winter 2024 Provider Pulse Newsletter | News & Announcements | Physicians PPGs Hospitals Ancillary providers | Medicare Advantage HMO/PPO
| The Winter 2024 issue of the quarterly Provider Pulse newsletter is available online, including instructions on how to access it. Highlights from this issue include the Medi-Cal expansion to ages 26-49 regardless of immigration status, articles about quality efforts, and several stories about the company’s philanthropic activities across the state. |
1 ECM – Enhanced Care Management; CS – Community Supports
2 Medi-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.
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 Health Net provider portal.
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.
For Medi-Cal, this information applies to Amador, Los Angeles, Calaveras, Sacramento, Inyo, Mono, San Joaquin, Stanislaus, Tuolumne, and Tulare counties.