24-159 Provider Communications Posted Online and Operations Manual Updates for January 2024
Date: 02/09/24
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The tables below outline provider communications posted online and operations manual changes made in January 2024.
- Communications posted online: Includes the posting date, material number and title, type of communication, applicable audience and counties, and a summary of the communication.
- Medi-Cal Provider Operations Manual changes (for physicians, participating physician groups (PPGs), hospitals, and ancillary providers): Includes the effective date of the change; document name, path to section where document is located and URL for the document; audience; 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 January 2024
Date, number and title | Type of notice | Audience1 | Medi-Cal counties | Summary |
|---|---|---|---|---|
1/2/24 24-029m, Follow Prior Authorization Requirements to Submit Palliative Care Requests | Contractual | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers | Fresno Kings Madera | 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 24-018m (PDF), Medication Trend Updates and Formulary Changes – 1st Quarter 2024 | Contractual | Physicians PPGs
| Fresno Kings Madera | Informs providers of formulary changes and medication safety issues for the first quarter of 2024. |
1/5/24 24-021m, Reminder: PPG Financial Survey Reporting, Filing and Oversight Requirements | Regulatory | Physicians PPGs
| Fresno Kings Madera | 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 24-024m (PDF), Update to Authorization Request for Sleep Studies Effective January 5, 2024 | Regulatory | Physicians PPGs
| Fresno Kings Madera | Informs providers about new changes to the process for requesting prior authorization for sleep studies, effective January 5, 2024. |
1/26/24 24-092m (PDF), Medical Policies – December 2023 | Contractual | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Fresno Kings Madera | 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 24-104m, Find Out What Changed: AB 1369 Expands Access to Care for Eligible Patients via Telehealth | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | 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.
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1/31/24 24-108m, Find Out What Changed: Sedation and Anesthesia Coverage for Dental Services | Regulatory | Physicians PPGs Hospitals Ancillary providers | Fresno Kings Madera | 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 24-112m, Stay Informed With the Winter 2024 Provider Pulse Newsletter | News & Announcements | Physicians PPGs
| Fresno Kings Madera | 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. |
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in January 2024
Effective Date | Document name, path (if applicable) and URL | Audience | Summary |
|---|---|---|---|
1/1/24 | Schedule of Benefits or Summary of Benefits (SOB)
| Physicians PPGs Hospitals Ancillary | ‘Summary of Benefits’ has been added to ‘Schedule of Benefits’ in all instances of the operations manuals where Schedule of Benefits is used. This change is a result of the Summary of Benefits replacing the Schedule of Benefits for select Medicare Advantage plans as of January 1, 2024. |
1/1/24 | 1. Minor’s Consent for Services > Access to Sensitive Services 2. Minor’s Consent for Services > Alcohol and Drug Abuse
| Physicians PPGs Hospitals Ancillary | Updated existing information in Medi-Cal manual to advise that minors ages 16 or older can consent to narcotic replacement therapy without parent or guardian consent, per Assembly Bill 816. This same information was added to the HMO and PPO manuals as a new content. |
1/1/24 | Palliative Care Services | Physicians PPGs Hospitals Ancillary | Updated requirements for submitting prior authorization for palliative care services. This included updating the form that providers use to submit requests for palliative care for Medi-Cal members to the Outpatient Medi-Cal Prior Authorization Form, and mandatory information that must be entered on the form before submitting it. |
1/1/24 | Member Rights & Responsibilities Overview
| Physicians PPGs Hospitals Ancillary | Updated member rights and responsibilities according to information included in members’ Evidence of Coverage for 2024. |
1/1/24 | Confidentiality of Medical Records
| Physicians PPGs Hospitals Ancillary | Added section that specifies requirements for a valid authorization for release of a member’s medical information. Also added a ‘medical information’ glossary term. |
1/5/24 | PPGs Hospitals
| Updated Financial Statements to remove financial solvency review standard benchmarks that no longer apply and add process information specific to PPGs with sub-delegating risk arrangements. Financial Survey Filing Requirements was updated with information and requirements that apply to PPGs and now hospitals. | |
1/19/24 | Access to care and availability standards
| Physicians PPGs Hospitals Ancillary | Added requirements when a deferral is needed for routine and expedited authorizations (pre-service). This change was made in accordance with the Department of Health Care Services All Plan Letter 20-011, CA Health and Safety Codes 1367.01, 1367.03(a)(5)(H) and 42 CFR 438.210(d) 438.404). |
1/31/24 | Confidentiality of Medical Records
| Physicians PPGs Hospitals Ancillary | Added information specific to entities that are allowed to exchange real-time information, per California Assembly Bill 352. This includes entities for which the exchange of health information does not apply, as well as services that are excluded. |
1/31/24 |
| Physicians PPGs Hospitals Ancillary | Updated information about coverage for 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, and other related requirements, per DHCS APL 23-028. |
Behavioral Health Provider Operations Manual changes in January 2024
Effective Date | Section | Topic | Summary |
|---|---|---|---|
1/18/24 | Applies to entire manual | Claims submission address and payer ID change | Updated claims submission address and payer ID in all applicable sections of manual. |
Additional information
If you have additional questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.
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.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.