24-572 Provider Communications Posted Online and Operations Manual Updates for May 2024
Date: 06/07/24
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The tables below outline provider communications posted online and operations manual changes made in May 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 May 2024
Date number and title | Type of notice | Audience1 | Lines of business2 | Summary |
|---|---|---|---|---|
5/6/24 24-422m, Know Your Rights and Protections as a Provider Serving American Indian Members | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Medi-Cal (all counties)
| On Feb. 8, 2024, the California Department of Health Care Services released All Plan Letter 24-002, Medi-Cal Managed Care Plan Responsibilities for Indian Health Care Providers and American Indian Members. It clarifies existing federal and state protections for American Indian members; consolidates health plan requirements pertaining to protections for Indian health care providers; and offers guidance on health plan tribal liaison requirements. |
5/10/24 24-459m, Alternate Sites of Care Optimization for Therapeutic Infusions – 2nd Quarter 2024 | Contractual | Physicians PPGs
| IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) | Informs providers about the availability of Site of Care Optimization for Therapeutic Infusions (SCOTI) program for Commercial members. It includes products available for home infusion and coverage information. |
5/21/24 24-467m, Medical Policies – April 2024 | Contractual | Physicians PPGs Behavioral Health providers
| IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Notifies providers about changes to existing medical policies for procedures and services for April 2024. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed online at Health Net Medical 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. |
5/24/24 24-241m (PDF), Improve Patient Satisfaction With Advanced Access | News & Announcements | Physicians PPGs | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) | This flyer encourages primary care physicians to offer patients advanced access (same-day appointment scheduling). It also advises providers who do not offer advanced access to contact Provider Network Management for help with implementing it. |
5/24/24 24-242m (PDF), Improve Patient Satisfaction With Advanced Access | News & Announcements | Physicians PPGs
| Medicare Advantage HMO/PPO
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5/24/24 24-476m(PDF), Medicare Prior Authorization Changes for Part B Medications
| Contractual | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Medicare Advantage HMO/PPO
| Notifies providers about the new list of HCPCS codes issued by the Centers for Medicare & Medicaid Services, effective January 1 and April 1, 2024.
|
5/29/24 24-498m (PDF), Support Nurse Practitioners and Physician Assistants in Expanding Access to Care | Legislative | Physicians PPGs Hospitals Ancillary providers | IFP (Ambetter HMO, Ambetter PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina Medicare Advantage HMO/PPO | Informs providers of Assembly Bill 890, Nurse practitioners: scope of practice: practice without standardized procedures. This expands access to care, and permits nurse practitioners in specific settings to provide care (under certain conditions) that does not meet “standardized procedures.” |
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.
Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in May 2024
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
|---|---|---|---|---|
5/6/24 | Services Not Requiring Prior Authorization (under Prior Authorization) | Physicians PPGs Hospitals Ancillary providers |
| Updated document to include services for American Indian members that do not require prior authorization, per All Plan Letter 24-002, Medi-Cal Managed Care Plan Responsibilities for Indian Health Care Providers and American Indian Members. |
5/30/24 | Provider Offshore Subcontracting Attestation (under Compliance and Regulations) | Physicians PPGs Hospitals Ancillary providers | Updated Provider Offshore Subcontracting Attestation Form referenced in document, and created branded version for Wellcare By Health Net. |
Behavioral Health Provider Operations Manual changes in May 2024
Effective Date | Section | Topic | Summary |
|---|---|---|---|
5/6/24 | Section 9: Utilization Management – Outpatient Services | Authorization | Updated section to include services for American Indian members that do not require prior authorization, per All Plan Letter 24-002, Medi-Cal Managed Care Plan Responsibilities for Indian Health Care Providers and American Indian Members. |
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, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.