24-574 Provider Communications Posted Online and Operations Manual Updates for May 2024
Date: 06/07/24
Access the Provider Library for the latest operational and Plan updates and changes to better service your patients
The tables below outline provider communications posted online and operations manual changes made in in May 2024.
- Communications posted online: Includes the posting date, material number and title, type of communication, applicable audience, 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 (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 | Summary |
|---|---|---|---|
5/6/24 24-423m, 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 | 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. |
5/21/24 24-468m, Medical Policies – | Contractual | Physicians PPGs Behavioral Health providers | 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 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 24-244m (PDF), Improve Patient Satisfaction With Advanced Access | News & Announcements | Physicians PPGs | 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. |
5/29/24 24-500m (PDF), Support Nurse Practitioners and Physician Assistants in Expanding Access to Care | Legislative | Physicians PPGs Hospitals Ancillary providers | 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
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in May 2024
Effective Date | Document name, path (if applicable) and URL | Audience | Summary |
|---|---|---|---|
5/6/24 | Services Not Requiring Prior Authorization (under Prior Authorization) | Physicians PPGs Hospitals Ancillary | 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. |
5/28/24 |
(under Benefits > Maternity) | Physicians PPGs Hospitals Ancillary | Added Confirmation of Pregnancy form branded for Community Health Plan of Imperial Valley. |
5/30/24 | Provider Offshore Subcontracting Attestation (under Compliance and Regulations) | Physicians PPGs Hospitals Ancillary | Updated Provider Offshore Subcontracting Attestation Form referenced in document and branded for Community Health Plan of Imperial Valley. |
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.
This information applies to Medi-Cal in Imperial county.