24-868 Provider Communications Posted Online and Operations Manual Updates for July 2024
Date: 08/09/24
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The tables blow outline provider communications posted online and operations manual changes made in July 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.
Read the latest issue of the summer Provider Pulse newsletter
Check out the summer issue for details on how we are working to support you, your patients and your community. Topics in this issue include:
- User-Friendly Enhancements to Our Provider Library and Operations Manuals Have Arrived
- California Child Health Care Services Simplified in July
- The California Department of Health Care Services Opens New Behavioral Health Care Center in Los Angeles and Breaks Ground on Another in Modesto
Download the current and past issues in the Provider Library. Then, select the applicable line of business > Provider Pulse Newsletter.
Communications posted online in July 2024
Date, number and title | Type of notice | Audience1 | Lines of business2 | Summary |
7/1/24 24-644m, Stay in Compliance With Drug Utilization Review Requirements | Regulatory | Physicians PPGs Ancillary providers Behavioral Health providers | Medi-Cal
| Informs providers of their responsibilities for a drug utilization review program, per All Plan Letter (APL) 23-026 (Revised). |
7/1/24 24-657m, Submit HEDIS® Supplemental Data By August 1, 2024 | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM provider CS providers Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Attention: For measurement year 2024 reporting, all new supplemental data sources must be documented by 8/1/24, and HEDIS live data is due 9/3/24. |
7/3/24 24-653m, Be Ready for the 2024 Provider Appointment Availability, After-Hours and Phone Surveys | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM provider CS providers | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina Medicare Advantage HMO/PPO | Be ready for the 2024 Provider Appointment Availability, After-Hours and Phone Surveys, which takes place from July through Dec. 2024. Learn more about the survey and appointment access standards that are required for different appointment types.
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7/9/24 24-634m, Tip Guide Helps Improve Patient's Health and Health Outcomes Survey Measures | News & Announcements | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Medicare Advantage HMO/PPO
| A new resource for you! Use the Medicare Health Outcomes Survey Tip Guide for tips and recommendations to help guide discussions with patients about their health. These conversations directly impact a patient’s satisfaction with their outcomes and overall health care experience. |
7/11/24 24-751m, 2024 Medicare and Medicare DSNP Plan Codes with Plan Name and Service Area | News & Announcements | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Medicare Advantage HMO/PPO
| Refer to this notice for information about 2024 Medicare and Medicare D-SNP plan codes. It includes a table that lists the ‘H’ contract number, plan name, service area (counties) and associated plan code. |
7/12/24 24-710m, Improve Your Access and Availability
| News & Announcements
| Physicians PPGs Hospitals Ancillary providers ECM provider CS providers Behavioral Health providers
| IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina
| Register and attend one of the upcoming Access and Availability webinars in 2024 to stay up to date on requirements and best practices.
|
7/12/24 24-711m, Improve Your Access and Availability | News & Announcements
| Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | Medicare Advantage HMO/PPO | Register and attend one of the upcoming Access and Availability webinars in 2024 to stay up to date on requirements and best practices.
|
7/19/24 24-695m, Medication Trend Updates and Formulary Changes – | Contractual | Physicians PPGs | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina Medicare Advantage HMO/PPO | Informs physicians and other providers of drug list and formulary changes and medication safety issues for the third quarter of 2024. |
7/26/24 24-734m, Ensure D-SNP Members Have Timely Access to Continuity of Care | News & Announcements | Physicians PPGs Hospitals Ancillary providers | Medicare Advantage HMO/PPO
| Learn about the Department of Health Care Services’ new guidelines for D-SNPs, effective 1/1/24. The new guidelines ensure members joining a D-SNP will continue to have access to out-of-network Medicare physicians and other providers, as well as access to covered services. |
7/29/24 24-782m, 2024 Medicare Mammogram Facility Incentive Program | News & Announcements | Physicians PPGs Hospitals Ancillary providers | Medicare Advantage HMO/PPO
| Learn about the Medicare Mammogram Facility Incentive Program that runs from 8/19/24, through 12/31/24. Includes information about the screening and eligible bonus that can be earned, and billing codes to use to help close care gaps. |
7/30/24 24-805m, Medical Policies – June 2024 | Contractual | Physicians PPGs Behavioral Health providers | IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Notice about changes to existing medical policies for procedures and services for June 2024. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services, and can be accessed online at http://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. |
7/31/24 24-673m, 2024 Provider Satisfaction Survey
| News & Announcements
| Physicians PPGs Hospitals Ancillary providers Behavioral Health provider
| IFP (Ambetter HMO/PPO) Employer Group (HMO/POS, PPO) Medi-Cal (all counties) Molina | Save the Date! Our annual provider satisfaction survey is launching this summer. Please take a moment to share your feedback when you receive the survey in the coming weeks.
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7/31/24 24-674m, 2024 Provider Satisfaction Survey |
| Physicians PPGs Hospitals Ancillary providers Behavioral Health provider
| Medicare Advantage HMO/PPO | Save the Date! Our annual provider satisfaction survey is launching this summer. Please take a moment to share your feedback when you receive the survey in the coming weeks.
|
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 July 2024
Effective Date | Document name (and path) | Audience | Lines of business and URL | Summary |
7/1/24 | Federally Qualified Health Centers Alternative Payment Methodology Type (under Claims and Provider Reimbursement) | PPGs |
| Added information on how both contracted and non-contracted FQHCs participating in the Department of Health Care Services APM are reimbursed. |
7/1/24 | Sensitive Services (under Benefits) Reproductive Privacy Act (under Compliance and Regulations) | Physicians PPGs Hospitals Ancillary | Sensitive Services Reproductive Privacy Act
| Added information about enhanced privacy protections for sensitive medical information, including gender-affirming care, abortion and contraception, effective 7/1/24, per AB 352 and SB 345. These laws require businesses handling such data to develop security policies, prohibit the sharing of medical information for investigations without authorization, and exclude certain data from being exchanged electronically. |
7/1/24 | Drug Utilization Review Requirements (under Benefits) | Physicians PPGs Hospitals |
| Updated providers’ responsibilities for a drug utilization review program, per APL 23-026 (Revised). |
7/1/24 | Multiple Documents Updated Due to Child Health and Disability Program (CHDP) Sunsetting on June 30, 2024 | Physicians PPGs Hospitals Ancillary | · Medi-Cal Pubic Programs EPSDT/Medi-Cal for Kids & Teens Services Tuberculosis Detection and Treatment Quality Improvement Health Education Program, Services and Resources Benefits Maternity > Coverage Explanation Maternity > CPSP Dental Services > Dental Screening and Services Initial Health Assessment > PCP Coordination Initial Health Assessment > Requirements Preventive and Screening Services Under Age 21 Claims and Provider Reimbursement Balance Billing > Free Prohibitions Billing and Submission > Additions and Exceptions Billing Submission > National Drug Codes for | Due to CHDP sunsetting on June 30, 2024, multiple changes were required throughout the Medi-Cal manual. Updates included:
|
7/11/24 | Pharmacist Services (under Claims and Provider Reimbursement > Reimbursement) | PPGs
| Pharmacists may be billed for covered services within the pharmacist’s scope of practice and under select conditions, as required under AB 317. | |
7/15/24 | Continuity of Care (under Utilization Management) | Physicians PPGs Hospitals |
| Updated continuity of care requirements for members. Select updates applied due to APL 23-022. |
7/24/24 | Rehabilitation Therapy (under Benefits > Coverage Explanation and Exclusions and Limitations) | Physicians PPGs Ancillary | Coverage Explanation Exclusions and Limitations
| Removed reference to AB 88; added that exclusions do not apply to members with mental health and substance use disorders. Therapy that develops or restores functioning is medically necessary when rehabilitation or habilitation criteria is met. |
7/25/24 | Health Education Program, Services and Resources (under Quality Improvement) | Physicians PPGs Hospitals Ancillary | Updated to include current information about the health programs, services and resources that are available to assist with the ongoing health of Medi-Cal patients and their families. | |
7/26/24 | Vision (under Benefits) | Physicians PPGs Hospital Ancillary
| Overview EyeMed Vision Care | Envolve Vision is now doing business as Centene Vision Services, and references in manual and Contacts section have been updated accordingly. |
Behavioral Health Provider Operations Manual changes in July 2024
Effective Date | Section | Topic | Summary |
7/1/24 | Section 13: State-Specific Information and Important Regulations | State-Specific Information and Important Regulations | Added information about enhanced privacy protections for sensitive medical information, including gender-affirming care, abortion and contraception, effective 7/1/24, per AB 352 and SB 345. These laws require businesses handling such data to develop security policies, prohibit the sharing of medical information for investigations without authorization, and exclude certain data from being exchanged electronically. |
7/1/24 | Section 13: State-Specific Information and Important Regulations | State-Specific Information and Important Regulations | Added information about providers’ responsibilities for a drug utilization review program, per APL 23-026 (Revised). |
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, including Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.