24-871 Provider Communications Posted Online and Operations Manual Updates for July 2024
Date: 08/09/24
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The tables below 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 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 (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
- Groundbreaking of Madera County Foodbank Demonstration Kitchen
- The California Department of Health Care Services Opens New BH 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 | Medi-Cal counties | Summary |
7/1/24 24-643m, Stay in Compliance With Drug Utilization Review Requirements | Regulatory | Physicians PPGs Ancillary providers Behavioral Health providers
| Fresno Kings Madera | Informs providers of their responsibilities for a drug utilization review program, per All Plan Letter (APL) |
7/1/24 24-658m, Submit HEDIS® Supplemental Data By | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | 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 24-654m, Be Ready for the 2024 Provider Appointment Availability, After-Hours and Phone Surveys | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers
| Fresno Kings Madera | 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. |
7/12/24 24-708m, Improve Your Access and Availability | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM provider CS providers Behavioral Health providers | Fresno Kings Madera | Register and attend one of the upcoming Access and Availability webinars in 2024 to stay up to date on requirements and best practices.
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7/19/24 24-696m, Medication Trend Updates and Formulary Changes – 3rd Quarter 2024 | Contractual | Physicians PPGs | Fresno Kings Madera | Informs physicians and other providers of drug list and formulary changes and medication safety issues for the third quarter of 2024. |
7/30/24 24-807m, Medical Policies – June 2024 | Contractual | Physicians PPGs Behavioral Health providers | Fresno Kings Madera | 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 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. |
7/31/24 24-671m, 2024 Provider Satisfaction Survey | News & Announcements | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers
| Fresno Kings Madera | 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
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in July 2024
Effective Date | Document name, URL and path (if applicable) | Audience | Summary |
7/1/24 | Multiple Documents Updated Due to Child Health and Disability Program (CHDP) Sunsetting on June 30, 2024 Pubic Programs EPSDT/Medi-Cal for Kids & Teens Services Tuberculosis Detection and Treatment Quality Improvement Health Education Program, Services and Resources CalViva 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 Medi-Cal Claims | Physicians PPGs Hospital Ancillary | Due to CHDP sunsetting on June 30, 2024, multiple changes were required throughout the Medi-Cal manual. Updates included: · References to CHDP removed and or updated in copy, as applicable. · Contact document for CHDP removed. · The main CHDP section and its subsections that were previously located under Public Programs were moved under Benefits, and the section was renamed “Preventive and Screening Services Under Age 21.”
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7/1/24 | Federally Qualified Health Centers Alternative Payment (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 |
(under Benefits) (under Compliance and Regulations) | Physicians PPGs Hospitals Ancillary | 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). |
7/11/24 | Pharmacist Services | 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 |
(under Utilization Management) | Physicians PPGs Hospitals
| Updated continuity of care requirements for members. Select updates applied due to APL 23-022. |
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 |
(under Benefits) | Physicians PPGs Hospitals Ancillary | 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.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.