25-030 Provider Communications Posted Online and Operations Manual Updates for December 2024
Date: 01/08/25
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 December 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, path to section where document is located, URLs, 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 December 2024
Date, number and title | Type of notice | Audience | Summary |
|---|---|---|---|
12/10/24 24-1168m (PDF), Improve Members’ Health and Social Outcomes With Enhanced Care Management | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | This quick reference guide helps providers determine whether a Medi-Cal member is eligible for Enhanced Care Management (ECM) services and aids in making a referral to ECM. |
12/10/24 24-1274m (PDF), Support Healthy Child Development and Mental Health With Dyadic Services and Family Therapy Benefits | News & Announcements | Physicians PPGs Hospitals Ancillary providers Behavioral Health providers | As a reminder, dyadic care services and family therapy benefits are available to Medi-Cal members under age 21. Review this notice for information on referrals, eligibility criteria, claims billing and submission, and training. |
12/16/24 24-1293m, Expanded Definition of Psychiatric Emergency Medical Condition | Regulatory | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | The definition of psychiatric emergency medical condition was expanded, per Assembly Bill (AB) 1316. Psychiatric emergency services are covered, regardless of whether the patient is voluntarily or involuntarily detained.
|
12/17/24 24-1303m, Register Today! Learn How to Reduce Implicit Bias and Promote Equitable Care | News & Announcements | Physicians
| Register for the no cost online training, Strengthening Cultural Humility, Dismantling Implicit Bias in the Healthcare Setting, to stay compliant with the California Dignity in Pregnancy and Childbirth Act (Senate Bill (SB) 464). Access the course flyer for detailed instructions on how to access the course. |
12/19/24 24-1280m, Prevent the Spread of Tuberculosis During Regular Check-Ups | Legislative | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Review new tuberculosis (TB) screening criteria due to AB 2132. Providers must offer TB screening assessments to members ages 18 and older if certain risk factors are identified, as detailed in this notice. |
12/20/24 24-1309m, Find Out What’s Changing for Partial Dual Eligible Medi-Cal Members in 2025 | Legislative | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Effective 1/1/25, per SB 311, the state’s Medi-Cal program will pay Medicare Part A premiums for eligible individuals who are not automatically enrolled in Medicare Part A. As a result, providers may see an increase in patients in Dual Eligible Special Needs Plans |
24-1348m, Medical Policies – | Contractual | Physicians PPGs Behavioral Health providers | Review changes to medical policies for procedures and services for November 2024. Medical policies, available online at medical policies, offer guidelines for determining medical necessity for certain procedures, equipment and services. 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. |
Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in December 2024
Effective Date | Document name, path (if applicable) and URL | Audience | Summary |
|---|---|---|---|
12/6/24 | Health Net Injectable Medications HCPCS/DOFR Crosswalk (PDF) (under Benefits > Injectables > Therapeutic Injections and Other Substances) | Physicians PPGs Hospitals Ancillary | The Injectable Medication HCPCS/DOFR Crosswalk has been updated for the 3rd quarter of 2024. |
12/9/24
| Tuberculosis Detection and Treatment/ Tuberculosis Screening
| Physicians PPGs Hospitals Ancillary | Updated TB screening criteria for members ages 18 and older if risk factors are identified, per AB 2132 requirements. |
12/17/24 | Administration of Immunizations (under Benefits > Immunizations) | Physicians PPGs Hospitals Ancillary | Updated document, per new regulations regarding administering immunizations. |
12/19/24 |
(under Provider Oversight > Delegated Medical Management) | PPGs Hospitals | Updated information about delegated PPGs’ responsibilities and their policies and procedures, per state requirements about use of artificial intelligence (AI) in utilization management. |
12/30/24 | Notification of Hospital Admissions (under Utilization Management) | Physicians PPGs Hospitals Ancillary |
Updated information to align with single point of contact requirements for
|
12/30/24 | Hospital Request for Authorization to Provide Post-Stabilization Services (under Emergency Services) | PPGs |
Behavioral Health Provider Operations Manual changes in December 2024
Effective Date | Section | Topic | Summary |
|---|---|---|---|
12/30/24 | Section 9 | 10.4 Requests for Authorization for Post-Stabilization Care | Added information to align with single point of contact requirements for post-stabilization care authorization, per APL 24-012. |
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.