Medi-Cal Update

AIDS Waiver Program | February 2020 | Bulletin 545

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1. Correction: 2020 HCPCS Policy Updates PDF Reposted with Updated Policy

A previously published Medi-Cal Update article titled “2020 HCPCS Annual Update” included an incorrect version of the 2020 HCPCS Policy Updates PDF. The correct 2020 updates to the HCPCS codes, along with updated policy for HCPCS code K1005, are available in the 2020 HCPCS Policy Updates PDF.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Orthotics and Prosthetics
Pharmacy
Therapies
dura cd fre (5)
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2. March 5, 2020 Medi-Cal Provider Seminar

The March Medi-Cal provider seminar is scheduled for March 5, 2020 at Concord Crowne Plaza Hotel in Concord, California. Providers can access a class schedule for the seminar by visiting the Provider Training web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary (FI) for Medi-Cal conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by February 17, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date of training. After February 17, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks page of the Medi-Cal website.

Note:

Wi-Fi will not be provided at the seminar. Please plan accordingly.

Providers that require more in-depth claims and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also request a custom billing workshop, presented by a regional field representative. To schedule the regional representative for your area, providers must contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a regional representative.

Providers are encouraged to bookmark the Provider Training web page and refer to it often for current seminar information.

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3. March 2020 Medi-Cal Seminar

The March Medi-Cal provider seminar is scheduled for March 24, 2020, at the Flamingo Conference Resort and Spa in Santa Rosa, California. Providers can access a class schedule for the seminar by visiting the Provider Training web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) for Medi-Cal, conduct Medi-Cal training seminars. These seminars, which target both new and experienced providers and billing staff, cover the following topics:

Providers must register by March 9, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date of training. After March 9, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks page of the Medi-Cal website.

Note:

Wi-Fi will not be provided at the seminar. Please plan accordingly.

Providers who require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also request a custom billing workshop presented by a field representative. To schedule the field representative for their area, providers must contact Provider Call Center (PCC) at 1-800-541-5555 and request to be contacted by a field representative.

Providers are encouraged to bookmark the Provider Training page and refer to it often for current seminar information.

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4. April 2020 Medi-Cal Provider Seminar

The April Medi-Cal provider seminar is scheduled for April 14–15, 2020, at the Riverside Convention Center in Riverside, California. Providers can access a class schedule for the seminar by visiting the Provider Training web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the California MMIS Fiscal Intermediary, conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by March 27, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After March 27th, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks page of the Medi-Cal website.

Note:

Wi-Fi will not be provided at the seminar. Please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. To contact the regional representative for your area, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a regional representative.

Providers are encouraged to bookmark the Provider Training page and refer to it often for current seminar information.

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5. Reminder: Screening for Adverse Childhood Experiences Is a Medi-Cal Benefit

Effective for dates of service on or after January 1, 2020, screening for Adverse Childhood Experiences (ACEs) is a Medi-Cal benefit. Medi-Cal reimburses for ACEs screenings for both children and adults up to 65 years of age, except for those dually eligible for Medi-Cal and Medicare Part B, with California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) funds. Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics will also be able to receive these reimbursements, in addition to their Prospective Payment System (PPS) and all-inclusive per-visit reimbursement.

Individuals under 21 years of age may receive periodic rescreening as determined appropriate and medically necessary, but screenings will not be reimbursed more than once per year, per provider. Screenings for individuals 21 years of age or older will not be reimbursed more than once in their lifetime, per provider. The required screening tool for use by providers is the top portion of the Pediatric ACEs and Related Life-events Screener (PEARLS) for individuals under 18 years of age and the ACEs questionnaire for individuals 20 years of age or older. For individuals 18 or 19 years of age, either tool may be utilized. If an alternative version of the ACEs questionnaire for individuals 20 years of age or older is used, it must contain questions on the 10 original categories of ACEs to qualify.

ACEs screenings will be reimbursed in both the fee-for-service Medi-Cal program and Managed Care Plans (MCPs) when billed with either of the two HCPCS codes below:

These codes may be billed to Medi-Cal directly even if the recipient has Other Health Coverage (OHC).

For fee-for-service Medi-Cal providers, screenings for ACEs are reimbursed at the Medi-Cal rate up to $29. For Medi-Cal MCPs, screenings for ACEs are reimbursed no less than $29 for each qualifying ACEs screening. Billing requires that the completed screening was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the recipient and/or family and any clinically appropriate actions were documented. This documentation should remain in the recipient’s medical record and be available upon request. The Department of Health Care Services (DHCS) will release additional information in a future announcement about how FQHCs, RHCs and IHS-MOA clinics can bill for trauma screening.

In order to be eligible for the trauma screening reimbursement after July 1, 2020, providers must complete the DHCS training for ACEs screening and trauma-informed care. In December 2019, DHCS launched www.ACEsAware.org, which includes information about DHCS’ provider training and other resources.

For more information, providers may visit the DHCS Trauma Screenings and Trauma-Informed Care Provider Trainings page of the DHCS website.

An Erroneous Payment Correction (EPC) will be implemented to reprocess any claims erroneously denied for dates of service on or after January 1, 2020. Providers should continue to bill their claims timely and check for updates on the Medi-Cal website.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
General Medicine
Medical Transportation
Obstetrics
oth hlth cpt (4)
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6. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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7. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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