Family PACT Update

January 2018 | Bulletin 124

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1. 2018 CPT-4/HCPCS Annual Update: Policy Updates

The 2018 updates to the Current Procedural Terminology – 4th edition (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the 2018 CPT-4/HCPCS Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

For Specialty Programs, current or future benefits for updated CPT-4 and HCPCS codes are reflected in the following PDF documents:

The code additions, changes and deletions are effective for dates of service on or after February 1, 2018. Please refer to the 2018 CPT-4 and HCPCS Level II code book for complete descriptions of these codes.

HCPCS codes J7210 and J7211 will be effective for dates of service on or after April 1, 2018.

Providers should refer to the HCPCS Annual Update for ongoing updates.

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids audio (9, 10); cal child ser (1–20, 25, 26, 30–32); tax (9–12)
Adult Day Health Centers audio (9, 10)
CHDP Provider Manual chdp trans (1)
Chronic Dialysis Clinics blood (7); cal child ser (1–20, 25, 26, 30–32); immun (9); immun cd (1); inject cd list (2–9, 12, 15, 16); inject drug a-d (14, 20, 21, 25, 26, 29, 30); inject drug e-h (2, 16–18, 27, 29, 32); inject drug i-m (4–6); inject drug n-r (2, 3); inject drug s-z (4, 15, 17, 18); medi non cpt (2); modif used (4, 10, 11); non inject (12, 13); path bil (8); vaccine (4, 8)
Clinics and Hospitals allergy (1, 2); blood (7); cal child ser (1–20, 25, 26, 30–32); chemo drug a-d (5, 6, 24, 30); chemo drug e-o (8, 9, 11, 12, 25); chemo drug p-z (16, 17); eval (22); fam planning (4); hyst (4); immun (9); immun cd (1); inject cd list (2–9, 12, 15, 16); inject drug a-d (14, 20, 21, 25, 26, 29, 30); inject drug e-h (2, 16–18, 27, 29, 32); inject drug i-m (4–6); inject drug n-r (2, 3); inject drug s-z (4, 15, 17, 18); medi non cpt (2); medne neu (3); medne pul (3); modif used (4, 10, 11); non inject (12, 13); non ph (8, 10–13, 23–25); once (5–7); path bil (8); path micro (5); path molec (2, 5, 11, 13, 19–24, 30, 32, 35, 36, 41, 42); preg com los (1); preg early (5); presum (11, 12, 15, 17, 19); radi dia (20, 22, 25); radi nuc (6); rates max (4); respir (6, 7); ster (26); surg aud (3, 4); surg bil mod (7, 8); surg cardio (5, 8); surg female (2); surg integ (5); surg lap (1); surg urin (6, 7); tar and non cd1 (3, 4); tar and non cd2 (6); tar and non cd3 (1–10); tar and non cd5 (5, 6, 8); tar and non cd6 (2, 4); tar and non cd8 (1–3); tar and non cd9 (1, 4–9); vaccine (4, 8)
Durable Medical Equipment cal child ser (1–20, 25, 26, 30–32); dura bil dme (33); dura cd (27, 46); dura cd fre (3, 5); ortho cd1 (25); ortho cd2 (6, 16); ortho cd fre1 (4); ortho cd fre2 (3); respir (6, 7); tax (9–12)
Family PACT ben fam (23, 25, 30, 41); ben grid (3, 4, 7, 24); drug (2, 7)
General Medicine allergy (1, 2); blood (7); cal child ser (1–20, 25, 26, 30–32); chemo drug a-d (5, 6, 24, 30); chemo drug e-o (8, 9, 11, 12, 25); chemo drug p-z (16, 17); eval (22); fam planning (4, 9); hyst (4); immun (9); immun cd (1); inject cd list (2–9, 12, 15, 16); inject drug a-d (14, 20, 21, 25, 26, 29, 30); inject drug e-h (2, 16–18, 27, 29, 32); inject drug i-m (4–6); inject drug n-r (2, 3); inject drug s-z (4, 15, 17, 18); medi non cpt (2); medne neu (3); medne pul (3); modif used (4, 10, 11); non inject (12, 13); non ph (8, 10–13, 23–25); once (5, 6, 7); path bil (8); path micro (5); path molec (2, 5, 11, 13, 19–24, 27, 30, 32, 35, 36, 41, 42); preg early (5); presum (11, 12, 15, 17, 19); radi dia (20, 22, 25); radi nuc (6); rates max (4); respir (6, 7); ster (26); surg aud (3, 4); surg bil mod (7, 8); surg cardio (5, 8); surg female (2); surg integ (5); surg lap (1); surg urin (6, 7); tar and non cd1 (3, 4); tar and non cd2 (6); tar and non cd3 (1–10); tar and non cd5 (5, 6, 8); tar and non cd6 (2, 4); tar and non cd8 (1–3); tar and non cd9 (1, 4–9); vaccine (4, 8)
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
cal child ser (1–20, 25, 26, 30–32)
Inpatient Services cal child ser (1–20, 25, 26, 30–32); hyst (4); ster (26); tar and non cd1 (3, 4); tar and non cd2 (6); tar and non cd3 (1–10); tar and non cd5 (5, 6, 8); tar and non cd6 (2, 4); tar and non cd8 (1–3); tar and non cd9 (1, 4–9)
Obstetrics cal child ser (1–20, 25, 26, 30–32); eval (22); fam planning (4, 9); hyst (4); immun (9); immun cd (1); inject cd list (2–9, 12, 15, 16); inject drug a-d (14, 20, 21, 25, 26, 29, 30); inject drug e-h (2, 16–18, 27, 29, 32); inject drug i-m (4–6); inject drug n-r (2, 3); inject drug s-z (4, 15, 17, 18); medi non cpt (2); modif used (4, 10, 11); non inject (12, 13); non ph (8, 10–13, 23–25); once (5, 6, 7); path bil (8); path micro (5); path molec (2, 5, 11, 13, 19–24, 27, 30, 32, 35, 36, 41, 42); preg early (5); presum (11, 12, 15, 17, 19); radi dia (20, 22, 25); radi nuc (6); rates max (4); ster (26); surg bil mod (7, 8); surg female (2); surg lap (1); surg urin (6, 7); tar and non cd1 (3, 4); tar and non cd2 (6); tar and non cd3 (1–10); tar and non cd5 (5, 6, 8); tar and non cd6 (2, 4); tar and non cd8 (1–3); tar and non cd9 (1, 4–9); vaccine (4, 8)
Orthotics and Prosthetics cal child ser (1–20, 25, 26, 30–32); dura cd (27, 46); dura cd fre (3, 5); ortho cd1 (25); ortho cd2 (6, 16); ortho cd fre1 (4); ortho cd fre2 (3); tax (9–12)
Pharmacy blood (7); cal child ser (1–20, 25, 26, 30–32); dura bil dme (33); dura cd (27, 46); dura cd fre (3, 5); immun (9); immun cd (1); inject cd list (2–9, 12, 15, 16); inject drug a-d (14, 20, 21, 25, 26, 29, 30); inject drug e-h (2, 16–18, 27, 29, 32); inject drug i-m (4–6); inject drug n-r (2, 3); inject drug s-z (4, 15, 17, 18); ortho cd1 (25); ortho cd2 (6, 16); ortho cd fre1 (4); ortho cd fre2 (3); presum (11, 12, 15, 17, 19); tax (9–12)
Psychological Services cal child ser (1–20, 25, 26, 30–32); psychol (2, 4)
Rehabilitation Clinics audio (9, 10); cal child ser (1–20, 25, 26, 30–32); immun (9); immun cd (1); inject cd list (2–9, 12, 15, 16); inject drug a-d (14, 20, 21, 25, 26, 29, 30); inject drug e-h (2, 16–18, 27, 29, 32); inject drug i-m (4–6); inject drug n-r (2, 3); inject drug s-z (4, 15, 17, 18); modif used (4, 10, 11); non inject (12, 13); non ph (8, 10–13, 23–25); respir (6, 7); vaccine (4, 8)
Therapies audio (9, 10); cal child ser (1–20, 25, 26, 30–32); dura cd (27, 46); dura cd fre (3, 5); ortho cd1 (25); ortho cd2 (6, 16); ortho cd fre1 (4); ortho cd fre2 (3); respir (6, 7)
Vision Care cal child ser (1–20, 25, 26, 30–32); medi non cpt (2)
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2. Family PACT Manual Sections Reorganized and Renamed

Effective February 1, 2018, certain Family PACT Policies, Procedures and Billing Instructions sections are reorganized and renamed.

The Client Eligibility Certification and HAP Card Activation section and the Client Eligibility Determination section of the Family PACT manual are retired. The content of those sections is retained and reorganized in the following two new Family PACT manual sections:

Also effective for dates of service on or after February 1, 2018, the Client Eligibility, Health Access Programs (HAP) Cards, Program Standards, Provider Enrollment and Provider Responsibilities sections of the Family PACT manual are updated for clarification.

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

Provider Manual(s) Page(s) Updated
Family PACT ben fam (36); client elig (1–19); fam (2, 6); hap cards (1–9); prog stand (1–14); prov enroll (1–10); prov res (1–11)
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3. Diabetes Prevention Program Established for Medi-Cal

Effective July 10, 2017, Senate Bill 97 (Chapter 52, Statutes of 2017), requires the Department of Health Care Services (DHCS) to establish the Diabetes Prevention Program (DPP) within the Medi-Cal fee-for-service and managed care delivery systems, consistent with the guidelines provided by the Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS). The DPP curriculum will promote realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and behavior modification.

A core benefit of Medi-Cal's DPP will include 22 peer-coaching sessions over 12 months, which will be provided regardless of weight loss. Participants who achieve and maintain a minimum weight loss of 5 percent by the conclusion of the 12 month period will also be eligible to receive ongoing maintenance sessions to help them continue healthy lifestyle behaviors. SB 97 also requires that Medi-Cal providers choosing to offer DPP services comply with CDC guidance and obtain CDC recognition in connection with the National DPP.

The benefit will be available to eligible Medi-Cal recipients on January 1, 2019. DHCS is working with its Managed Care Plans, the Department of Public Health, Public Health Advocates and other interested stakeholders to discuss policy implications and potential collaborations. DHCS will begin drafting its policy and submit a CMS State Plan Amendment in 2018. To join the stakeholder list and to submit questions or comments, email DHCSDPP@dhcs.ca.gov.

DHCS is conducting a provider survey to better understand how Medi-Cal providers discuss prediabetes with their patients and to receive any comments or concerns regarding Medi-Cal's DPP benefit. DHCS would appreciate provider's feedback through a short 10-minute survey.

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4. Provider Orientation

Medi-Cal providers applying to become a Family Planning, Access, Care and Treatment (Family PACT) provider are required to attend a Provider Orientation per Welfare and Institutions Code (W&I Code), Section (§) 24005(k). The Family PACT Provider Orientation provides an overview of the Family PACT Program, provider enrollment process, program standards and benefits and client eligibility and enrollment.

Solo or group providers or primary care clinics are eligible to apply for enrollment in the Family PACT Program if they currently have a National Provider Identifier (NPI) and are enrolled in Medi-Cal in good standing.

The medical director, physician, nurse practitioner or certified nurse midwife responsible for overseeing the family planning services to be rendered at the site to be enrolled is eligible to certify the site. Site certifiers shall sign a statement affirming responsibility.

The Family PACT Provider Orientation is delivered in two parts. Part one consists of an online orientation that must be completed prior to attending a part two in-person orientation. Medi-Cal providers who wish to enroll in the Family PACT Program will be required to complete both the online orientation and attend the in-person orientation. The Family PACT Provider Orientation is open to all site staff.

Complete the orientation process by following three simple steps:

  1. Visit: http://www.ofpregistration.org/ to register and create a profile in the Office of Family Planning Learning Management System (LMS). Once your profile has been set up, you are ready to proceed with the orientation.

  2. Complete part one of the orientation. Part one must be completed in order to register for the (part two) in-person orientation. Print the Certification of Completion when you have completed the online orientation.

  3. Complete part two by attending the in-person orientation. Register through the LMS and select an in-person orientation session. Site certifiers must attend the in-person orientation and are required to present photo identification during registration.

Upcoming In-Person Orientation

Oakland
February 15, 2018
10:00 a.m. – 2:00 p.m.
California Endowment
2000 Franklin Street
Oakland, CA 94612
Sacramento
March 13, 2018
9:00 a.m. – 1:00 p.m.
Sierra Health Foundation
1321 Garden Highway
Sacramento, CA 95833

Please contact the Office of Family Planning by phone (916) 650-0414 or email us at ProviderServices@dhcs.ca.gov if you have any questions regarding the orientation process.

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5. February 2018 Medi-Cal Provider Seminar

The next Medi-Cal provider seminar is scheduled for February 13 – 14, 2018, at the Ontario Airport Hotel & Conference Center in Ontario, California. Providers can access a class schedule for the seminar by visiting the Provider Training 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 DHCS 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 and request by January 30, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After January 30, 2018, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web 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. On the Lookup Regional Representative web page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a representative.

Providers are encouraged to bookmark the Provider Training web page and refer to it often for current educational information, such as the annual provider seminar and webinar schedule, provider training workbooks, online tutorials, recorded webinars and additional curriculum on the MLP.

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7. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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