Family PACT Update

July 2018 | Bulletin 130

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1. 2018 Federal Poverty Guidelines for Family PACT Program

Effective April 1, 2018, Family Planning, Access, Care and Treatment (Family PACT) Program providers are to use the following income eligibility guidelines when determining client eligibility for Family PACT services. Providers should disregard all previous Family PACT income eligibility guideline charts.

Family PACT Income Guidelines
200 Percent of Poverty by Family Size
Effective April 1, 2018
Number of persons in family/household Monthly Income Annual Income
1 $2,023 $24,280
2 $2,743 $32,920
3 $3,463 $41,560
4 $4,183 $50,200
5 $4,903 $58,840
6 $5,623 $67,480
7 $6,343 $76,120
8 $7,063 $84,760
For each additional person, add $720 $8,640

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

Provider Manual(s) Page(s) Updated
Family PACT client elig (1, 11, 14); fam (2); prov res (2)
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2. Supplemental Payments for Selected Providers Extended

Supplemental payments for selected providers will not expire in 2018 as previously announced but extend into 2019. The provider types for the supplemental payments are as follows: Physicians; Family Planning, Access, Care and Treatment (Family PACT); Abortion; and AIDS Waiver.

The supplemental payment date range is July 1, 2017 to June 30, 2019.

ICF/DD Correction and Payment Chart
The supplemental payment date range is August 1, 2017 to July 31, 2019 for the facility types listed below. This date range corrects the range announced in a NewsFlash article that posted in April 2018, titled Supplemental Payment Program Implemented for ICF-DD Services.

A single reimbursement payment includes the current per diem rate in addition to the supplemental payment amount shown below. The supplemental payment amount is automatically added to reimbursements for claims meeting the supplemental payment criteria.

ICF/DD Supplemental Payment Plan
Facility Type LTC Accommodation Code Bed Hold Accommodation Code Supplemental Payment Per Diem
ICF/DD 41 (1 – 59 beds) 43 $15.47
ICF/DD 41 (60+ beds) 43 $0.00
ICF/DD-H 61 (4 – 6 beds) 63 $10.75
ICF/DD-H 65 (7 – 15 beds) 68 $0.00
ICF/DD-N 62 (4 – 6 beds) 64 $12.47
ICF/DD-N 66 (7 – 15 beds) 69 $22.30

No action is required of providers. An Erroneous Payment Correction (EPC) will be initiated to reprocess affected claims.

Note:

Facilities in peer groups in which the unfrozen 2017 – 2018 65th percentile rate is lower than the current reimbursement rate will not receive the supplemental payment.

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3. Clinic Dispensing of Miscellaneous Drugs for Medi-Cal

Effective for dates of service on or after July 1, 2018, Medi-Cal providers may dispense a limited number of miscellaneous drugs for non-surgical procedures for the treatment of family planning-related conditions using Healthcare Common Procedure Coding System (HCPCS) code S5000 (prescription drug, generic) or S5001 (prescription drug, brand name). These codes may be used only by hospital outpatient departments, emergency rooms, surgical clinics and community clinics.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals fam planning (15–25); fam planning ub (8)
Family PACT drug onsite (3–5)
General Medicine
Obstetrics
fam planning (15–25)
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4. Reminder: VeriFone VX 520 POS Device to Decommission in July 2018

In July 2018, the VeriFone VX 520 Point of Service (POS) device will be decommissioned. Providers may contact the POS Help Desk at 1-800-541-5555 (option 5, followed by option 6) for information about the decommission and for options.

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5. Correction: No TAR Required for Copper IUDs

In a previous Medi-Cal Update published on May 31, 2018, the Department of Health Care Services (DHCS) introduced a new manual section titled Physician Administered Drugs in the Part 2 Medi-Cal Pharmacy provider manual. The new section stated in error that a Treatment Authorization Request (TAR) is always required for copper intrauterine devices (IUDs).

A TAR is not required for copper IUDs. This information has been corrected in the Physician Administered Drugs section.

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

Provider Manual(s) Page(s) Updated
Pharmacy physician (1)
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6. A New Way to Subscribe – Contact Medi-Cal Subscription Service Representatives

Medi-Cal is committed to keeping you up-to-date on the latest Medi-Cal news and policy updates.

The Medi-Cal Subscription Service (MCSS) is a free service that provides subscribers with personalized email notifications for urgent, high-impact announcements and monthly news/policy updates as they post to the Medi-Cal website.

Providers can now contact MCSS representatives directly at MCSSCalifornia@conduent.com to subscribe and for assistance with managing subscriptions. Subscribing is simple and free!

If you have not yet subscribed to MCSS, Medi-Cal encourages you to utilize one of the following two methods to subscribe.

To subscribe by email:
  1. Download the linked MCSS Subscriber Form

  2. Enter your name, email address, ZIP code and subscriber type in the appropriate fields

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

  4. Attach your completed form to an email and send to MCSSCalifornia@conduent.com
To subscribe online:
  1. Go to the MCSS Subscriber Form page on the Medi-Cal website

  2. Enter your email address and ZIP code, and select a subscriber type from the drop-down menu

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

  4. Click “Subscribe Now” at the bottom of the page

After the form has been received, 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, visit the MCSS Help page.

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7. 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 Provider Orientation training is delivered online and in person and includes information on comprehensive family planning, program benefits and services, client eligibility, provider responsibilities and compliance.

Each provider's service location is required to be certified for enrollment in the Family PACT Program. Applicants who are enrolled in Medi-Cal and in good standing or are pending Medi-Cal enrollment and who have submitted a Family PACT application packet may complete the Provider Orientation to certify a site for enrollment.

Each service location must designate one eligible representative to be the site certifier. The site certifier cannot certify multiple sites.

The medical director, physician, nurse practitioner or certified nurse midwife who is responsible for overseeing the family planning services rendered at the location to be enrolled is eligible to certify the site.

Provider Orientation details and registration information is posted on the Family PACT website at www.familypact.org.

Upcoming In-Person Orientation

Sacramento
August 22, 2018
10 a.m. – 2 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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8. August 2018 Medi-Cal Provider Seminar

The August Medi-Cal provider seminar is scheduled for August 14 – 15, 2018, at the Sacramento Marriott in Sacramento, 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 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 by July 31, 2018, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After July 31, 2018, 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. 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 seminar information.

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9. Reminder: Do Not Staple Paper Claim Forms

Providers are reminded to not staple paper claim forms as staples delay claims processing. For more general reminders about paper claim submission, providers are encouraged to check the Billing Tips: Paper Claims page of the Medi-Cal website.

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10. 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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