Family PACT Update

November 2019 | Bulletin 146

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1. Family PACT Program HAP Cards Reviewed by the Office of Family Planning

Effective for dates of service on or after November 1, 2019, the Family Planning, Access, Care and Treatment (Family PACT) Program is discontinuing policy on annual distribution of Health Access Programs (HAP) cards with annual limits. The initial HAP card supply issued to providers upon enrollment remains the same at 200 pre-numbered sequential cards; and revised to 50 blank replacement cards. All requests for additional HAP cards will be reviewed on a case-by-case basis.

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

Provider Manual(s) Page(s) Updated
Family PACT hap cards (1–4)
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2. DME and Medical Supplies for Recipients Impacted by the State of Emergency

Update: Replacement Durable Medical Equipment (DME) and Medical Supplies for Recipients Impacted by Fires and Extreme Weather Conditions or Public Safety Power Shutoff

On October 28, 2019, in response to the Governor’s recent proclamation of a statewide state of emergency due to the risk of wildfires, the Department of Health Care Services (DHCS) issued guidance for dispensing replacement medication(s) to recipients impacted by fires and extreme fire weather conditions or public safety power shutoff. This article provides additional guidance for dispensing DME and medical supplies.

Providers are instructed to incorporate the statement “Patient impacted by fires and extreme fire weather conditions or public safety power shutoff.” within the Miscellaneous Information field on the Treatment Authorization Requests (TAR) for DME, medical supplies or situations requiring a TAR.

DME and medical supply providers must provide requested equipment or supplies immediately or, for items not in stock, as soon as possible, if the need to dispense DME or medical supplies is related to the recipient’s displacement or subjection to fires and extreme fire weather conditions or public safety power shutoff. Providers must not have the recipient return after receiving TAR approval. The need for a TAR should not negatively affect the decision to provide DME or medical supplies immediately or as soon as possible, and the TAR can be submitted retroactively. It is imperative that the impacted recipient receive the DME or medical supply in a timely manner to facilitate compliance and assist the recipient to perform activities of daily living.

TARs for new or replacement DME or medical supplies will be automatically approved if the TAR indicates that the recipient is impacted by fire or by power shutoffs, and the provider will be paid for the claim for the DME or medical supply. The negative impact of the fire or power shutoff, alone, will meet the criteria of medical necessity.

Providers are encouraged to monitor the Medi-Cal website for future updates. Questions regarding this notice may be directed to the Telephone Service Center (TSC) at 1-800-541-5555, Monday through Friday, except holidays.

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3. Updates to Clinic Dispensing of Internal (Female) Condoms

Effective for dates of service on or after May 1, 2019, HCPCS code A4268 (contraceptive supply, condom, female, each) may be billed separately at the rate of $2.50 per unit for the Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) programs. The clinic dispensing fee is 10 percent of the subtotal billed. In addition, the dispensing limit for code A4268 is up to 12 units per claim and up to 24 units in a 90-day period.

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

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
fam planning (5, 13, 14)
Family PACT ben grid (24); clinic (4, 8, 10); drug (3, 5); drug onsite (1)
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4. Remove Frequency Limits for Select Intrauterine Devices and Contraceptive Implant

Effective retroactively for dates of service on or after January 1, 2016, the frequency limit of HCPCS code J7307 (etonogestrel [contraceptive] implant system, including implant and supplies) is removed. Effective retroactively for dates of service on or after October 1, 2016, the frequency limits of HCPCS codes J7297 (levonorgestrel-releasing intrauterine contraceptive system, [liletta], 52 mg) and J7298 (levonorgestrel-releasing intrauterine contraceptive system, [mirena], 52 mg) are removed.

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

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
fam planning (9, 11)
Family PACT ben fam (23, 30); ben grid (24)
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