Family PACT Update

January 2020 | Bulletin 148

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1. New Medi-Cal Provider Website Nearing Completion

The Department of Health Care Services (DHCS) is nearing completion of the new Medi-Cal Provider website. DHCS anticipates this new website to be available to providers beginning in the spring of 2020.

This new Medi-Cal Provider website will contain content from the current Medi-Cal website but will offer the following additional features:

Access to Outreach and Education, including provider training, and Transaction Services will continue to be available from the Providers tab located within the navigation bar of the home page of the new website.

DHCS will publish additional updates about the new Medi-Cal Provider website in the coming months leading up to the spring of 2020. Providers are encouraged to regularly check the current Medi-Cal website as well as subscribe to the Medi-Cal Subscription Service (MCSS) to ensure they receive the latest policy and program updates.

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2. 2019 ICD-10-CM Diagnosis Codes: Provider Manual Updates

The 2019 ICD-10-CM diagnosis codes have been updated in the Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) provider manuals.

The codes were previously rolled out and are effective retroactively for dates of service on or after October 1, 2018. Certain ICD-10-CM diagnosis codes have been:

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

Information and downloads for these codes can be found on the 2019 ICD-10-CM web page of the Centers for Medicare & Medicaid Services (CMS) website.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics path chem (4)
Clinics and Hospitals
General Medicine
ophthal cd (2); path chem (4); radi dia ult (1); surg eye (11)
Family PACT ben fam (47, 48, 54); lab (19–22, 24, 25, 37)
Obstetrics path chem (4); radi dia ult (1)
Vision Care pro serv cd (2)
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3. Additional Screening of Family PACT Provider Applicants in Certain Counties

Pursuant to Welfare and Institutions Code (W&I Code), Section 14132(aa)(2) and 24005(e), the Department of Health Care Services (DHCS) Office of Family Planning (OFP) has the authority to screen Family Planning, Access, Care and Treatment (Family PACT) Program provider applicants pursuant to requirements developed by DHCS to determine suitability for the Family PACT Program. Accordingly, OFP requires that any Family PACT provider applicant located in Los Angeles, Orange, Riverside or San Bernardino counties seeking enrollment in the Family PACT Program for the first time or submitting an application for a change in enrollment will be subject to certain screening requirements, with the exception of entities who are licensed as clinics under Health and Safety Code (H&S Code), Section 1204, clinics exempt from licensure under H&S Code, Section 1206, student health centers and those operated by government entities.

DHCS has assessed the risk of fraud, waste and abuse from a program integrity perspective posed by the specific geographic locations described above. DHCS has determined that newly enrolling Family PACT provider applicants or existing Family PACT providers submitting an application for a change in enrollment in Los Angeles, Orange, Riverside or San Bernardino counties should be deemed to pose a risk of fraud, waste and abuse to the Family PACT Program, with the exception of entities who are licensed as clinics under H&S Code, Section 1204, clinics exempt from licensure under H&S Code, Section 1206, student health centers and those operated by government entities. This designation is based upon criteria including, but not limited to, the following:

Due to the potential risk of fraud, waste and abuse, the Family PACT provider applicants described above are subject to the following additional enrollment screening:

DHCS will conduct onsite visits prior to any application approval, including newly enrolling Family PACT provider applicants or existing Family PACT providers submitting an application for a change in enrollment, as described above.

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4. Family PACT Benefits Update: Tests for Herpes Simplex Virus

Effective for dates of service on or after January 1, 2020, CPT codes 87252 (virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect) and 87273 (infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 2) are no longer Family Planning, Access, Care and Treatment (Family PACT) benefits.

CPT code 87529 (infectious agent detection by nucleic acid [DNA or RNA]; Herpes simplex virus, amplified probe technique) is a Family PACT benefit reimbursable only when billed with ICD-10-CM diagnosis code N76.6 or N48.5 in conjunction with the following ICD-10-CM diagnosis codes that identify the contraceptive method for which the client is seen, as listed in the Family PACT Policies, Procedures and Billing Instructions manual: : Z30.011, Z30.013, Z30.015, Z30.016, Z30.017, Z30.018, Z30.02, Z30.41, Z30.42, Z30.430, Z30.431, Z30.432, Z30.433, Z30. 44, Z30.45, Z30.46, Z30.49, Z98.51, or Z98.52.

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

Provider Manual(s) Page(s) Updated
Family PACT ben fam rel (13); ben grid (14); lab (24, 25)
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5. Updates to Family PACT and Medi-Cal Clinic Dispensing Policy on Select Drugs

Effective for dates of service on or after February 1, 2020, the quantity limits for clinic dispensing of select drugs for Family Planning, Access, Care and Treatment (Family PACT) and Medi-Cal programs are updated.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
prev (16)
Family PACT ben fam rel (23); clinic (2, 5, 9, 15); drug onsite (1–5)
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6. 2020 Medi-Cal Provider Training Schedule

The 2020 Medi-Cal provider training schedule is now available. Providers can access Medi-Cal training information and registration details by clicking on the Outreach & Education slideshow area of the Medi-Cal website homepage or by visiting the Training Calendar web page of the Medi-Cal Learning Portal (MLP).

Training Date Webinar or Seminar Location Address
January 7 – 30 Webinar Information posted on the Medi-Cal website
February 11 – 12 Seminar Santa Ana
Double Tree by Hilton
201 East MacArthur Blvd.
Santa Ana, CA  92707
March 5 Seminar Concord
Crowne Plaza
45 John Glenn Drive
Concord, CA  91764
March 24 Seminar Santa Rosa
Flamingo Conference Resort & Spa
2777 Fourth Street
Santa Rosa, CA  95405
April 14 – 15 Seminar Riverside
Riverside Convention Center
3637 Fifth Street
Riverside, CA  92501
May 12 Seminar Redding
Red Lion Hotel Redding
1830 Hilltop Drive
Redding, CA  96002
June 2 – 30 Webinar Information to be published on Medi-Cal website
July 29 – 30 Seminar Escondido
California Center for the Arts
340 North Escondido Blvd.
Escondido, CA  92025
August 26 – 27 Seminar Sacramento
Sacramento Marriott
11211 Point East Drive
Rancho Cordova, CA   95742
September 15 – 16 Seminar Long Beach
Long Beach Marriott
4700 Airport Plaza Drive
Long Beach, CA  90815
October 14 – 15 Seminar Fresno
Double Tree Hilton
2233 Ventura Street
Fresno, CA  93721
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7. January 2020 Medi-Cal Provider Training Webinars

Beginning January 7, 2020, and continuing throughout the month of January, Medi-Cal providers may participate in provider training webinars that are:

Providers will be able to print class materials and ask questions during the training sessions. Recorded webinars will be archived and available for on-demand viewing from the MLP.

To view the webinars, providers must have internet access and a user profile in the MLP. Detailed instructions about the registration process and how to access webinar classes are available on the Outreach & Education page of the Medi-Cal website.

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8. February 2020 Medi-Cal Provider Seminar

The February Medi-Cal provider seminar is scheduled for Feb. 11 – 12, 2020, at the Santa Ana Double Tree by Hilton in Santa Ana, California. Providers can access a class schedule for the seminar by visiting the Provider Training webpage of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging into 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 new and experienced providers and billing staff, cover the following topics:

Providers must register by January 24, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After January 24, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks webpage 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 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 webpage and refer to it often for current seminar information.

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9. 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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10. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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