Medi-Cal Update

Hospice Care Program | January 2020 | Bulletin 544

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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. 2020 HCPCS Annual Update

The 2020 updates to the Healthcare Common Procedure Coding System (HCPCS) codes are available in the 2020 HCPCS Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for dates of service on or after January 1, 2020. Please refer to the 2020 HCPCS code book for complete descriptions of these codes.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
chemo drug e-o (9); chemo drug p-z (7–9); inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); presum bill (12); radi nuc (3, 4); radi onc (12, 13); surg eye (12); vaccine (4)
Obstetrics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); presum bill (12); radi nuc (3, 4); radi onc (12, 13); vaccine (4)
Pharmacy dura bil wheel (6); dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); dura inf (3); dura other (22); inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mc sup (2); ortho auth ortho (31, 32); ortho auth pros (42); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); presum bill (12); tax (9, 10)
Durable Medical Equipment dura bil wheel (6); dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); dura inf (3); dura other (22); mc sup (2); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); tax (9, 10)
Orthotics and Prosthetics dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); ortho auth ortho (31, 32); ortho auth pros (42); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); tax (9, 10)
Therapies dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3)
Rehabilitation Clinics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); vaccine (4)
Chronic Dialysis Clinics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); vaccine (4)
Psychological Services psychol (4, 9); psychol cd (3)
Audiology tax (9, 10)
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3. Annual Hospice Reimbursement Rates Update

Effective for dates of service on or after October 1, 2019, the Department of Health Care Services (DHCS) has updated the Medi-Cal reimbursement rates for the 2019 – 2020 daily and hourly hospice rates for routine home care, continuous home care, inpatient respite care, general inpatient care and service intensity add-on for hospice providers.

Providers should bill using the new hospice care rates. Providers do not need to rebill to adjust their payments. The California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) will reprocess any retroactive rate adjustments for claims paid at the old rate for services provided on or after October 1, 2019.

For billing or payment questions, providers should call the Telephone Service Center at (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday.

Providers can find their rates posted on the Hospice Care page of the DHCS website.

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4. 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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5. 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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6. 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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7. 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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8. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Additions, effective January 1, 2020
NDC Labeler Code Contracting Company’s Name
21922 ENCUBE ETHICALS
50261 THERAPEUTICSMD
61990 APOLLO PHARMACEUTICALS USA INC.
69800 ADMA BIOLOGICS, INC.
70752 QUAGEN PHARMACUETICALS LLC
71626 MEDSTONE PHARMA LLC
71839 BE PHARMACEUTICALS INC.
72000 NABRIVA THERAPEUTICS US, INC.
72028 HARMONY BIOSCIENCES, LLC
72065 XERIS PHARMACEUTICALS, INC.
72266 FOSUN PHARMA USA
72485 ARMAS PHARMACEUTICALS INC.
72572 CIVICA, INC.
72694 SERVIER PHARMACEUTICALS LLC
 
Terminations, effective January 1, 2020
NDC Labeler Code Contracting Company’s Name
13310 AR SCIENTIFIC, INC.
20482 INSYS THERAPEUTICS, INC.
53329 MEDLINE INDUSTRIES, INC.
66663 PHARMELLE, LLC

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Multipurpose Senior Services Program
Obstetrics
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (6, 7, 10, 11, 14, 16, 18, 20, 21)
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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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