Medi-Cal Update

Psychological Services | July 2019 | Bulletin 526

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1. Update: Fiscal Intermediary Transition Frequently Asked Questions

The Department of Health Care Services (DHCS) California Medicaid Management Information System (MMIS) Division is engaged in a multi-year initiative to transition contracts for the Fiscal Intermediary (FI) responsible for the business operations of fee-for-service Medi-Cal.

The transition from the current vendor to the incoming FI, DXC Technology Services, LLC, shall occur on October 1, 2019, with a primary objective being a successful transition without disruptions to state programs, providers or beneficiaries.

As part of our commitment to keeping the provider community informed throughout this process, DHCS began releasing Frequently Asked Questions on the Medi-Cal website. The first round of FAQs was released in a previously published NewsFlash article titled “Fiscal Intermediary Frequently Asked Questions” The following questions and answers are a continuation of this effort.

FI Transition FAQs:

  1. Is Medi-Cal making any changes to Computer Media Claims (CMC)/electronic claim submissions or electronic attachments with the transition to the new FI on October 1, 2019?

    No. Medi-Cal is not making any changes to electronic claims or attachment submission requirements prior to October 1, 2019. Providers and/or submitters are not expected to reapply or retest as part of the vendor transition.

  2. Is Medi-Cal making any changes to the hours of operation for any of the provider or member support areas?

    All areas, with one exception, are retaining the same hours of operation for provider and member support. Effective October 1, 2019, the hours of operation for the Point of Service (POS) Helpdesk/ Internet Help Desk is 8 a.m. to 5 p.m., Monday through Friday, except holidays. Providers and submitters may need to update business or operational practices to align with this change.

  3. Will I need to submit my applications via a different portal from the Provider Application and Validation for Enrollment (PAVE)?

    No. If you currently enroll through PAVE, you will continue to enroll through PAVE. The transition to a new vendor does not impact provider enrollment processes or the PAVE provider enrollment portal PAVE.

  4. Will my current provider ID numbers change once the transition occurs?

    No. The transition will have no impact on provider ID numbers; current provider ID numbers will not change once the transition occurs. Additionally, Provider Identification Numbers (PINs) will not change.

  5. Will my application be fully processed if I am already in the enrollment process during the transition?

    The transition will have no impact on the provider enrollment process, or providers who are in the enrollment process during the transition.

  6. How will I be notified of further changes?

    Updates about the transition will be posted on the Medi-Cal website.

    To receive personalized email notifications with links to the most up-to-date information, providers may subscribe to the Medi-Cal Subscription Service (MCSS) MCSS Subscriber Form on the Medi-Cal website.

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2. Cognitive Skills Development Code Erroneously Denied for Certain Providers

The Department of Health Care Services (DHCS) identified a claims processing issue denying reimbursement for certain providers when billing with HCPCS code G0515 (development of cognitive skills to improve attention, memory, problem solving, direct patient contact, each 15 minutes). The issue has been resolved. No action is required of providers. Claims for code G0515 with dates of service on or after February 1, 2018, will be reprocessed.

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

Provider Manual(s) Page(s) Updated
Psychological Services psychol (9); psychol cd (1, 3)
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3. EPSDT: Policy Overview and New Provider Manual Section

The new EPSDT provider manual section is available to help providers understand the scope of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

EPSDT
EPSDT services are a benefit of the Medi-Cal program as specified in Title XIX of the Social Security Act (SSA), Section 1905(r)(5) [Title 42 of the United States Code, Section 1396d(r)]. The benefits covered under EPSDT provide comprehensive and preventive health care services for individuals under 21 years of age who are enrolled in Medi-Cal. These services are key to ensuring that children and youth receive appropriate preventive medical, dental, vision, hearing, mental health, substance use disorder, developmental and specialty services, as well as all necessary services to address any defects, illnesses or conditions identified.

Medical Necessity
The standards to meet medical necessity differ between Medi-Cal and EPSDT. The EPSDT standard is as follows:

EPSDT services are medically necessary or a medical necessity if they correct or ameliorate defects and physical and mental illnesses and conditions discovered through screening. This standard is set forth in Title XIX of the Social Security Act, Section 1905(r)(5) and in Welfare and Institutions Code (W&I Code), Section 14059.5(b)(1).

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

Provider Manual(s)

Page(s) Updated

Part 1 cmc enroll (1, 9); mcp cohs (3); mcp gmc (5); mcp imperial (4); mcp spec (2, 4, 11); mcp two plan (4)
Acupuncture hcpcs iii (1)
Adult Day Health Care Centers audio (2); hcpcs iii (1); ind health (2, 4); ind health cd (3); spe dev (7); tar field (1, 2); ub comp op (10)
AIDS Waiver Program hcpcs iii (1); medi non hcp (2); modif app (10); ub comp op (10)
Audiology and Hearing Aids audio (2); cal child (3); epsdt (1–7); hcpcs iii (1); hear aid bill (6); medi cr cms (5); medi non hcp (2); modif app (10); spe dev (7); tar field (1, 2)
Chiropractic hcpcs iii (1); medi cr cms (5)
Chronic Dialysis Clinics cal child (3); hcpcs iii (1); medi non hcp (2); modif app (10); tar field (1, 2); ub comp op (10)
Clinics and Hospitals cal child (3); epsdt (1–7); hcpcs iii (1); incont (1); ind health (2, 4); ind health cd (3); medi non hcp (2); modif app (10); spec (3); spe dev (7); tar field (1, 2); ub comp op (10)
Durable Medical Equipment cal child (3); hcpcs iii (1); incont (1); medi cr cms (5); medi non hcp (2); modif app (10); spe dev (7); tar field (1, 2)
General Medicine cal child (3); epsdt (1–7); hcpcs iii (1); incont (1); medi cr cms (5); medi non hcp (2); modif app (10); spec (3); tar field (1, 2)
Heroin Detoxification hcpcs iii (1); medi non hcp (2); tar field (1, 2); ub comp op (10)
Home Health Agencies/Home and Community-Based Services cal child (3); hcpcs iii (1); home (5); medi non hcp (2); modif app (10); ped (1–6); tar field (1, 2); ub comp op (10)
Hospice Care Program hcpcs iii (1); medi non hcp (2); tar field (1, 2); ub comp op (10)
Inpatient Services cal child (3); hcpcs iii (1); tar field (1, 2); ub comp ip (11)
Local Educational Agency cal child (3); hcpcs iii (1); modif app (10); ub comp op (10)
Long Term Care epsdt (1–7); incont (1); tar field (1, 2)
Medical Transportation cal child (3); hcpcs iii (1); medi cr cms (5); medi non hcp (2); modif app (10); tar field (1, 2)
Multipurpose Senior Services Program hcpcs iii (1); ub comp op (10)
Obstetrics cal child (3); epsdt (1–7); hcpcs iii (1); medi cr cms (5); medi non hcp (2); modif app (10); tar field (1, 2)
Orthotics and Prosthetics cal child (3); epsdt (1–7); hcpcs iii (1); medi cr cms (5); medi non hcp (2); modif app (10); spe dev (7); tar field (1, 2)
Pharmacy cal child (3); epsdt (1–7); incont (1); medi non hcp (2); tar field (1, 2)
Psychological Services cal child (3); epsdt (1–7); hcpcs iii (1); medi cr cms (5); medi non hcp (2); spec (3); tar field (1, 2)
Rehabilitation Clinics audio (2); cal child (3); hcpcs iii (1); medi non hcp (2); modif app (10); spe dev (7); tar field (1, 2); ub comp op (10)
Therapies audio (2); cal child (3); hcpcs iii (1); medi cr cms (5); medi non hcp (2); modif app (10); spe dev (7); tar field (1, 2)
Vision Care cal child (3); epsdt (1–7); medi non hcp (2); modif app (10); modif used vc (2)
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4. Updated Reimbursement Rates for Allied Health and Other Programs

Effective retroactively for dates of service on or after July 1, 2018, rates are updated for Allied Health and Other Programs. No action is required of providers; an Erroneous Payment Correction (EPC) will be issued for dates of service on or after July 1, 2018. See below for the updated rates.

HCPCS Code Description Old Rate New Rate
G0156 Services of home health/hospice aide in home health or hospice settings, each 15 minutes 0 $7.09
G0162 Skilled services by a registered nurse (RN) for management and evaluation of the plan of care; each 15 minutes 0 $17.04
G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes 0 $15.21
G0300 Direct skilled nursing services of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes 0 $11.03
S9123 Nursing care, in the home; by registered nurse, per hour $31.94 $47.91
S9124 Nursing care, in the home; by licensed practical nurse, per hour $24.42 $36.63
T1002 RN services, up to 15 minutes 0 $16.74
T1003 LPN/LVN services, up to 15 minutes 0 $12.13
T1016 Case management, each 15 minutes $9.94 $13.41
T1026 Pediatric comprehensive care package, per hour 0 $44.12
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5. Counseling to Prevent Perinatal Depression is Now Reimbursable

Effective for dates of service on or after February 12, 2019, and consistent with the U.S. Preventive Services Task Force recommendation, Medi-Cal will now reimburse individual and/or group counseling sessions for pregnant or postpartum women with certain depressive, socioeconomic and mental health related risk factors. These risk factors include perinatal depression, a history of depression, current depressive symptoms (that do not reach a diagnostic threshold), low income, adolescent or single parenthood, recent intimate partner violence, elevated anxiety symptoms and a history of significant negative life events.

Up to a combined total of 20 individual counseling (CPT codes 90832 and 90837) and/or group counseling (CPT code 90853) sessions are reimbursable when delivered during the prenatal period and/or during the 12 months following childbirth. Modifier 33 must be submitted on claims for counseling given to prevent perinatal depression.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
preg early (2); preg post (4); prev (8)
Home Health Agencies/Home and Community-Based Services
Inpatient Services
preg post (4)
Obstetrics preg early (2); preg post (4)
Psychological Services psychol (1, 3, 4, 9)
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6. August 2019 Medi-Cal Provider Seminar

The August Medi-Cal provider seminar is scheduled for August 14 - 15, 2019, at the Long Beach Marriott in Long Beach, 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 California Medicaid Management Information System (CA-MMIS) 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, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After July 31, 2019, 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 regional representative.

Providers are encouraged to bookmark the Provider Training web page and refer to it often for current seminar information.

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7. 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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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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