Medi-Cal Update

Vision Care | November 2019 | Bulletin 502

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1. Notice: Obsolete CHDP Information Retired

After November 2019, Child Health and Disability Prevention (CHDP) program information is incorporated into several Medi-Cal provider manuals, including the General Medicine and Clinics and Hospitals manuals.

CHDP Manual Discontinued
The CHDP Provider Manual primarily contained instructions for billing non-HIPAA compliant local codes on the Confidential Screening/Billing Report (PM 160) claim form. This information is outdated and is discontinued.

New EPSDT/CHDP Provider Manual Sections
CHDP program information may now be found in three new EPSDT/CHDP provider manual sections, as follows:

Title Content
EPSDT/CHDP Most of the CHDP policy moved from the obsolete CHDP Provider Manual is captured in this section, including information about:

CHDP program background, provider enrollment, provider responsibilities, recipient eligibility, components of health assessments and immunizations. There is some billing instruction but most of the billing is according to standard Medi-Cal practices as explained in the provider manual billing sections.

The Part 2 Medi-Cal manual section, Child Health and Disability Prevention (CHDP) Program, is discontinued, with select information incorporated into this new EPSDT/CHDP section.
EPSDT/CHDP: Gateway This section contains information from the former Gateway and Gateway Transactions Overview sections.
EPSDT/CHDP: School-Based Services Primarily carried over from CHDP Provider Manual section, CHDP Transition to National Standards: School-Based Services.

The three EPSDT/CHDP sections do not contain new policy.

Note:

Providers were notified in a previous NewsFlash titled “Transition of CHDP Information to EPSDT/CHDP Sections” that providers wishing to retain CHDP Provider Manual content for future research should save the manual sections to their own computers. After November 30, 2019, there is no assurance the former CHDP Provider Manual sections will be available on the Medi-Cal website.

CHDP More Closely Aligned with EPSDT Section in Medi-Cal Manual
In California, CHDP administers the Early and Periodic screening components of the federally mandated Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for individuals under the age of 21. The CHDP program information is now aligned with the EPSDT section of the Medi-Cal provider manual under EPSDT/CHDP.

Finding EPSDT/CHDP Information
The EPSDT/CHDP sections will publish in the following Part 2, Medi-Cal provider manuals. Additionally, EPSDT/CHDP articles will publish in the monthly bulletin that corresponds to each of the following manuals:

CHDP Updates Continue
The Department of Health Care Services (DHCS) is working diligently to update CHDP information in provider manuals and on both the Medi-Cal and DHCS websites. Because both the DHCS and Medi-Cal websites have or will undergo reorganization, updating efforts will continue for some time.

Providers are encouraged to watch for EPSDT/CHDP updates in the NewsFlash area on the Medi-Cal website and subscribe to MCSS to receive timely notifications related to CHDP by completing the MCSS Subscriber Form.

CHDP Gateway Internet User Guide
Recent updates were made to the CHDP Gateway Internet Step-by-Step User Guide unrelated to this process. Providers are encouraged to review the guide for current information regarding CHDP Gateway transactions.

Questions
Providers with questions may call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

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

Provider Manual(s) Page(s) Updated
Part 1 check (1); cmc enroll (1–7, 12); elect (1); prog (4); prov guide (11)
Acupuncture
Chiropractic
cms comp (21)
Audiology and Hearing Aids
Obstetrics
Orthotics and Prosthetics
cal child bil guide (1); cms comp (21); epsdt chdp (1–31); epsdt chdp gate (1–13)
Chronic Dialysis Clinics
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational Agency
Rehabilitation Clinics
cal child bil guide (1)
Clinics and Hospitals cal child bil guide (1); epsdt chdp (1–31); epsdt chdp gate (1–13); epsdt chdp school (1–6); spec (6)
Durable Medical Equipment
Medical Transportation
Pharmacy
Therapies
cal child bil guide (1); cms comp (21)
General Medicine cal child bil guide (1); cms comp (21); epsdt chdp (1–31); epsdt chdp gate (1–13); epsdt chdp school (1–6); spec (6)
Psychological Services cal child bil guide (1); cms comp (21); epsdt chdp (1–31); epsdt chdp gate (1–13); spec (6)
Vision Care cal child bil guide (1); cms comp vc (11); epsdt chdp (1–31); epsdt chdp gate (1–13); pia (1); rates max eye app (2)
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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. 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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4. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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