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Medi-Cal Update

Durable Medical Equipment and Medical Supplies | July 2021 | Bulletin 550

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1. In-Person Signature Requirement for Delivered Medications

In an April 28, 2020 article titled, “Temporary Suspension of In-Person Signature Requirement for Delivered Medications,” the Welfare and Institutions Code, Section 14043.341 requirement that “providers who dispense controlled drugs, dangerous drugs or dangerous devices to a Medi-Cal beneficiary to maintain a record of the signature of the person receiving the drug or device” was waived pursuant to Executive Order (EO) N-55-20 in response to the coronavirus disease 2019 (COVID-19) public health emergency.

EO N-55-20 will expire on June 30, 2021 per Governor Newsom’s most recent EO N-08-21 (issued June 11, 2021) to lift specific COVID-19-related executive orders that were put in place since March 2020. The Department of Health Care Services will end this policy change effective July 1, 2021 for all programs. Beneficiaries and clients, or their representatives, will need to sign for medications in person from their home or sign onsite at their provider location.

 

2. Additional Practitioner Types Allowed to Prescribe DME Items

Effective for dates of service on or after August 1, 2021, Medi-Cal has expanded the practitioners who can prescribe Durable Medical Equipment (DME) items to include Physicians, Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants.

 

3. Medi-Cal Provider Website: Future Enhancements and Changes

The Department of Health Care Services (DHCS) is committed to improving and enhancing the Medi-Cal Provider website. As such, DHCS launched its series of ongoing releases of enhancements, updates and changes to improve website navigation and user experience.

DHCS will incorporate Provider and Stakeholder feedback, industry best practices and California State web publishing guidelines when evaluating potential website changes. This new update includes:

  • Standardized website color scheme, font and formatting

  • Improved navigation and organization for Publications News, Provider Bulletins and Provider Manuals

  • Updated filters and sorting capabilities on the Medi-Cal News Articles page

  • Added ability for search to yield only News and Provider Bulletins content

A complete list of the enhancements, updates and additional website changes can be viewed within the Medi-Cal Provider Website Release Change Log (PDF file size 158 KB).

Providers are also encouraged to subscribe to the free Medi-Cal Subscription Service (MCSS). The MCSS allows each subscriber to choose and tailor both the subject matters and types of communications they wish to receive from the Medi-Cal Program.

 

4. September Virtual Claims Assistance Room Events

Receive free one-on-one billing assistance at our Virtual Claims Assistance Room (CAR) event scheduled for the month of September.

Multiple morning and afternoon sessions are available.

Providers must register through the Mediā€‘Cal Learning Portal Event Calendar.

Reminder: First time users must complete a one-time registration. For instructions on how to enroll in one of these sessions, use the link to the short video in the descriptive text on the “Provider Seminars and Webinars” tile on the Medi-Cal Learning Portal home page.

Providers are encouraged to bring their more complex billing issues to receive individual assistance from a Provider Field Representative.

For additional assistance, please contact the Telephone Service Center (TSC) at 1-800-541-5555.

 

5. Updates to the List of Enteral Nutrition Products

Recently, the Department of Health Care Services (DHCS) updated the List of Enteral Nutrition Products with changes effective July 1, 2021.

Please note that the Maximum Acquisition Cost (MAC) and Estimated Acquisition Cost (EAC) pricing for Abbott Nutrition’s Ensure Harvest product and Nestlé HealthCare Nutrition’s four Compleat Organic Blends products were listed incorrectly. The correct MAC and EAC pricing, effective July 1, 2021, is as follows:


Manufacturer Product Label Name Medi-Cal Billing Code (NDC like number) MAC per gm or ml EAC per gm or ml
Abbott Nutrition  Ensure Harvest 8oz Recloseable Carton 70074067965 0.0145 0.0161
Nestlé HealthCare Nutrition Compleat Pediatric Organic Blends – Chicken-Garden Blend, 24 x 10.1oz (300mL) pouch 43900084642 0.0131 0.0147
Nestlé HealthCare Nutrition Compleat Pediatric Organic Blends – Plant Based, 24 x 10.1oz (300mL) pouch 43900011721 0.0131 0.0147
Nestlé HealthCare Nutrition Compleat Organic Blends – Chicken-Garden Blend, 24 x 10.1oz (300mL) pouch 43900047993 0.0153 0.0169
Nestlé HealthCare Nutrition Compleat Organic Blends – Plant Based, 24 x 10.1oz (300mL) pouch 43900019270 0.0153 0.0169

For dispensing to eligible Medi-Cal fee-for-service outpatient beneficiaries, the contractors have guaranteed that Medi-Cal providers may purchase, upon request, the products at or below the MAC with an approved Treatment Authorization Request (TAR) or a Service Authorization Request (SAR). Providers can locate MAC price suppliers by calling manufacturer phone numbers referenced in the List of Enteral Nutrition Products.

Listing of a product is not a guarantee of its availability. The product number approved on an authorization must be the same product number dispensed to the beneficiary and claimed for reimbursement by the provider.

The amount reimbursed to providers for enteral nutrition products shall not exceed the published estimated acquisition cost (EAC) plus a 23 percent markup.

Medi-Cal beneficiaries denied enteral nutrition products who believe the denial was in error may ask for a state hearing by contacting the California Department of Social Services at 1-800-743-8525 or 1-855-795-0634 or by sending a written request to:

California Department of Social Services
State Hearings Division
P.O. Box 944243, MS 9-17-37
Sacramento, CA   94244-2430

 

6. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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.

 

7. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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