Family PACT Update

June 2021 | Bulletin 165


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1. Family PACT Update: DMPA-SQ as Permanent Pharmacy Benefit

An article titled “Family PACT Update:  DMPA-SQ Administration Guidelines” temporarily allowed for pharmacy dispensing of subcutaneous depot medroxyprogesterone acetate (DMPA-SQ) directly to Family Planning, Access, Care and Treatment program clients for self-administration at home. This was pursuant to flexibilities related to the coronavirus disease 2019 (COVID-19) public health emergency. DMPA-SQ is now made a permanent pharmacy benefit.

Provider Manual(s) Page(s) Updated
Family PACT ben fam (17); ben grid (4, 45); pharmacy (9, 17)

2. Start of the Reporting Year (RY) 2023 Payment Error Rate Measurement (PERM) Cycle

The California Department of Health Care Services (DHCS) wishes to notify all California Medi-Cal providers of the start of the Reporting Year (RY) 2023 Payment Error Rate Measurement (PERM) by the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS). The purpose of PERM is to identify erroneous payments made in Medicaid and the Children’s Health Insurance Program (CHIP) in all 50 states and report improper payment estimates to Congress.

During RY 2023 PERM, Medicaid and CHIP Medi-Cal claims will be randomly selected for Medical Reviews for the fiscal year beginning July 1, 2021, and ending June 30, 2022. Your cooperation will help ensure that the payment measurement rate for PERM reviews are accurate and that California retains its much-needed federal match monies for the Medi-Cal program.

What if one of my claims is selected for the PERM?

If one of your Medi-Cal claims is selected for the PERM, you will receive a notification letter from DHCS letting you know you have been selected, and the CMS Review Contractor, (RC) NCI Information Systems, Inc., will be contacting you for medical records. The letter from DHCS will not contain patient specific information.

The RC will contact you via telephone to verify your contact information and, patient name. The RC will also arrange to send you an official request letter on CMS letterhead detailing what information is needed.

DHCS anticipates its notification letters will be sent out for the first quarter of sampled claims in late 2021. The RC may begin contacting quarter one providers in late 2021 or early 2022. A total of four quarters of claims will be selected for review during the PERM cycle so it is possible you may receive multiple requests at different times during the PERM process.

Am I obligated to submit medical records for the PERM?

Yes. One of the most common types of error findings are caused by providers failing to respond to requests for medical records. Another error finding frequently cited is submission of insufficient documentation.

To reduce error findings in PERM reviews and ensure that providers are compliant with State and federal regulations, DHCS would like to remind providers of the following:

  • Title 22 of the California Code of Regulations, Section 51476, states that, “each provider shall keep, maintain, and have readily retrievable, such records as are necessary to fully disclose the type and extent of services provided to a Medi-Cal beneficiary.” This includes medical records, orders, treatment authorization requests, and the time and date of service for each beneficiary.

  • Under Sections 1902(a)(27) and 2107 (b)(1) of the Social Security Act, CMS and their representatives have the authority to collect all documentation to support a Medicaid claim.

  • DHCS requires all enrolled providers to report changes to any information previously submitted as part of the provider enrollment application package, which includes the business address or phone number, within 35 days of the date of change.

  • Failure to respond to requests for medical records may result in suspension from the Medi-Cal program as per Welfare and Institutions Code (W&I), Section 14124.2(b)(1) and Section 14124.2.

Not only do error findings affect California’s PERM rate, but claims cited with error findings at the conclusion of the medical review are also considered improperly paid. Therefore, in accordance with W&I Section 14172.5, DHCS is authorized to recoup these payments. Providers that receive a demand for recovery of claim payments are urged to remit the demand amount as soon as possible.

Where can I find out more about PERM and my responsibility to participate?

You can find more information about PERM on the DHCS website:
https://www.dhcs.ca.gov/individuals/Pages/AI_MRB_PERM.aspx

You can find information about provider specific responsibility on the CMS PERM website:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicaid-and-CHIP-Compliance/PERM/Providers

You may contact a member of the DHCS PERM Team with your questions at:
PERM@dhcs.ca.gov

3. Reminder: Acceptable Benefits Identification Card Designs

The Department of Health Care Services (DHCS) would like to remind providers that the California poppy and the blue and white versions of the Benefits Identification Card (BIC), are still to be accepted by providers.

Providers must continue to verify eligibility. Possession of a Medi-Cal BIC does not guarantee eligibility. Providers may refer to the Eligibility: Recipient Identification section of the Part 1 provider manual for more details.

State of California Benefits Identification Card Poppy Version        State of California Benefits Identification Card Blue and White Version

4. June 2021 Medi-Cal Provider Training Webinars

Provider Outreach and Education along with the Department of Health Care Services, is offering category-specific webinar sessions in June. Training categories offered will include the following:

  • Resources: June 1, 2021, and June 2, 2021

  • Long Term Care: June 10, 2021

  • Common Denials: June 15, 2021

  • Claims: June 23, 2021

  • Presumptive Eligibility Programs: June 29, 2021

A variety of courses will be offered in each of the training categories listed. Providers must register through the Medi Cal Learning Portal (MLP) Event Calendar. Providers will be able to print class materials and ask questions during the training sessions. 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 Provider website.

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

5. July 2021 Medi-Cal Provider Training Webinars

Beginning July 6, 2021, continuing throughout the month of July, Medi-Cal providers may participate in the following category-specific webinar sessions.

Categories offered will include the following:

  • Family PACT: July 6, 2021

  • Health Access Programs: July 8, 2021

  • Medical Services: July 13, 2021

  • Home Health Services: July 21, 2021

  • Specialty Programs: July 27, 2021

A variety of courses will be offered in each of the categories listed. Providers must register through the Medi-Cal Learning Portal (MLP) Event Calendar.

Providers will be able to print class materials and ask questions during the training sessions.

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.

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

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!

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  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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