Family PACT Update

July 2021 | Bulletin 166

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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. Family PACT Adds Phexxi as a Pharmacy Benefit

Effective for dates of service on or after July 1, 2021, Phexxi® contraceptive vaginal gel (lactic acid, citric acid and potassium bitartrate) is a pharmacy benefit for the Family Planning, Access, Care and Treatment (Family PACT) Program.

Provider Manual(s) Page(s) Updated
Family PACT ben grid (44); pharmacy (9, 17)

3. Removal of Sex Indicator From Benefits Identification Card

Beginning September 1, 2021, Medi-Cal will no longer print a sex indicator on the face of newly-created Benefits Identification Cards (BIC). All other information displayed on the face of the BIC, in addition to the information contained in the magnetic strip on the back of the card, will remain unchanged. Providers should continue to accept all BIC designs currently in circulation and verify eligibility accordingly.

These changes will be reflected in a future Medi-Cal Update.

4. Updated Rates for Hormone Containing Vaginal Rings

Effective for dates of service on or after April 1, 2021, rates are updated for claims billed with HCPCS code J7303 (contraceptive supply, hormone containing vaginal ring, each) and modifier U1 (etonogestrel and ethinyl estradiol) or U2 (segesterone acetate and ethinyl estradiol vaginal system), as follows:

Procedure Code with Modifier Description Rate
J7303 U1 Contraceptive vaginal ring, each (etonogestrel and ethinyl estradiol)  $121.62  
J7303 U2 Contraceptive vaginal ring (segesterone acetate and ethinyl estradiol vaginal system)  $2,090.00  

5. Updated Rates for Select Physician-Administered Drugs

Effective for dates of service on or after April 1, 2021, reimbursement rates are updated for claims billed with HCPCS code J3490 (unclassified drugs) with the following modifiers:

Procedure Code with Modifier Description Rate
J3490 U5 Ulipristal acetate, 30 mg $34.28
J3490 U6 Levonorgestrel, 1.5 mg $9.28
J3490 U8 Medroxyprogesterone acetate, 150 mg/ml $41.42

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because Medi-Cal had not yet implemented the system changes to support appropriation and adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Part 2 Medi-Cal Provider Manual.

6. 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 Medi‑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.

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