Family PACT Update

January 2022 | Bulletin 172

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1. Medi-Cal Rx Implemented: Reminder Notification

Effective January 1, 2022, Medi-Cal Rx is fully implemented.

As part of this transition, the pharmacy Medi-Cal provider manual, Family PACT Policies, Procedures and Billing Instructions manual and Medi-Cal Providers website were updated to remove or alter billing policy and information regarding pharmacy claims, where appropriate. Providers interested in what was removed may refer to the December 31, 2021, Medi-Cal Update.

What remains is a version of the pharmacy provider manual and Pharmacy community that focuses primarily on professional and institutional billing policy relevant to pharmacy providers who continue to bill Medi-Cal for appropriate services.

Pharmacy providers looking for instruction on how to bill and submit claims to Medi-Cal Rx should refer to the Medi-Cal Rx Provider Manual on the Medi-Cal Rx website. The Medi-Cal Rx Provider Manual is considered current billing policy on January 1, 2022.

Pharmacy claims submitted on or after January 1, 2022, will be adjudicated and processed by Medi-Cal Rx. Providers seeking assistance with the status of their pharmacy claims or instructions on how to properly submit to Medi-Cal Rx should refer to the Medi-Cal Rx website.

Providers may sign up for the Medi-Cal Rx Subscription Service (MCRxSS) to be notified of updates or announcements related to Medi-Cal Rx.

2. Billing Unit for Contraceptive Vaginal Gel

The Family Planning, Access, Care and Treatment (Family PACT) Program is issuing a clarification to the billing unit for HCPCS code A4269U5 (contraceptive supply, vaginal gel). The billing unit has been updated to reflect “box” Instead of “gram.”

Provider Manual(s) Page(s) Updated
Family PACT ben grid (45); clinic (9); drug onsite (1)

3. HAP Client Eligibility System Updated to Capture Modality Used for Enrollment

Effective for dates of service on or after February 1, 2022, the Health Access Programs (HAP) client eligibility system is updated to capture the modality used to enroll or recertify applicants or clients in the Family Planning, Access, Care and Treatment (Family PACT) Program. Family PACT providers may enroll or recertify clients via phone, audio-visual or in-person and must denote the modality used in the HAP system.

4. Rates Update for Certain Contraceptive Drugs

Effective for dates of service on or after October 1, 2021, HCPCS code J3490 with modifier U6 (Levonorgestrel, 1.5 mg) and modifier U8 (Medroxyprogesterone Acetate, 150 mg/ml) have been updated as follows:

HCPCS Code with Modifier Description Rate
J3490 U6 Levonorgestrel, 1.5 mg $9.29
J3490 U8 Medroxyprogesterone Acetate, 150 mg/ml $44.64

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 were paid based on the previously published rate.

5. Updates to Family PACT and Medi-Cal Programs Clinic Dispensing Policy for STIs

Effective for dates of service on or after February 1, 2022, the Family Planning, Access, Care and Treatment (Family PACT) and Medi-Cal family planning programs have updated the policy and treatment benefits for Sexually Transmitted Infections (STIs) for clinic dispensing. These updates are in accordance with the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Infections Treatment Guidelines, 2021.

6. Hospital Presumptive Eligibility: Residency Requirements for Refugees

In order to enroll applicants in Hospital Presumptive Eligibility (HPE), qualified providers must determine whether the applicant is a state resident. However, many evacuees or refugees temporarily housed at U.S. military bases may not know when or where they will be resettled.

Per November 2021, direction from Centers for Medicare & Medicaid Services (CMS) on Health Coverage Options for Afghan Evacuees, qualified providers can accept the state where the individual is temporarily housed as their state of residence.

HPE applications are completed via self-attestation and an applicant cannot be required to provide proof of income, immigration status, or state residency. Qualified providers must accept attested information provided by the individual.

7. March Virtual Claims Assistance Room (CAR) Event

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

There are multiple morning and afternoon sessions available. Providers must register through the Medi Cal Learning Portal using the Event Calendar.

Reminder: First time users must complete a one-time registration. There is a link to a short video in the descriptive text under the “Provider Seminars and Webinars” tile on the Medi-Cal Learning Portal homepage, that gives directions on how to register for one of these sessions. Providers can also download the video file.

Providers are encouraged to bring their more complex billing issues and 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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