CalOptima is now CalOptima Health. The agency’s Board of Directors approved the new name at its August 4 meeting. As part of this change, CalOptima Community Network will become CalOptima Health Community Network.

CEO Michael Hunn told the Board that adding “Health” to the name was important, both to encapsulate the agency’s main focus and to increase community recognition of the organization as a health care plan. In late 2021, a public survey poll of 904 Orange County residents found that while more than 60% reported they had heard of CalOptima, fewer than half were aware that the agency’s primary role is to provide health coverage.

Along with the name change, the Board approved a new logo, replacing the previous one in use since 2009. The new logo signifies the agency’s community of members, providers and partners and represents the following attributes:

• Communication
• Connection
• Diversity
• Innovation
• Excellence
• Inspiration
• Growth
• Wellness

In partnership with providers, CalOptima Health looks forward to continuing to serve the needs of our members as it embarks on a new chapter in the agency’s history.

The Department of Health Care Services (DHCS) shared important information regarding monkeypox and Medi-Cal benefits for testing and vaccines, in light of the state of emergency Gov. Gavin Newsom declared on August 1. As of August 12, there were 11,177 confirmed cases in the United States, with 1,945 cases in California.

Monkeypox is caused by an orthopoxvirus similar to smallpox, though less severe and transmittable. The disease manifests as flu-like symptoms, fever and a rash that usually appears within 1–3 days after the fever. Monkeypox is mainly transmitted by direct contact with infectious sores, scabs or bodily fluids through activities such as sex, kissing or other forms of close physical contact. It can also be transmitted by touching contaminated items such as clothing and bedding.

The new Current Procedural Terminology (CPT) code 87593 should be used to report monkeypox testing. This code is not currently a billable Medi-Cal benefit. Medi-Cal will provide instructions for billing once the claims adjudication system is ready. Until then, providers should test for monkeypox when medically indicated and hold the Medi-Cal claim submission. For more information, see the Medi-Cal NewsFlash from July 28.

Vaccination helps protect against monkeypox when given before or shortly after exposure. Two vaccines have been approved by the U.S. Food and Drug Administration: Jynneos (also known as Imvamune or Imvanex) and ACAM2000. The latter is licensed for use against smallpox but is available for use against monkeypox under an Expanded Access – Investigational New Drug Application. Vaccines are available through local health departments based on supply. The federal government has allocated a limited number of vaccines for California, so the current recommendation is to vaccinate people who have been exposed to monkeypox or are more likely to contract it. Information about vaccine allocations can be found on the California Department of Public Health’s (CDPH) website.

These vaccines are a Medi-Cal benefit. However, providers should hold off submitting these claims until further billing instructions are released.

There are no treatments specifically for monkeypox viral infections, but antivirals such as tecovirimat (TPOXX) may be recommended for patients who are more likely to become severely ill, such as those with weakened immune systems.

For additional information, please visit the monkeypox websites at the Orange County Health Care Agency, CDPH and the Centers for Disease Control and Prevention.

CalOptima Health is committed to ensuring contracted providers have the support needed to provide the best possible health care to our members. If you have not yet participated in the survey on your satisfaction with CalOptima Health, our departments and provider communications, please take a few minutes to complete it by clicking here.

In November 2016, voters approved Proposition 56, the California Healthcare Research and Prevention Tobacco Tax Act, which raised taxes on tobacco products to fund specific DHCS programs. The Physician Services, Family Planning, HYDE (Pregnancy Termination) and Dental directed payment programs will continue to be funded through Proposition 56.

However, several of the programs supported by Proposition 56 are going through funding changes as follows:

• The Value-Based Payments Program ended as of June 30. The program was scheduled to sunset on December 31, 2022, but ended early due to updated legislative funding restrictions.

• There are no programming changes to the Adverse Childhood Experience Screening Services and Developmental Screenings directed pay programs. However, effective July 1, those programs are funded through the state’s General Fund.

• The Community-Based Adult Services, Intermediate Care Facilities for the Developmentally Disabled and Freestanding Pediatric Subacute non-directed payment programs are now funded through the state’s General Fund. The Behavioral Health Integration Incentive Program will continue to be funded by Proposition 56 until the programs ends on December 31, 2022. 

On August 4, CalOptima Health sent contracted providers an alert about Gov. Gavin Newsom’s Executive Order N-6-22 regarding sanctions in response to Russian aggression in Ukraine.

The executive order directs all agencies and departments that are subject to the governor’s authority, including CalOptima Health, to notify all contractors of their obligation to comply with existing economic sanctions imposed by the U.S. and state governments in response to Russia’s actions in Ukraine.

Providers have 60 days from the August 4 notice to review the economic sanctions found on the U.S. Department of the Treasury website and report compliance to CalOptima Health by completing the Compliance With Economic Sanctions Form.

Additionally, providers need to submit a written report describing the steps, if any, they have taken in response to Russia’s actions in Ukraine. An example can be found at this link. Please attach the report to the completed Compliance With Economic Sanctions Form and submit it to providerservicesinbox@caloptima.org.

CalOptima Health urges providers to return the Compliance With Economic Sanctions form as soon as possible.

August is National Immunization Awareness Month, an annual observance to highlight the importance of vaccination for people of all ages. In recognition, CalOptima Health’s OneCare Connect program is reminding providers to use this table of diagnosis (Dx) codes for immunizations.

• On July 21, 2022, DHCS distributed APL 22-013: Provider Credentialing/Recredentialing and Screening/Enrollment and an updated Frequently Asked Questions (FAQs). The purpose of this APL is to inform managed care plans (MCPs) of their responsibilities for screening and enrolling network providers.

• On July 21, 2022, DHCS distributed APL 22-014: Electronic Visit Verification Implementation Requirements. The purpose of this APL is to provide directions for Medi-Cal MCPs for implementing federally mandated Electronic Visit Verification requirements.

Click on the link below to find an outline of changes made to CalOptima Health’s policies and procedures during July 2022. The full description of these policies is available at www.caloptima.org.

Policies and Procedures Monthly Update 

Click below for a list of training webinars and links happening in August 2022:

Health education webinars 

Based on Medi-Cal Bulletins and NewsFlashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:

• Pfizer COVID-19 Vaccine Booster Dose Authorization for Individuals 5 to 11 Years of Age
• 2022 COVID-19 Vaccine Administration FAQs Available
• 2022 HCPCS Quarter 3 Update
• Community Health Worker and Asthma Preventive Services are Medi-Cal Benefits
• Clinical Laboratory Claims Adjustments
• Update to Clinic Dispensing Policy for Certain Family Planning-Related Drugs for Family PACT and Medi-Cal Programs
• O&P Services Recategorized as Surgery Supplies
• September Virtual Claims Assistant Room Event
• New Electronic Claims Resubmission Helps Providers Avoid Paper CIFs/Appeals
• Tax Status Change for Select HCPCS codes
• Guidance for Respiratory DME Codes E0482 and E0483 Updated
• Paper RADs and No Pay Documents Will No Longer Be Mailed Due to Supply Chain Issues
• PHE Telehealth Policy Clarification for Medication Abortion: HCPCS Code S0199
• HPV Vaccine Added as Family PACT Benefit
• Diagnosis-Related Group State Fiscal Year 2022–23 Grouper Setting Updates
• Medi-Cal Coverage of Community Health Worker Services is Effective July 1, 2022

For detailed information regarding these changes, please refer to July General Medicine Bulletin 577, July Durable Medical Equipment and Medical Supplies Bulletin 562, and Medi-Cal NewsFlashes from June 29, June 30, July 1, July 13 and July 14.

• CalOptima Health Board of Directors: September 1 at 2 p.m.
• CalOptima Health Joint Provider and Member Advisory committees: October 13 at 8 a.m.

At this time, all meetings have an option for virtual attendance due to COVID-19. To select the virtual meeting you would like to attend, visit www.caloptima.org/en/About/BoardAndCommitteeMeetings.aspx.

CalOptima Health regularly posts on social media to engage members with heath tips, community resources, event dates, program updates and other pertinent information. Follow the agency on Facebook, Instagram, Twitter and LinkedIn.