School-Aged Medi-Cal Patients Can Receive No-Cost Online Mental Health Services Through Hazel Health |
To make mental health services more accessible for school-aged members in Orange County, CalOptima Health has partnered with Hazel Health and county school districts to provide no-cost online therapy.
Hazel Health works with school districts to provide online therapy that can be accessed at home and, in most cases, at school. Students are matched with a licensed, qualified therapist for weekly one-on-one counseling sessions.
Hazel Health therapists can help with mental health concerns affecting kids and teens, such as:
- Anxiety
- Depression
- Mood changes
- Self-esteem
- Change and transitions
- Grief/loss
- Loneliness
- Academic stress
- Bullying
- Anger management
Other benefits for your Medi-Cal patients include:
- It’s online — Members can join therapy from any connected device
- It’s confidential — No information is shared with the school without parent/guardian consent
- It’s for everyone — A diverse, multilingual therapist team speaks more than 19 languages
If your patients could benefit from Hazel Health’s services, they can call 1-888-541-7063 or visit getstarted.hazel.co. Families can self-refer, and no prior authorization is required. We have also created this flyer that providers can download and share with their patients.
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Review These Important Updates to CalOptima Health Member Health Rewards for 2025 |
CalOptima Health offers health rewards to eligible members for taking an active role in their health. Here are important updates to member health rewards for both Medi-Cal and OneCare (HMO D-SNP), a Medicare Medi-Cal Plan, for 2025.
Medi-Cal:
The following Medi-Cal member health rewards need a completed physical health reward form filled out and attested by the provider for processing and approval:
- Breast Cancer Screening (mammogram)
- Cervical Center Screening
- Colorectal Cancer Screening (colonoscopy only)
- Diabetes A1C Test
- Diabetes Eye Exam (dilated or retinal eye exam)
- Follow-Up Care for Children Prescribed ADHD Medication
- Osteoporosis Screening (bone mineral density test, DXA or DEXA)
- Postpartum Checkup (one to 12 weeks after delivery): The reward is now $25.
The following health rewards do not require provider attestation or a form submission. Members will be rewarded based on claims and encounter data:
- Annual Wellness Visit
- Blood Lead Test at 12 Months of Age
- Blood Lead Test at 24 Months of Age
- Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication
For these health rewards, please submit claims and encounter data in a timely manner.
OneCare:
Both CalOptima Health OneCare Complete (HMO D-SNP) and OneCare Flex Plus (HMO D-SNP) members are eligible to participate in member health rewards. The following health rewards are changing to digital self-submissions. The member can complete and submit the online health reward form at www.caloptima.org/healthrewards.
- Annual Wellness Visit (can be submitted by member through online form but will also be identified through claims and encounter data)
- Breast Cancer Screening (mammogram)
- Colorectal Cancer Screening (colonoscopy only)
- Diabetes A1C Test
- Diabetes Eye Exam (dilated or retinal eye exam)
- Osteoporosis Screening (bone mineral density test, DXA or DEXA)
The following health rewards do not require a form submission. Members will be rewarded based on claims and encounter data received:
- Annual Wellness Visit (can be submitted by member through online form but will also be identified through claims and encounter data)
- Health Risk Assessment
For these health rewards, please submit claims and encounter data in a timely manner.
Rewards will be added to the member's CalOptima Health OneCare &moreTM card within five business days of submitting the online form. Physical gift cards will no longer be issued.
For more information about member health rewards or to find reward forms, please visit www.caloptima.org/healthrewards.
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Blood Pressure Monitors Are a Covered Benefit for Your Patients |
High blood pressure, or hypertension, is the second most common condition among CalOptima Health members, right behind high cholesterol, which directly contributes to elevated blood pressure.
To support better management of hypertension, blood pressure monitors are a fully covered Medi-Cal benefit. This coverage is also available to members participating in OneCare and who are part of the CalOptima Health Community Network (CHCN). Ensuring that your patients have access to home blood pressure monitors is an important part of helping them manage hypertension.
There are two options for ordering an at-home blood pressure monitor:
- Place the order through a Medi-Cal Rx-contracted pharmacy for Medi-Cal members — Providers must submit a prescription to a Medi-Cal Rx-contracted pharmacy.
- Place the order through a CalOptima Health-contracted Durable Medical Equipment (DME) vendor — Providers must submit an order that includes the patient’s name, date of birth, client index number (CIN), address, phone number and diagnoses. The order must also include the provider’s full name, signature and contact information, along with the date of service and Healthcare Common Procedure Coding System (HCPCS) code A4670-NU Automatic Blood Pressure Monitor. Missing information will delay the delivery of the blood pressure monitor.
Below are some Medi-Cal- and OneCare-contracted pharmacy or DME providers that can ship directly to a member’s home. Additional pharmacies can be located through Medi-Cal Rx or our Provider Directory:
- Planet Health Inc. (A1 Care) – Phone: 714-541-3900; Fax: 714-541-3901
- ProCare Pharmacy (West Group Pharmaceutical) – Phone: 714-899-1111; Fax: 714-784-5445
- Homedical Inc. – Phone: 714-438-2230; Fax: 714-438-2233
- SG Homecare – Phone: 949-474-2050; Fax: 949-474-4460
What you need to know:
- Prior authorization is not required.
- Blood pressure monitors are a Medi-Cal-covered benefit for an ICD-10-CM diagnosis code that justifies medical need, including hypertension (including gestational hypertension and preeclampsia), heart disease, chronic kidney disease, hypertensive crisis, and diabetes or obesity (as part of an intensive lifestyle management program).
- Members are limited to one digital blood pressure cuff per member every five years. Units will provide instructions and batteries.
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For questions, call our Customer Service department at 714-246-8500, Monday through Friday, 8 a.m.–5:30 p.m.
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CalOptima Health Offers Digital Literacy Support for OneCare Members |
We are now offering OneCare members digital literacy support to ensure they can access their telehealth benefits. We have partnered with our Companion Care vendor, Papa, to provide telephonic and in-person support to help members connect to the telehealth platforms that their providers use. Our OneCare Customer Service team is screening members for low digital health literacy to offer this additional assistance.
If your OneCare patients need help in accessing their telehealth benefits, please refer them to OneCare Customer Service at 877-412-2734. Additionally, if you use a telehealth platform, please share the information with us so we can better support our members.
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Follow These Instructions When Submitting Attachments Through Office Ally Portal |
Electronic data interchange (EDI) is the controlled transmission of claims data between providers and CalOptima Health. Using EDI takes significantly less time to process claims submissions and can reduce payment cycle times. We contract with Office Ally as an EDI clearinghouse for electronic claims.
To better help our providers submit electronic claims, we are sharing instructions for adding attachments through the Office Ally portal. Please review these instructions; if you have any questions, please reach out to our Provider Relations department at 714-246-8600 or providerservicesinbox@caloptima.org.
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CHOC and Rady Children’s Hospital Announce Merger Closing |
Children’s Hospital of Orange County (CHOC) and Rady Children’s Hospital San Diego (Rady Children’s) have announced that the merger between their parent companies has closed, creating a new combined health care system called Rady Children’s Health. The first official day of Rady Children’s Health was January 1, 2025.
Kimberly Chavalas Cripe, who has served as the president and CEO of CHOC since 1997, and Patrick A. Frias, M.D., who was appointed president and CEO of Rady Children’s in 2018, will be co-CEOs of Rady Children’s Health. CHOC and Rady Children’s will build on their respective affiliations with the University of California and its medical schools at UC Irvine and UC San Diego — relationships that are vital to advancing pediatric research, training and education.
Rady Children’s Health includes three hospitals — CHOC Hospital in Orange, CHOC at Mission Hospital in Mission Viejo and Rady Children’s Hospital in San Diego — and a growing network of primary and specialty care centers spanning six counties. Each hospital will maintain a separate medical staff, local governing boards and on-site leadership to ensure they continue to meet the unique needs of their respective communities while providing the new benefits of an integrated health care system.
To learn more, please see this press release from CHOC and Rady's Chidlren's Hospital about the merger.
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DHCS Updates Requirements for Enrollment in CBO and LHJ Pathways |
On November 22, 2024, the Department of Health Care Services (DHCS) sent a communication to managed care plans (MCPs) regarding updates to Medi-Cal enrollment requirements and procedures for community-based organizations (CBOs) that provide community health worker (CHW), asthma preventive (AP) or justice–involved (JI) services. The guidance also applies to local health jurisdictions (LHJs) and county children and families commissions that provide CHW and AP services.
Effective November 25, 2024, CBOs with CHWs offering JI services and licensed/unlicensed individuals rendering care management services can enroll through the CBO pathway. This option is available to both first-time CBO applicants and currently enrolled CBO providers submitting a supplemental application. Additionally, county children and families commissions are eligible to apply for Medi-Cal enrollment through the LHJ pathway for CHW and AP services.
For more information on the updated enrollment requirements for CBOs, LHJs and county children and families commissions, please see this DHCS Provider Bulletin.
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On December 2, 2024, DHCS distributed Numbered Letter (NL) 10-1224: California Children’s Services Whole-Child Model, which provides guidance to MCPs regarding county California Children’s Services (CCS) responsibilities in the CCS Whole-Child Model (WCM) program.
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On December 2, 2024, DHCS sent out All Plan Letter (APL) 24-015: California Children’s Services Whole-Child Model Program, which provides updated direction and guidance to MCPs participating in the CCS WCM Program. This APL conforms with CCS NL 10-1224.
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On December 5, 2024, DHCS distributed APL 24-016: Diversity, Equity, and Inclusion Training Program Requirements, which provides MCPs with guidance regarding requirements for the Diversity, Equity and Inclusion (DEI) training program.
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On December 5, 2024, DHCS sent out APL 24-017: Transgender, Gender Diverse, Intersex (TGI) Cultural Competency Training Program and Provider Directory Requirements, which gives MCPs guidance regarding the transgender, gender diverse, intersex cultural competency training program and Provider Directory changes required by Senate Bill 923.
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On December 13, DHCS distributed APL 24-018: Medical Loss Ratio Requirements for Subcontractors and Downstream Subcontractors, which provides MCPs with guidance on the Medical Loss Ratio requirements from the Centers for Medicare & Medicaid Services (CMS) in the CalAIM Section 1915(b) waiver’s special terms and conditions.
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Health Education: Trainings and Meetings |
Click below for training webinars and meetings happening in January 2025:
Health education webinars
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Based on Medi-Cal Bulletin and NewsFlashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:
- Justice-Involved Reentry Initiative: Rebranding and Screening Portal Updates
- Rate Update for Specific Contraceptive HCPCS Codes
- Resources for the Breast and Cervical Cancer Treatment Program
- Licensed Midwife and Certified Nurse Midwife Categories of Services Removed
- Required Modifiers for HCPCS Code J0178
- Required Modifiers for HCPCS Code J2778
- Age Requirement Updated for Gene Transfer Therapy HCPCS Code J1413
- Non-Benefit Status for PE4PP CPT Code 87469
- Benefit Status Effective Date is Updated for Select Medicine and Radiology Codes
- Provider Manual Revisions
- 2025 Whole-Child Model Transition
- 2025 FFS Updates to the List of Contracted Intermittent Urinary Catheters Supplies
- 2025 Updates to the List of Contracted Advanced Wound Care Products
- DHCS 3097 Reconciliation Requests for FQHCs/RHCs with Fiscal Year Ending in 2024
- Transition to the New Family PACT Portal Coming January 2025
For detailed information regarding these changes, please refer to General Medicine Bulletin 606, Medi-Cal Program & Eligibility Bulletin 29, Durable Medical Equipment and Medical Supplies Bulletin 591, Long Term Care Bulletin 574, and Medi-Cal NewsFlashes from November 20 and December 9.
To access the updated Physician Administered Drug Prior Authorization List (PAD PA List), please refer to: www.caloptima.org/en/ForProviders/ClaimsandEligibility/PriorAuthorizations.aspx.
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- CalOptima Health Board of Directors: February 6 at 2 p.m.
- Joint Meeting of the Provider and Member Advisory Committees: February 13 at Noon
All meetings have an option for virtual attendance. Visit the CalOptima Health website for more information.
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Follow Us on Social Media | | |
CalOptima Health regularly posts on social media to engage members with health tips, community resources, event dates, program updates and other pertinent information. Follow the agency on Facebook, Instagram, X and LinkedIn. | | |
CalOptima Health, A Public Agency www.caloptima.org
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