Orange County Declares RSV Health Emergency |
Due to record numbers of pediatric hospitalizations and daily emergency room visits for respiratory infections, local public health officials issued a health emergency on October 31 advising Orange County residents to follow disease prevention measures. The County Health Officer and Orange County Health Care Agency medical directors strongly encourage the community to follow preventive measures, such as staying home when sick, covering coughs and sneezes, washing hands frequently and masking up in large group settings. View the health emergency declaration here and Centers for Disease Control and Prevention information for providers here.
|
|
|
Rate Increase for Mental Health Service Providers Coming in 2023 |
Mental health providers are essential to improving the lives and overall wellness of CalOptima Health members. CEO Michael Hunn, Executive Director for Behavioral Health Integration Carmen Katsarov and staff recognize your vital role in providing quality evidence-based treatment for our members, which includes more than 20,000 members per year who access mental health counseling services. Your dedicated care exemplifies our motto that we are “Better. Together.” In that spirit, we are happy to share good news that reaffirms our continued dedication to supporting you and your mission.
On October 6, CalOptima Health’s Board of Directors approved an increase in rates for Medi-Cal fee-for-service mental health outpatient assessment and counseling services. Though the rate increases will vary by provider type — ranging from 0% to 100% — the average increase will be 22.9%.
The rate increases go into effect January 1, 2023, and CalOptima Health will send you a contract amendment that outlines the specific rate increase for each Current Procedural Terminology (CPT) code.
Please note that these rate increases are separate from the extension of the supplemental COVID-19 payments for fiscal year 2023 that the Board approved in June.
The increases will help providers deal with challenging circumstances such as labor shortages, rising overhead costs and heightened demand for mental health services due to the COVID-19 pandemic. After analyzing the market, as well as commercial and other Medi-Cal organizations, CalOptima Health decided these rate increases were necessary to ensure Medi-Cal members in Orange County have access to quality providers and services.
Thank you for your current support and future collaboration in caring for our members. If you have any questions about these rate increases, please contact the Provider Relations department by emailing providerservicesinbox@caloptima.org.
|
|
|
Members Receive Notice of Upcoming OneCare Connect to OneCare Transition |
In October, CalOptima Health began notifying members that its OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) will end on December 31, 2022, and that OneCare Connect members will transition seamlessly into OneCare (HMO D-SNP), a Medicare Medi-Cal Plan.
During this period, providers can help ensure these members know they will still be covered after the change. Important points to share about the transition include:
- Members will automatically transition to OneCare on January 1, 2023.
- Members do not need to do anything to enroll in OneCare.
- Members will NOT have premiums, fees or deductibles to obtain health care services from providers.
- OneCare has been a CalOptima Health program since 2005. It will continue to assist members with their health care needs and coordinate benefits, including medical care, home- and community-based services, medical supplies, and medications.
All contracted OneCare providers must also complete the CalOptima Health OneCare Model of Care training on CalOptima Health’s website.
|
|
|
New DHCS Population Health Management Program Coming in 2023 |
In 2023, CalOptima Health will implement a new population health management (PHM) program based on guidance from the Department of Health Care Services (DHCS) to ensure all members have access to a comprehensive set of services based on their needs and preferences across the continuum of care. The goal is for members to live longer, healthier lives, improve health outcomes, and achieve health equity.
On September 2, DHCS released its final program guide for managed care plans (MCPs) to implement a new PHM program. Considered the cornerstone of California Advancing and Innovating Medi-Cal (CalAIM), the launch of the DHCS PHM program will provide a cohesive set of requirements for CalOptima Health, providing targets and benchmarks that measure quality and focus on meaningful outcomes for preventive care and wellness. In addition to the PHM program, DHCS will roll out a PHM service, a universal data platform tool to assign member risk levels that will be required in all Medi-Cal organizations and delegated health networks.
DHCS’ changes to the PHM program are aimed at:
- Building trust and meaningful engagement with members
- Using data-driven risk stratification and predictive analytics to identify gaps in care and effective opportunities for intervention
- Revising and standardizing the assessment processes
- Addressing upstream drivers of health
- Promoting health and wellness
- Identifying and delivering care management services for members at high risk for poor outcomes
- Strengthening transitional care services
- Reducing health disparities and addressing social determinants of health
CalOptima Health is committed to working with health networks and providers to successfully launch this program beginning in January 2023. Implementation will require strong coordination between CalOptima Health and its health networks, as well as close partnerships with the County of Orange Social Services Agency and Orange County Health Care Agency. The agency looks forward to engaging with providers, community-based organizations, emergency departments, and skilled nursing and long-term care facilities to continue serving members together.
Click on this table to view the PHM program implementation timeline and DHCS reference documents.
|
|
|
OneCare and OneCare Connect Members to Receive Annual Wellness Visit Incentive |
CalOptima Health has implemented a new incentive for eligible members to complete their annual wellness visit in 2022.
Beginning in October, CalOptima Health members enrolled in OneCare and OneCare Connect can receive a $50 incentive if they have an annual wellness visit with their primary care provider (PCP) by December 31.
OneCare and OneCare Connect providers are encouraged to inform members of this incentive to increase the number of annual wellness visits completed.
|
|
|
DHCS Issues Reminder to Providers to Not Balance Bill Medi-Cal Members |
On October 12, DHCS sent a reminder that Medi-Cal and Medicare members should not pay for physician visits and other medical care when receiving covered services within their provider network. This practice is known as balance billing, and it includes charging co-payments and deductibles.
|
|
|
National Drug Code Needed for All Physician-Administered Drug Claims |
Providers need to include the National Drug Code (NDC) on all Medi-Cal claims submitted for physician-administered drugs (PADs).
As part of the Federal Deficit Reduction Act of 2005, providers should include the NDC for PADs, in addition to the Healthcare Common Procedure Coding System (HCPCS) Level I, II or III codes. PADs include any covered outpatient drug billed by a provider other than a pharmacy. This includes (but is not limited to) the following provider types:
- Physicians
- Clinics
- Hospitals
The NDC reporting requirement applies to claims submitted using the following formats:
- 837 electronic transactions for institutional and professional claims
- CMS-1500 and UB-04 paper claims
- Internet Professional Claims Submission (IPCS) system
For additional information regarding NDCs on claims, contact Medi-Cal’s Telephone Service Center at 800-541-5555, select option 11 for English or option 12 for Spanish, and then select the appropriate option based on claim type.
|
|
|
World Diabetes Day 2022 Theme Shows Need for Disease Management |
November 14 is World Diabetes Day, a global awareness campaign focusing on diabetes education, treatment and care. To coincide with the 2022 theme of “Access to Diabetes Care,” please ensure that diabetic patients have completed the following and that they have a record of the result:
- Labs within the past three months for an A1c of nine or higher
- Diabetes retinal eye exam
- Medication adjustment within the past six months as appropriate
- Glucometer readings discussion
- Foot exam with a podiatrist
- Visit with a dietitian
Providers should ask diabetic patients how they are managing their condition. Make sure their blood sugar is under control (HbA1c <9), and that they are following a care regimen that includes an appropriate diet, physical activity, medicines and observation of blood sugar levels.
|
|
|
Health Education: Trainings and Meetings |
Click below for a list of training webinars and links happening in November 2022:
|
|
|
Based on Medi-Cal Bulletins and NewsFlashes, CalOptima Health has updated the procedural codes and other relevant information for the subjects listed below:
- 2022 HCPCS Quarter 4 Update
- Rate Change for Orthopoxvirus Test
- Clarified Policy Guidance for Palliative Care
- Corneal Cross-Linking for Keratoconus and Ectasia (Billed with HCPCS Code J2787 and CPT Code 0402T) Added as Medi-Cal Benefits
- Cognitive Assessment CPT Codes 96125 and 99483 are Medi-Cal Benefits
- CCS Service Code Groupings Policy Update
- Policy Update for Psychological and Psychiatric Services
- Levonorgestrel 0.75mg Tablet Discontinued for Family PACT and Medi-Cal
- Update to LOA Documentation Options
- Reminder for Providers Regarding Patient Privacy
- New Electronic Claim Resubmission Helps Providers Avoid Paper CIFs/Appeals
- Billing Correction made for Tracheostomy
- Updates to CGM Systems and DIDDs Billing Codes
- Coming Soon: Monkeypox Vaccine Reimbursement at the Medicare Rate
- Notification: DRG Payment System Update to Mapper and Hospital Acquired Condition V40.0 after October 1, 2022
- Attention: Home Health Care Services Providers and Individual Nurse Providers
|
|
|
- CalOptima Health Board of Directors: November 3 at 2 p.m.
- CalOptima Health Joint Provider and Member Advisory committees: December 8 at 8 a.m.
At this time, all meetings have an option for virtual attendance due to COVID-19. Visit the CalOptima Health website for more information.
|
|
|
Follow Us on Social Media |
|
|
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.
|
|
|
CalOptima Health, A Public Agency www.caloptima.org
|
|
|
|
|
|
|
|
