July 1, 2022

DHCS Urges Physicians to Hold Vaccine Administration Claims for Children

CMA learned on Tuesday that DHCS has not yet completed the system and operational changes required to enable successful claims adjudication for administration of the Pfizer-BioNTech and Moderna COVID-19 vaccines for children under age 5. DHCS is urging physicians to hold Medi-Cal claims for vaccine administration for children under age 5 until further notice. 

As a reminder, the KidsVaxGrant application deadline has been extended to July 15. Enroll your practice or medical organization in the federal Vaccines for Children (VFC) program or expand your operating hours for awards of up to $15,000. Click here to apply or learn more. 

ACCMA Member in the News

A recent New York Times opinion article features a letter to the editor from our very own Katrina Saba, MD. She references a letter to the editor published 30 years ago in the NYT – at a time when several Supreme Court seats were potentially at stake – quoting Julia Child and reminding women that they are alone in the voting booth. Dr. Saba states “As we fight to get our rights back, I hope that women, regardless of their political party, will remember that advice this November”.

Reinstatement of Drug Prior Authorization and Claim Edits, Phase I: Reject Codes

DHCS announced that it would begin reinstating pharmacy claim edits and prior authorization requirements for prescription drugs through a three-phased approach. Phase I, to be reinstated July 22, consists of claim edits for diagnosis and Drug Utilization Review (DUR) requirements, referred to as DUR 88 and Reject Code 80 edits. For claims or prior authorization assistance, call the Medi-Cal Rx Customer Service Center at (800) 977-2273, or email [email protected].

CMA Asks Cigna to Rescind Burdensome Modifier 25 Policy

CMA is urging Cigna to rescind its recently announced policy that would require the submission of medical records with all Evaluation and Management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. This change effectively penalizes physicians for providing efficient, unscheduled care to Cigna enrollees. Cigna’s policy change would result in significant, unnecessary administrative burden and compliance cost to physician practices, would disincentivize physicians from providing unscheduled services and would create duplicate requests thus wasting health care dollars. CMA recently sent a letter outlining these concerns in detail and has asked the payor to rescind the policy before the August 13 effective date.

CDPH Issues Monkeypox Advisory for Providers

The California Department of Public Health (CDPH) has released an advisory for health care providers on the evolving monkeypox outbreak. The advisory includes information for physicians who are or may soon be caring for patients exposed to or confirmed to have monkeypox infections. Topics covered include epidemiology, clinical presentation, differential diagnostic considerations, testing strategies, medical countermeasures, infection control, and recommendations for communicating effectively with patients about monkeypox. 

Behavioral Health Integration Immersion Program

The AMA and seven partner organizations are launching a new, free initiative this fall – the Behavioral Health Immersion Program – designed to provide enhanced technical assistance to physician practices. Selected practices will participate in a 12-month curriculum designed and taught by industry experts on how to effectively implement behavioral health integration. Upon completion, practices will be able to identify the best approach for delivering integrated care, determine internal staffing needs along with outside partnerships, design a workflow with processes and protocols that works best for their practice, and establish short- and long-term goals of success, including measurable improvement targets and indicators. Click here to learn more and apply. Applications close August 5. 

New 988 Suicide and Crisis Lifeline Goes Live July 16



In April, the Department of Health and Human Services, through its Substance Abuse and Mental Health Services Administration, awarded nearly $105 million in grant funding, provided by the American Rescue Plan, to 54 states and territories in advance of the transition of the National Suicide Prevention Lifeline from a 10-digit number the 988 3-digit dialing code. States and territories are expected to use the funds to improve response rates, increase capacity to meet future demand, and ensure calls initiated in their states/territories are first routed to local, regional, or state crisis call centers. 988 goes live on all devices on July 16.

Assembly Health Committee Advances CMA-Sponsored Prior Authorization Bill

SB 250 has passed out of the Assembly Health Committee and now heads to the Assembly Appropriations Committee. This CMA-sponsored bill will allow physicians to spend less time on paperwork and billing and will allow patients to get the care they need without unnecessary delays. SB 250 would require health plans to exempt physicians from prior authorization rules if they have practiced within the plan's criteria 80% of the time. All other physicians will have the right under the bill for a prior authorization appeal to be conducted by a physician in the same or similar specialty. Share your prior authorization story to demonstrate to lawmakers how prior authorization policies are harmful to patients.

Guidelines for Responding to Requests for Patient Records

Protect yourself from the inappropriate release of patient medical records to avoid potential violations of federal or state patient privacy laws. Guidance to help you properly respond to the most common types of requests for patient records, which can originate from subpoenas, attorney’s letters, law enforcement, regulatory agencies, and patients themselves, is provided in a recent article published by the Cooperative of American Physicians (CAP). 

Managing Pain Safely: Non-Pharmacological Treatments 

Available On Demand | Free 

This webinar discusses some of the evidence-based non-pharmacological treatments recommended in the treatment guidelines. Conditions usually not considered for non-pharmacological treatments are discussed to help improve the management of more difficult conditions such as osteoarthritis and disc herniations. A colleague that regularly utilizes non-pharmacological treatments shares tips in patient management. This webinar is hosted by the East Bay Safe Prescribing Coalition, Alameda-Contra Costa Medical Association, and Napa Solano Medical Society. 

Access the webinar here. 

Leadership Reading and Discussion Group

Wednesday, July 6 | 6:00 to 7:30 pm   

FREE | CME Available | Online   

Physicians are free to join any meeting of the Leadership Reading and Discussion Group; reading the book is not required. Doctor Hilary Worthen, course director of the Physician Leadership Program, facilitates the discussion group that is held on Zoom. The book selection for July is “Healing: Our Path from Mental Illness to Mental Health” by Thomas Insel, MD. This is a terrific book that gives a hard and well-informed overview of the state of care for people with mental illness. 

Register here. 

Leveraging Open EHR Platforms to Advance Usability, Care and Outcomes 

Tuesday, July 12 | 9:00 to 10:00 am 

Free | Hosted by the American College of Healthcare Executives 

An open platform makes it easier for organizations to share information and integrate apps that enhance workflows and fill growing business needs, such as ambulatory care, clinical decision support, scheduling and emergency medicine. Openness takes the EHR to the next level and is a powerful way to help providers be more proactive in addressing issues such as the opioid crisis, prescription price transparency, patient safety and emergency department readmission rates. Join us in this webinar to hear how open EHR platforms provide the foundation for healthcare innovation and collaboration. 

Register here.

Virtual Grand Rounds 

Tuesday, July 12 | 12:00 to 1:00 pm 

Hosted by CMA 

Learn from experts about the status of COVID-19 and monkeypox in California. CMA will be welcoming back state epidemiologist Erica Pan, MD who will share the latest updates about COVID-19, including information about vaccinations, epidemiology and patient care. 

Infectious disease expert Peter Chin-Hong, MD from UCSF will discuss the emergence of monkeypox as a global phenomenon, as well as the epidemiology, signs and symptoms of this disease. 

Register here. 

No Surprises Act Implementation: Good Faith Estimate

Wednesday, July 13 | 10:00 to 11:00 am 

Hosted by AMA and CMS  

This webinar will cover Good Faith Estimate provisions to the No Surprises Act, followed by another webinar on July 13 focused on surprise billing provisions. CMS will spend a majority of the time answering questions from physicians and medical societies, both through live Q&A and pre-submitted questions. Please send questions you may have about NSA requirements to Emily Carroll ([email protected]). 

Click here for registration instructions.

Medical Debt Crisis: Impact on Black American Families

Wednesday, July 13 | 11:00 am to 12:00 pm 

Hosted by National Consumer Law Center and Community Catalyst 

Despite the aims of the Affordable Care Act, medical debt remains a looming crisis, disproportionately affecting Black households and communities. Race contributes to whether households have medical debt, with 27.9% of Black households carrying medical debt compared to 17.2% of white non-Hispanic households. Households in the South, the region with the highest concentration of Black people, carry more medical debt than households in other areas of the country. Structural and systemic racism underlies these disparities in medical debt. For these reasons, medical debt must be addressed as a racial justice issue that exacerbates the existing racial wealth and health gap facing Black families and communities. Participants will be encouraged to share their experiences in healthcare advocacy, data trends they have seen in medical debt in their states, and best practices and policy ideas for addressing medical debt in Black communities. 

Register here.

Making MAT Happen In-Person Workshop 

Oakland | Friday, July 15 | 9:00 am to 3:30 pm 

Hosted by CA Bridge 

CA Bridge is excited to return to in-person training events! We are hosting a series of regional workshops to review the basics of the CA Bridge model for initiating medication for addiction treatment (MAT) in emergency departments and navigating patients to ongoing care. These workshops are tailored to hospitals that are new to the program, had delays in getting started, or have run into challenges along the way. 

Register here.