DHCS receives approval on Medi-Cal supplemental tobacco tax payments for FY 2018-2019 The California Department of Health Care Services (DHCS) recently received federal approval on its plan to increase Medi-Cal fee-for-service physician payments for the 2018-2019 fiscal year. The supplemental payments—made possible by the Proposition 56 tobacco tax funding—will raise payments for a total of 23 CPT codes, including 10 new preventive CPT codes. DHCS will be increasing the supplemental payment for the previously eligible CPT codes to 85 percent of Medicare (a 40 percent average increase in payments for these eligible codes compared with 2017 – 2018 payment levels). The 10 ... September 21, 2018 Managed Care, Medi-Cal Advocacy, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
Have you received your supplemental Medi-Cal managed care payments? The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. While the California Department of Health Care Services (DHCS) began disbursing FY 2017-2018 supplemental fee-for-service payments in January 2018, federal approval of the supplemental Medi-Cal managed care payments was delayed. This resulted in delayed payment for Medi-Cal managed care services. DHCS began dispersing the FY 2017-2018 funds to the plans ... September 21, 2018 Managed Care, Medi-Cal Advocacy, Medi-Cal, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
CMA calls on CMS to reverse step therapy decision The California Medical Association (CMA) and an American Medical Association (AMA)-led coalition of 94 medical societies delivered a letter to the Centers for Medicare and Medicaid Services (CMS) about the serious concerns physicians have with the agency’s recent decision to allow Medicare Advantage plans to use step therapy for Part B drugs. The letter calls on CMS to reinstate its 2012 policy prohibiting Medicare Advantage plans from utilizing step therapy protocols for Part B physician administered medications. The growing burdens generated by step therapy and prior authorization programs create a ... September 14, 2018 Medi-Cal, Medicare Advocacy, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
L.A. Care issues recoupment letters for services dating back to 2012 The California Medical Association (CMA) has learned that L.A. Care Health Plan, the publicly operated Medi-Cal health plan serving more than 2 million Los Angeles County residents, issued letters to physicians in late July requesting the refund of claim overpayments dating back to 2012. The letters, dated July 28 and received by practices through mid-August, cited that the overpayments were a result of processing errors, including the following: L.A. Care incorrectly processed Medi-Medi claims as the primary payor instead of secondary to Medicare. ... September 12, 2018 Medi-Cal Payor Issues and Reimbursement, Practice Management, Public Payors 0 0 Comment Read More »
New Medi-Cal provider enrollment system to go live Sept. 4 The California Department of Health Care Services (DHCS) is releasing an update to its Medi-Cal provider enrollment system—called the Provider Application and Validation for Enrollment (PAVE)—on Tuesday, September 4, 2018. The current iteration (2.0) of the PAVE system, launched on November 18, 2016, transformed DHCS’ provider enrollment from a manual paper-based process to a web-based portal that providers could use to complete and submit their applications, verifications and to report changes. Version 2.0 included most physicians and allied provider types. The new 3.0 update will include even more eligible provider ... August 29, 2018 Medi-Cal Payor Contracting, Public Payors 0 0 Comment Read More »
UnitedHealthcare Community Plan preps for entry into additional Medi-Cal and Medicare Advantage markets Looking to potentially enhance its footprint in the Medi-Cal and Medicare Advantage marketplace by 2021, UnitedHealthcare (UHC) Community Plan of California has issued unilateral contract amendments to contracted physicians in seven California counties. Additionally, UHC providers in the seven counties who are not currently contracted for the Medicare Advantage product will receive a combined contract amendment for participation in both UHC Community Plan of California (Medi-Cal) and UHC Medicare Advantage products. As a condition of participation in the Medi-Cal Managed Care request for proposal process in late 2019 or early 2020, ... August 23, 2018 Managed Care, Medi-Cal, Medicare Commercial Payors, Payor Contracting, Public Payors 0 0 Comment Read More »
Medi-Cal to unveil updated provider enrollment system this summer The California Department of Health Care Services (DHCS) will soon be releasing an update to its Medi-Cal provider enrollment system, called the Provider Application and Validation for Enrollment (PAVE). The current iteration (2.0) of the PAVE system, originally launched on November 18, 2016, transformed DHCS’ provider enrollment from a manual paper-based process to a web-based portal that providers could use to complete and submit their applications, verifications and to report changes. The original launch included most physicians and allied provider types. The new update (3.0) will include even more eligible ... August 15, 2018 Medi-Cal Medi-Cal, Practice Management, Public Payors 0 0 Comment Read More »
DHCS requires enrollment for all Medi-Cal managed care providers In January 2018, the California Department of Health Care Services (DHCS) began requiring that all Medi-Cal managed care providers be enrolled through the Medi-Cal program. Medi-Cal managed care plans have the option to develop and implement a managed care physician screening and enrollment process that meets federal requirements, or they may direct their network physicians to enroll through the DHCS fee-for-service (FFS) enrollment portal. (Enrolling through DHCS does not obligate managed care network providers to also see FFS patients.) Some physicians have already reported receiving notices from Medi-Cal managed care ... July 11, 2018 Managed Care, Medi-Cal DHCS, Medi-Cal, Medi-Cal Provider Enrollment, Department of Health Care Services 0 0 Comment Read More »
Health plans terminate relationship with Vantage Medical Group The California Medical Association (CMA) has learned that two health plans, the Inland Empire Health Plan (IEHP) and Molina Healthcare, are terminating their contracts with Vantage Medical Group. Two other plans, Blue Shield of California and Care1st Health Plan, have issued notices of material breach with an intent to terminate. The plans have filed requests with the California Department of Managed Health Care (DMHC) to transfer their enrollees to other delegated groups. According to IEHP’s block transfer filing with DMHC, Vantage engaged in conduct that resulted in the inappropriate delay, ... July 11, 2018 General, Managed Care, Medi-Cal Blue Shield, Commercial Payors, Department of Managed Health Care, DMHC, Payor Contracting 0 0 Comment Read More »
State budget includes 10 new CPT codes eligible for supplemental tobacco tax payments Governor Jerry Brown last week signed a $139 billion California budget for the 2018-2019 fiscal year. The budget continues the Administration’s commitment to using the Proposition 56 tobacco tax funding to provide supplemental payments for Medi-Cal providers, with $500 million in tobacco tax funds allocated to improve provider reimbursement through supplemental payments. The total funding for provider payments is approximately $1.3 billion. DHCS plans to allocate the tobacco tax funds to increase payments for a total of 23 CPT codes, which includes 10 new preventive CPT codes. The supplemental rate ... July 11, 2018 General, Managed Care, Medi-Cal California State Budget, Medi-Cal, Prop. 56 (tobacco tax) 0 0 Comment Read More »
