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IEHP & Molina Healthcare Launch Together4IE

This month, Molina Healthcare of California (“Molina”), and Inland Empire Health Plan (IEHP) announced a joint effort in leading a new healthcare initiative, “Together4IE.” This collaboration aims to raise awareness about available coverage through Medi-Cal and the health insurance marketplace (Covered California) to support Californians affected by income or employment changes during the COVID-19 pandemic. The health plans launched a website and are offering a toll-free number (1-866-U2Apply) to learn more about securing affordable health insurance. The California Employment Development Department reported that as of July 2020, more than 275,000 ...

Telehealth Expansion Due to COVID-19

President Donald Trump today announced the federal government is immediately suspending HIPAA enforcement and penalties to facilitate use of telehealth for health care services in both the Medicare and Medicaid programs. As of this morning, March 17, the Centers for Medicare and Medicaid (CMS) has announced that Medicare will immediately expand telehealth coverage for seniors so that they can be treated from home and not risk their own health and that of providers by being required to visit a medical office.  Please see important information, guidelines and links here: CMA Newsroom ...

SBCMS President Congratulates Dr. Bradley Gilbert as New Head of Calif. DHCS

SBCMS Statement: On behalf of the entire leadership and membership of San Bernardino County Medical Society (SBCMS), we would like to extend our enormous congratulations to Bradley P. Gilbert, M.D., upon his appointment to California’s Department of Health Care Services (DHCS) by Governor Gavin Newsom.  Read more here.   Having had the opportunity to work closely with Dr. Gilbert for many years in his position as CEO of the of the Inland Empire Health Plan (IEHP) and as a member of our SBCMS board of directors, we know firsthand what levels of ...

DHCS loads 2019 CPT Codes and Pricing by January 1

The California Department of Health Care Services (DHCS) has confirmed that the 2019 CPT/HCPCS updates have been loaded to the Medi-Cal system and were effective January 1, 2019.  Every year, the Centers for Medicare and Medicaid Services (CMS) issues new, updated and terminated CPT and HCPCS codes. However, in past years it has taken DHCS up to 10 months to update its system with the new or updated codes and pricing. This has caused unnecessary delays and denials in payment not only on Medi-Cal fee-for-service claims, but also for many ...

Medi-Cal provider enrollment moving exclusively to PAVE starting March 5

The Medi-Cal Provider Enrollment Division (PED) recently announced that it will no longer accept paper enrollment forms, effective March 5, 2019. Medi-Cal enrollment applications and forms will move entirely to the e-form application process through the California Department of Health Care Services’ (DHCS) Provider Application and Validation for Enrollment (PAVE) portal.  While PAVE was anticipated to eventually replace the paper application process, DHCS moved swiftly to eliminate the paper option for providers after the September PAVE update (3.0). Prior to the announcement, PED did seek feedback from stakeholders including the ...

Golden Shore Medical Group to shut down following Molina contract termination

The California Medical Association (CMA) has learned that Molina Healthcare has terminated its contract with Golden Shore Medical Group. The plan filed requests in late 2018 with the California Department of Managed Health Care (DMHC) to transfer its enrollees to other delegated groups and the request was approved by the Department on January 11, 2019. According to Molina’s block transfer filing with DMHC, the termination was the result of the parties’ inability to agree on contractual terms. As a result of the termination, Golden Shore has announced to its network ...

Prop. 56 webinar: Are you getting your share of the supplemental Medi-Cal funds?

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. A total of $325 million was allocated for physician payments in the budget for 2017-18, with $488 million proposed for 2018-19. The California Medical Association (CMA) is hosting a webinar with the California Department of Health Care Services on Wednesday, November 7, to discuss the status of distribution of ...

Some Medi-Cal managed care plans slow to distribute Prop 56 funds

In May, the California Department of Health Care Services (DHCS) distributed the Proposition 56 supplemental funds for FY 2017-2018 to the Medi-Cal managed care plans. At the California Medical Association’s request, DHCS specified that plans must distribute the funds to providers within 90 days. However, the 90-day window ended August 31 and CMA has received complaints from physicians that some plans have still not issued supplemental payments. The supplemental payments are a result of the California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56), which created ...

IEHP completes termination of Vantage contract; three plans extend termination dates

The California Medical Association (CMA) has confirmed that Inland Empire Health Plan (IEHP) completed its contract termination with Vantage on August 31, 2018. IEHP transitioned its 273,000 covered lives to the following delegated groups: Receiving Provider Group Number of Enrollees Alpha Care Medical Group 80,190 La Salle Medical Associates 74,428 IEHP Direct 74,176 ...

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 ...