Message to Our Providers
Update 1/15/21 – Guidance Related to Non-Discrimination in Medical Treatment for COVID-19
DHCS issued guidance to remind Medi-Cal providers that, under state and federal law, they are prohibited from illegally discriminating against Medi-Cal members. Also, in the context of the COVID-19 PHE, providers are prohibited from illegally discriminating against Medi-Cal members in determining how to allocate scarce resources for the treatment of COVID-19. DHCS’ Office of Civil Rights has an established discrimination complaint process for Medi-Cal consumers to file complaints of alleged discrimination. More information is available on the DHCS website.
Update 7/23/20 – DHCS issues suicide prevention letter in light of increased emotional distress and suicidal behaviors during the COVID-19 pandemic. Click here to download.
Update 7/15/20 – CMS released specific HCPCs codes for detection of SARS-COV-2 or the diagnosis of the virus that causes the coronavirus disease 2019 (COVID-19). Click here to read more.
Update 7/15/20 – New CPT code approved for COVID-19 testing. Click here to read more.
Update 6/3/20 – View the May 27 webinar from California ACEs Aware Initiative, “Primary Care & Telehealth Strategies for Addressing the Secondary Health Effects of COVID-19” click here.
Update 5/6/20 – Guidelines and practices for perinatal care during COVID-19. Click here to download.
Update 5/6/20 – The Drug Enforcement Administration announced it will waive the Ryan-Haight act. Click here to read conditions.
Update 5/1/20 – The California Medical Association has just issued a COVID-19 Financial Toolkit for Physician Practices. Download Financial Toolkit.
Update 4/28/20 – The American Academy of Pediatricians recommends providers keep the regular pediatric well-care schedule for children during COVID-19. Click here to read more.
Update 4/8/20 – American Academy of Pediatricians recommends providers keep the regular pediatric well-care schedule for children. Click here to to learn more.
Update 4/8/20 – Prior Authorization requirement for the following CPT codes. Click here to read.
Thank you to all of our providers and their staff who are working diligently to keep our members and community healthy during this unprecedented time.
Is CenCal Health open for business?
Yes. We are taking a variety of measures to ensure continuation of service for members and providers, while protecting staff. These actions come in response to a rapidly changing business environment due to the coronavirus, ongoing guidance from county and state officials, and school closings. As a public health measure, CenCal Health has implemented social distancing through staggered worktimes, teleworking for most employees, and closing our offices to visitors.
What is the expected impact of these changes?
Staffing levels may vary, so phone response times may lengthen. Please be patient. We are committed to answering or returning every call. Remember that you can find the answers to many questions inside the Provider Portal on our website.
What CenCal Health operations are temporarily changing?
- All in-person contact with the public, including community agencies, providers, hospitals, and other facilities, is suspended until further notice. This includes provider office visits, meetings, trainings, and outreach activities in public or other community settings. (Online training still available by request).
- Conference calls will replace in-person meeting attendance.
- All medical record reviews held at provider offices for HEDIS purposes are suspended until further notice. Reviews will be conducted remotely when access is available. Otherwise, providers may submit medical record images by secure email or fax.
- We have enacted our Pharmacy Emergency Preparedness Protocol. This allows a pharmacy in CenCal Health’s network to use an override code and provide an emergency fill/refill of a medication without having to contact the health plan or PBM. Refills can be up to 90 days for routine (non-narcotic) maintenance medications.
CenCal Health has reached out to our DME providers to ensure they are still providing necessary DME for our members. We have also reached out to our CBAS provider and ensured they are going to be checking on our aged members telephonically, delivering meals, and helping them stay in their homes.
How can we help patients get their prescriptions easier?
A list of network pharmacies providing free delivery of medications, as well as a mail-order option, is available on our website at cencalhealth.org/coronavirus
Effective March 25, 2020, CenCal Health elected to allow for prescription fills up to 90-days for routine (non-narcotic) maintenance medications in an effort to reduce both pharmacy deliveries and member trips to the pharmacy.
Medication-Assisted Treatment and Telehealth
During the national state of emergency, the Drug Enforcement Administration (DEA) announced it will waive the Ryan-Haight act and allow the initial and ongoing buprenorphine prescription and all follow up care to be provided by telemedicine and telephone, without an in-person medical evaluation. The following conditions must be met:
- The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice.
- The telemedicine communication is conducted between the DEA-registered practitioner and the patient, or a health care professional who is treating the patient, using an audio-visual, real-time, two-way interactive communication system or by telephone.
- The practitioner is acting in accordance with applicable Federal and State law (including the telemedicine requirements of 21 USC §802(54)).
- If the practitioner satisfies the above requirements, the practitioner may issue a prescription either electronically or by calling a prescription into the pharmacy.
Prescriptions for new patients receiving other controlled medications (e.g., sedatives or stimulants) may be prescribed after a telehealth assessment; the DEA has not yet authorized prescribing these controlled medications for new patients by telephone.
Has the process for authorizations changed?
No. Physicians and other providers are to continue to submit all services that require authorization in the same manner as they do today: Via the portal, secure link, or fax. CenCal Health has approved the following exceptions/extensions for authorizations:
The Prior Authorization requirements for the following CPT codes have been removed until further notice:
- 87486 - Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique.
- 87581 - Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique.
- 87633 - Infectious agent detection by nucleic acid (DNA or RNA); Respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapeumovirus, parainfluenzavirus, respiratory syncytial virus, rhinovirus), incl multiplex reverse transcription, when performed, & multi amplified probe technique; multi type.
- 87798 - Infectious agent detection by nucleic acid not otherwise specified; amplified probe technique, each.
The Prior Authorization requirements for the following have been modified or removed until further notice:
- Member transfers to a local/ in area SNF, an Acute Inpatient Rehab or a LTAC.
- First week in facility approved automatically.
- Notify Cal Health’s Health Services department of transfers within 48 hours via the Provider Portal or fax.
- Out of area transfers still require a prior authorization.
- Waived approved prior authorization for members discharged from hospital to home health agency.
- Waived approved prior authorization for member movement from an equivalent location for the same service(s).
The following new CPT code(s) have been approved for COVID-19 testing:
87426 – Infectious agent antigen detection by immunoassay technique [e.g., enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA)], qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus [e.g., SARS-CoV, SARS-CoV-2 (COVID-19)]. Effective for dates of service (DOS) on or after 6/25/2020.
How should providers bill CenCal Health for COVID-19 testing?
DHCS provided the following guidance to all health plans on March 13, 2020:
HCPCS Code Addition for COVID-19:
- U0001, Laboratory testing of patients for SARS-CoV-2
- Has been deployed to the production environment on March 21, 2020
- Will be effective for dates of service beginning February 4, 2020
- U0002, Laboratory testing of patients for COVID-19
- Has been deployed to the production environment
- Will be effective for dates of service beginning February 4, 2020
The reimbursement rates for the above codes will be $35.91and $51.31 respectively. The rates are subject to Medi-Cal policy and contracted provider agreements, if applicable.
Effective for dates of service on or after March 18, 2020, the Centers for Medicare & Medicaid Services (CMS) has released specific HCPCS codes U0003 (SARS Cov-2 COVID-19 Amp prob high throughput) and U0004 (COVID-19 lab test non-CDC high throughput) for the detection of SARS-COV-2 or the diagnosis of the virus that causes the coronavirus disease 2019 (COVID-19).
These codes are:
- Limited to two of each tests per day, per patient, on the same DOS.
- Eligible as a Presumptive Eligible benefit.
- Billable with modifiers 33, 59, 90 and 99.
- Not reimbursable when billed with each other, CPT® code 87635 or HCPCS codes U0001 or U0002.
Can providers bill CenCal Health for telemedicine services?
CenCal Health will reimburse for care delivered via telemedicine per DHCS guidelines. Please see DHCS telemedicine billing FAQ
- Capitated providers: Telemedicine services will be included in capitation payment.
- FFS providers: Telemedicine services will be paid at the contracted rate.
- BH providers: Telemedicine services for mental health is allowable. Please contact The Holman Group for more information. If you are a FQHC and offer mental health services, please submit your claims with the Medi-Cal allowable codes. Visit DHCS’ website and search “COVID-19 Medi-Cal Services and Telemedicine
Notice.” Click here for more information.
Virtual Communication (audio and video)
Providers should continue to attempt to provide telemedicine services via HIPAA-compliant telecommunications methods. However, according to the Department of Health and Human Services (HHS) issued on March 23, 2020, “…covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telemedicine without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telemedicine during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.”
We ask that you notify our Provider Services department by email email@example.com if you intend to provide services over an electronic platform.
Telephonic Communication (audio alone)
This includes a brief communication with another practitioner or with a patient, who in the case of COVID-19, cannot or should not be physically present (face-to-face). Medi-Cal providers may be reimbursed using the below Healthcare Common Procedure Coding System (HCPCS) codes G2010 and G2012 for brief virtual communications.
HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 hours, not originating from a related evaluation and management (E/M) service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
HCPCS code G2012: Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. G2012 can be billed when the virtual communication occurred via a telephone call.
Additionally, CenCal Health will waive the authorization requirement for ages 21 and over for CPT codes 98966-98968 to support providers in delivering care by telephone without video through June 30, 2020.
What is CenCal Health communicating to members?
We are including a bilingual COVID-19 FAQ sheet in our Spring 2020 Member Newsletter that mails in April, as well as posting it to our website. In addition to discussing precautions and symptoms, we discuss:
- Member Services phone lines are still open, but hold and wait times will be longer than usual.
- Pharmacy renewal limits, for an extra 30 days of most medications, have been removed.
- Their PCP may test for other illnesses first, such as the flu or strep, before COVID-19.
- There will be no cost to members if they need a coronavirus test, and CenCal Health will cover the costs of all medically-necessary treatment from the infection.
Regarding testing for COVID-19, we instruct members to call their PCP if they have the symptoms described, and that their PCP will decide if they need testing and where to get it, if needed. We also tell them that their PCP may decide to test for other illnesses, like the flu or strep.
Most importantly, we are encouraging our members to call their PCP office first for next-step instructions if they have COVID-19 symptoms. We are cautioning members not to show up at their PCP office with symptoms without calling first, in order to prevent possibly spreading the virus.
The County of Santa Barbara Public Health Department has created a Testing Triage Tool for providers to determine if patients are eligible for COVID-19 testing. Download the tool from the list of Alerts at www.countyofsb.org/phd/dcp/provideralerts.sbc.
California Department of Public Health Recommends Reassuring Messaging to Patients
AAP and CDC recommend that childhood immunizations continue to be prioritized during the COVID-19 pandemic. But parents may be reluctant to bring their children in during the pandemic. To help reassure them, consider informing them of steps your practice is taking. Included below are only examples.
1. Emphasize steps your practice is taking to keep patients and clinic staff safe.
- Are you scheduling baby shot visits in the morning and only seeing sick children in the afternoon?
- Are you screening everyone who comes into the office, including taking everyone’s temperature?
- Are you disinfecting your clinic twice daily and exam rooms after each visit?
- Do you have designated areas in your office to separate sick patients from healthy patients?
- Is everyone in the office required to wear masks at all times?
- Are you scheduling appointments so only one patient is at the clinic at a given time?
2. Consider alternate ways to deliver care.
- Do you offer telehealth appointments, where you can address patient questions and concerns on their phone or computer?
- Does your clinic offer ‘drive-thru’ immunizations, so that patients do not have to come inside?
3. Reinforce the fact that vaccine-preventable diseases will continue to be a threat to the child.
Diseases can still harm the patient’s child during and after the pandemic. It is important that children ages 24 months and younger get their vaccinations at this time.
4. Inform them that getting caught up later may not be so easy.
When California ‘reopens,’ there may be many children who need to catch up on immunizations, increasing wait times for appointments. While waiting patients can be exposed to dangerous vaccine-preventable diseases circulating in the community. Encourage your patients to keep their children on track with their vaccinations.
To help your vital work, we encourage you to check out CDC’s NIIW tools and resources and the California Department of Public Health’s on-demand webinar on guidance for immunizations during the pandemic. Thank you again for all that you do!
Disclaimer: This article was adapted from “California Department of Public Health Recommends Reassuring Messaging to Patients,” written and published by the Immunization Branch of the CDPH.
Where can I get current information on COVID-19 news?
Check credible sources for information, especially public health agencies.
It is crucial that providers stay informed as to the most current guidance and best practices relative to COVID-19, and should whenever possible support continuity and integration of medical and behavioral health services via telehealth and related adaptations in delivery during the crisis. CenCal Health and our network providers have a crucial responsibility to ensure strong care coordination and service linkage among primary care, behavioral health, and other specialty care, among other areas of health care services. During a public health crisis such as COVID-19, this role is more important than ever.
DHCS is asking that providers stay alert for signs of and assess for stress-related morbidity, and create responsive treatment plans, including supplementing usual care with measures that help regulate the stress response system.