Insurance Agents to Contact CalOptima Health Providers About OneCare Benefits |
CalOptima Health has contracted with two additional independent agents to promote OneCare (HMO D-SNP), a Medicare Medi-Cal plan.
CalOptima Health is now partnering with JAR Insurance Services and Applied General Agency (AGA) field marketing organizations (FMOs) with experience in Medicare plans, to promote the 2023 OneCare benefits for dual eligible beneficiaries. They are also enrolling individuals during the current Medicare annual enrollment period ending today, December 7, with coverage starting January 1, 2023.
With the addition of JAR and AGA, CalOptima Health now has three FMOs engaged in promoting OneCare, including iPros Insurance Professionals.
Agents from these FMOs will be contacting and meeting with providers to talk about OneCare’s benefits for their patients and practices.
For more information regarding our partnership with FMOs, please contact CalOptima Health’s OneCare Sales and Marketing department by calling 657-900-1222 or by emailing agentsupportocsales@caloptima.org.
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DHCS Updates COVID-19 PHE Unwinding Plan |
The PHE — which has been continuously renewed in 90-day increments — lasts through January 11, but the U.S. Department of Health & Human Services (HHS) did not provide the guaranteed 60-day termination notice by November 11. Therefore, it is expected to be renewed for an additional 90-day period from January to April. However, it is not yet known if the PHE will be terminated in April or renewed again.
The updated unwinding plan reflects two new flexibilities approved by the Centers for Medicare & Medicaid Services (CMS) effective October 18 and will remain in effect 14 months after the COVID-19 PHE ends. The additional approved flexibilities are:
- Partnering with the National Change of Address (NCOA) Database and United States Postal Service (USPS) In-State Forwarding Address to Update Member Contact Information.
- Partnering with Program of All-Inclusive Care for the Elderly (PACE) Organizations to Update Beneficiary Contact Information.
Since 2020, DHCS has implemented more than 100 program flexibilities to minimize strain on the Medi-Cal program, providers and members. Many of these flexibilities will end with the PHE, but those with the most positive impact on Medi-Cal will continue.
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OneCare Connect Transitions to OneCare in 2023 |
CalOptima Health’s OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) will end on December 31, 2022. At that time OneCare Connect members will transition seamlessly into OneCare.
The agency began notifying members of the change in October. Providers can help ensure members know they will still be covered. 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.
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CDC Recommends Variety of Vaccines for 2022–23 Influenza Season
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The Centers for Disease Control and Prevention (CDC) recommends annual influenza vaccines for everyone 6 months and older. The vaccine has proven to prevent millions of influenza illnesses, tens of thousands of hospitalizations and thousands of deaths each year.
For the 2022–23 influenza season, providers can choose to administer any licensed, age-appropriate influenza vaccine, including the following:
- Quadrivalent inactivated influenza vaccine (IIV4)
- Quadrivalent recombinant influenza vaccine (RIV4)
- Quadrivalent live attenuated influenza vaccine (LAIV4)
Three vaccines are recommended for people 65 years and older: quadrivalent adjuvanted inactivated (aIIV4), quadrivalent high-dose inactivated influenza vaccine (HD-IIV4) and quadrivalent recombinant influenza vaccine (RIV4).
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FDA Authorizes Updated COVID-19 Boosters |
On October 12, 2022, the U.S. Food and Drug Administration (FDA) authorized the updated (bivalent) booster dose of the Pfizer-BioNTech for anyone 5 years of age and older or Moderna COVID-19 vaccine for anyone 6 years of age and older. This vaccine offers more protection to populations at higher risk for severe disease, hospitalization and death.
On October 19, 2022, FDA authorized the Novavax COVID-19 Vaccine, Adjuvanted, for use as a first booster dose to individuals 18 years of age and older for whom an FDA-authorized mRNA bivalent COVID-19 booster vaccine is not accessible or clinically appropriate, and individuals 18 years of age and older that elect to receive it.
The CDC recommends anyone 5 years of age and older receive an updated booster or anyone 18 years of age and older receive the Novavax booster. CalOptima Health encourages providers to recommend the booster dose of the COVID-19 vaccine to patients 5 years of age and older with significant comorbidities, and to all patients 65 years of age and over.
For COVID-19 vaccine information, please see the Orange County Health Care Agency’s website, which includes administration locations.
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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.
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, 2022.
OneCare and OneCare Connect providers are encouraged to inform members of this incentive to increase the number of annual wellness visits completed.
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Avoid Provider Dispute Resolution Delays by Ensuring Form Is Completed Correctly |
To ensure prompt processing, Medi-Cal, OneCare and OneCare Connect providers submitting a Provider Dispute Resolution Request must complete the form in its entirety. All fields with an asterisk(*) must be filled out. Incomplete forms will be returned, resulting in a delay in resolving your dispute. For more information, click on this link to download provider dispute forms.
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DHCS Ending Local LTC Codes and Form |
As part of the California Advancing and Innovating Medi-Cal (CalAIM) Long-Term Care (LTC) carve-in, DHCS announced in October that LTC local service codes and the Payment Request for Long-Term Care form will be retired.
These codes and the form will be replaced with the National Uniform Billing Committee data elements and UB-04 claim form.
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Use These Resources for Patients with Lung Cancer or Chronic Obstructive Pulmonary Disorder |
CalOptima Health’s OneCare Connect program recommends the following tips and resources for treating patients with chronic obstructive pulmonary disorder (COPD) or lung cancer.
COPD: Evaluate, assess and document patients who have dyspnea, chronic cough or sputum production, a history of recurrent lower respiratory tract infections, and/or a history of exposure to risk factors for the disease.
COPD Resources:
Lung Cancer:
- Document the etiology (e.g., smoking and pollutants, host factors), pathophysiology (e.g., small airway disorders or abnormalities, emphysema, systemic effects), airflow limitation (persistent airflow limitation) and clinical manifestations (e.g., symptoms, exacerbations, comorbidities) that affect your patient’s care, quality of life, medication effectiveness, treatment responses and/or your medical decision making (MDM). Elaborate on your patient’s complete clinical picture during each episode of care and across the patient’s continuum of care.
- In your documentation, reference the clinical evidence (e.g., spirometry, CT chest) that was used as part of your MDM or document how the condition(s) have been established.
- Chronic conditions managed by a specialist can be documented as an acknowledgment that records were reviewed and providers’ clinical impression of how the conditions are being managed and treated as part of coordination and continuity of care.
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Identify, capture, address, document and report patients’ social determinants of health as contributing risk factors for chronic conditions.
Lung Cancer Resources:
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Proactive Care and Social Determinants of Health Important for Addressing Chronic Conditions |
CalOptima Health encourages providers to take a proactive and preventive, rather than reactive, approach toward care for patients with chronic conditions. Part of proactive care is the abbreviation “MEAT.”
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M = Monitor condition statuses for signs, symptoms, stability, regression or progression
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E = Evaluate test results with documentation of the clinical evidence used in medical decision-making. Also document how the condition has been established, cause-and-effect of disease processes and risk factors, treatment responses, medication effectiveness, and how the condition affects the patient’s quality of life and/or care management
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A = Assess/Address via counseling, education, ordered tests, discussion, reviewing records and obtaining records
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T = Treatment of medications, therapies, referrals and other modalities
As gatekeepers of their patient’s care, primary care providers (PCPs) should document during face-to-face visits how patients’ chronic conditions are being managed and treated by specialists. This serves as an acknowledgment that records have been reviewed as part of the patient’s continuum of care coordination.
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On October 31, DHCS distributed APL 22-022: Abortion Services. This APL supersedes APL 15-010 and is a significant update, including clarifying language, updated terminology and rearranged text.
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Health Education: Trainings and Meetings |
Click below for a list of training webinars and links happening in December 2022:
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Based on Medi-Cal Bulletins and NewsFlashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:
- Bivalent Booster Dose Approved for Select COVID-19 Vaccines
- Removal of Outdated Manual Sections and Addition of DPH Manual Sections
- Digital Breast Tomosynthesis Added into the EWC Program
- Pasteurized Donor Human Breast Milk Billable with HCPCS Ccode T2101
- Ciprofloxacin HCL 500 mg Tablet Added as Benefit for Family PACT and Medi-Cal Family Planning Programs
- Dyadic Services Added as Medi-Cal Benefits and Psychotherapy Updates
- Billing Update to the Axillary Ultrasound for Breast Cancer
- ICD-10-CM Update for Family PACT and Medi-Cal Family Planning Programs
- FQHC, RHC, and Tribal Clinic Providers: Abortion Services
- Follow Up Days Updated for Retina Treatment
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Maximum Doses of Palivizumab (Synagis®) Increased for 2022–2023 RSV Season
- Updates to the List of O&P Codes
- Medical Supplies Update: MAPC Change for Nonsterile Gloves
- LTC Code and Claim Form Conversion: CalAIM LTC Carve-In Transition
- Coming Soon: Booster Dose for Novavax and Pediatric Bivalent Pfizer-BioNTech and Moderna COVID-19 Vaccines
- Billing Issue: Radiology Codes 76641 and 76642 for Bilateral Breast Ultrasound
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- CalOptima Health Board of Directors: February 2 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.
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Follow Us on Social Media |
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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.
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CalOptima Health, A Public Agency www.caloptima.org
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