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CMA's VACCINE RESOURCES
Medi-Cal now covering Merck's commercial COVID-19 antiviral Lagevrio
DHCS recently announced that Merck’s new commercial Lagevrio (molnupiravir) COVID-19 anti-viral drug is now a covered Medi-Cal Rx benefit.
Los Angeles psychiatrist George Fouras, M.D., elected vice speaker of the CMA House of Delegates
Los Angeles psychiatrist George Fouras, M.D., was newly elected as vice speaker of the California Medical Association (CMA) House of Delegates at the association’s annual meeting this past weekend. He will join Speaker Jack Chou, M.D. , on the dais to lead delegates as they shepherd resolutions into successful policy.
DHCS system issue caused erroneous denials of four COVID-19 vaccine admin codes
CMA has been made aware of a DHCS system issue that caused erroneous denials for four COVID-19 vaccine administration codes approved for use on April 18, 2023. The system issue affected all claims submitted with these four codes. DHCS updated its system at the end of September 2023 and advised that an Erroneous Payment Correction (EPC) will be implemented to automatically reprocess the claims that erroneously denied with RAD Code 0037. CMA is waiting to hear back from DHCS on the timing o...
Medi-Cal not ready to process claims for new COVID-19 vaccine; Physicians should NOT hold claims
According to DHCS it has not yet completed the necessary system and operational changes to allow for adjudication
New COVID-19 vaccines spur major billing and coding changes
AMA recently published new CPT codes that consolidate over 50 previous codes and greatly streamline the reporting of COVID-19 immunizations.
PHC’s COVID-19 vaccine programs supported 4,500 vaccination sites to increase access in underserved communities
PHC has worked closely with the state of California to bring much-needed resources to increase access to COVID-19 vaccines and treatments in marginalized communities and high-priority health equity areas throughout California.
May 11 marks the end of the COVID-19 public health emergency
After three years of pandemic operations, May 11, 2023, marks the end of the federal COVID-19 public health emergency. According to the U.S. Dept. of Health and Human Services (HHS), COVID-19 deaths have declined by 95% and hospitalizations are down nearly 91% since the peak in January 2021.
Reminder: Medi-Cal provider enrollment flexibilities have ended
Medi-Cal providers who were temporarily and provisionally enrolled as Medi-Cal providers who wish to remain enrolled must submit a complete application and meet all program requirements if they would like to continue treating Medi-Cal patients.
CDPH COVID-19 Therapeutics Warmline launches online case submission form
California health care providers can now receive free and confidential consultation on COVID-19 testing and treatment through the CDPH COVID-19 Therapeutics Warmline.
California begins issuing $1 billion in health care workers retention payments
The California Department of Health Care Services (DHCS) today began issuing $1 billion in one-time retention payments to physicians and others who worked part- or full-time at qualifying hospitals and skilled nursing facilities during the COVID-19 public health emergency.
COVID-19 Medi-Cal provider enrollment flexibilities to end March 29
DMHC is winding down the provider enrollment flexibilities authorized under State of Emergency, which ended on Feb. 28.
What physicians need to know about the end of the COVID-19 state of emergency
CMA has published a guide to help physicians navigate the end of the state’s emergency authority.
KidsVaxGrant 3.0 deadline extended to March 3
As California continues its efforts to vaccinate all eligible residents against COVID-19, the state is offering additional financial support for Vaccine for Children (VFC) providers serving pediatric populations.
Next installment of our Virtual Grand Rounds to focus on COVID-19 therapeutics
Please join us for the next installment of our monthly Virtual Grand Grounds – COVID-19 Therapeutics:- When and How to Treat for COVID-19 –
CDPH launches COVID-19 therapeutics “warmline” support for providers
California health care providers can now call (866) 268-4322 (COVID-CA) to receive free and confidential consultation on COVID-19 testing and treatment.
CMS extends deadline to apply for hardship exception to March 3, 2023
The Centers for Medicare and Medicaid Services has extended the extreme and uncontrollable circumstances application deadline for the 2022 performance year.
Deadline to apply for a health care worker retention bonus is Dec. 30
Physicians and physician groups are reminded that the deadline to apply for a health care worker retention bonus is Friday, December 30, 2022. In order to apply, you must have already registered with the California Department of Health Care Services. Once you have successfully registered, you will need to submit an application.
Protecting patients during the winter virus season
California and many parts of the US are experiencing a “tripledemic” with flu, SARS-CoV-2, and respiratory syncytial virus (RSV) filling hospital beds.
Next Virtual Grand Rounds to provide updates on the “tripledemic”
This fall saw an unprecedented early surge of RSV, as well as early and record-breaking rates of influenza and a new COVID-19 surge.
New law requires providers to submit immunization data to a California registry
Effective January 1, 2023, a new state law requires California health care providers who administer vaccines to enter the immunizations they administer into a California immunization registry.
Reminder: Health care worker retention bonus registration deadline is 12/21
The retention bonuses, of up to $1,000, will be available to employees of hospitals, clinics that are 1206(l)s and affiliated with a hospital, or skilled nursing facilities and physicians who provided patient care in those facilities during the eligibility period, which ran from July 30 to October 28, 2022.
CDPH urges physicians to prescribe COVID-19 therapeutics to mitigate impact of winter respiratory surge
CDPH is urging physicians to lower barriers for prescribing COVID-19 therapeutics.
Next Virtual Grand Rounds to focus on emerging viruses: COVID-19, MPX and enterovirus
COVID-19 remains on our radar, but other infectious diseases are also causing new or unusual symptoms and warrant attention. To learn more, plan to join us on on Tuesday, December 13, 2022, from 12 – 1 p.m. for the latest installment of our monthly Virtual Grand Rounds – Updates of Emerging Viruses: COVID-19, MPX, and Enterovirus, Including Polio .
Health care worker retention bonus application portal now open
CMA worked with the Governor and legislature to secure $1.3 billion in the state budget to provide retention bonuses for California’s physicians and other health care providers.
Physicians urged to remain vigilant in recommending COVID-19 and flu vaccines for kids
Recent authorizations of bivalent COVID-19 vaccines for children 5 years and up will help protect young patients from the ever-evolving SARS-CoV-2 virus that causes COVID-19.
CMA to host webinar on health care worker retention bonus application process
CMA will be hosting a webinar on November 17, 2022, where DHCS staff will provide an overview of and answer questions about eligibility and the registration/application process.
Next Virtual Grand Rounds to focus on COVID-19 and the Health Implications of Wildfire Smoke
Wildfires seem to have become a yearly norm in California. Join us on November 8 for the latest installment of our monthly Virtual Grand Rounds to learn from experts about the short -and long-term health impacts of frequent particulate exposure.
Physicians no longer required to report all cases of COVID-19
Under the new requirements, physicians and other health care providers must still report patient hospitalizations and deaths due to COVID-19,
Bracing for another spike in cases, HHS extends PHE for another 3 months
HHS has extended the COVID-19 public health emergency, for additional 90 days, effective October 13, 2022. As the U.S. braces for a spike in cases this winter, the public health emergency will continue through at least January 11, 2023.
Reminder: Provider Relief Funding reports due Sept. 30
The deadline for providers to submit a Provider Relief Fund (PRF) Reporting Period 3 report is September 30, 2022, at 11:59 pm ET.
Study finds COVID-19 pandemic has driven physician burnout to an all time high
The burnout rate among physicians in the United States spiked dramatically during the first two years of the COVID-19 pandemic, according to a newly published study in Mayo Clinic Proceedings.
CDPH and PHC launch grant to improve COVID-19 treatment in underserved communities
CDPH has launched the COVID-19 Test to Treat Equity Grant Program. COVID-19 treatment greatly reduces risk of hospitalization and death for those who have COVID-19, but many communities still are not able to access these life-saving medications.
CDPH ends weekly testing requirements for most unvaccinated heath care workers
CDPH is ending COVID-19 policies that required weekly COVID-19 testing for unvaccinated individuals in high-risk workplaces and schools who applied for and were granted an exemption from vaccination requirements.
DHCS publishes FAQ on health care worker retention bonuses
DHCS has published an FAQ that answers common questions about the health care worker retention bonuses authorized under legislation recently signed by Governor Newsom to stabilize and retain California’s health care workforce and recognize the sacrifices our health care workers have made over the course of the pandemic
HHS expected to renew public health emergency in Oct.
Although the COVID-19 public health emergency declaration is slated to expire at the end of October, it is expected that U.S. Health and Human Services Secretary Xavier Becerra will issue another extension.
CMA updates COVID vaccine billing resources to include new bivalent boosters
In a critical next step forward in our country’s COVID-19 vaccination program, the U.S. Centers for Disease Control and Prevention (CDC) and U.S. Food and Drug Administration (FDA) last week approved the use of updated COVID-19 boosters from Pfizer-BioNTech for people ages 12 years and older and from Moderna for people ages 18 years and older.
DHCS announces payment eligibility period for COVID-19 health care worker retention bonuses
In June 30, 2022, Governor Newsom signed legislation aimed at stabilizing and retaining California's health care workforce and recognizing the sacrifices our health care workforce has made over the course of the pandemic. The bill provides $1.3 billion to provide a financial stipend for every individual working in eligible hospital settings, including physicians.
Provider Relief Funding reports due September 30
Next installment of our Virtual Grand Rounds to focus on cardiac manifestations of long COVID
The latest installment of our monthly Virtual Grand Rounds will be September 13, 2022.
New funding available to support physicians providing pediatric COVID-19 vaccines
PHC today announced that CDPH is investing an additional $10 million to support physicians providing pediatric COVID-19 vaccines.
CDPH launches COVID-19 therapeutics webinar series August 1
CDPH is launching a new bi-weekly webinar series for physicians about therapeutics used to treat COVID-19.
Medi-Cal now ready to accept COVID-19 vaccine admin claims for small children
DHCS is now ready to accept Medi-Cal vaccine administration claims for individuals 6 months and older.
DHCS urges physicians to hold vaccine administration claims for small children
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 this age range.
CDPH substantially expands definition of “close contact”
CDPH recently expanded the definition of “close contact” to better acknowledge that COVID-19 is an airborne disease, rather than one spread by respiratory droplets.
Next Virtual Ground Rounds to provide updates on COVID-19 and Monkeypox
Join us on Tuesday, July 12, 2022, from 12 – 1 p.m. for the latest installment of our monthly Virtual Grand Rounds to learn from experts about the status of COVID-19 and monkeypox in California.
Are you ready for COVID-19 vaccines for children under 5?
COVID-19 vaccines for children under age 5 may be available as soon as the end of June. Vaccine preorders are now available through myCAvax.
AMA announces CPT update for pediatric COVID-19 vaccine candidate
AMA announced an update to the CPT code set to now include the Moderna COVID-19 vaccine for children ages 6 months through 5 years old.
Deadline extended for pediatric COVID-19 vaccine grant program; apply by July 15
PHC has extended the deadline for its KidsVaxGrant program – which will award grants of up to $15,000 to support Vaccines for Children (VFC) providers providing pediatric COVID-19 vaccines. Applications will now be accepted through July 15, 2022.
CDPH to host COVID-19 vaccine administration billing and reimbursement webinar
CDPH is hosting a COVID-19 Vaccine Administration Billing and Reimbursement webinar on Wednesday May 25, 2022,
Regulator issues guidance on COVID-19 testing and vaccination reimbursement
A CMA-sponsored law that took effect on January 1, 2022, requires health plans and insurers to cover COVID-19 testing and vaccine administration with no patient cost-sharing, no prior authorization and regardless of the provider’s network status, retroactive to March 4, 2020 .
HRSA to allow late Period 2 Provider Relief Fund reporting through May 18
The deadline for providers to request to submit a late Provider Relief Fund (PRF) Reporting Period 2 report has been extended to May 18, 2022, at 11:59 pm ET.
AMA says a “staggering” 16k providers missed first Provider Relief Fund reporting deadline
AMA is urging the HHS to allow more time for physicians who accepted federal COVID-19 relief funds to meet the Period 1 Provider Relief Fund reporting requirements. Although the HHS Health Resources and Services Administration (HRSA) did briefly reopen the reporting portal last month, approximately 16,000 providers still missed the deadline.
CMA files declaration in support of LA County COVID-19 vaccine policy for employees
CMA filed a declaration with U.S. District Court for the Central District of California, in support of a County of Los Angeles policy that requires county employees to receive the COVID-19 vaccine.
FQHC, RHC and Tribal FQHC providers may now submit claims for COVID-19 vaccine admin
DHCS has indicated it will automatically reprocess claims previously submitted. These claims will be automatically reprocessed at the lower of either the $67 rate or the billed charge if less than $67.
DHCS enlisting “coverage ambassadors” to help patients maintain coverage as PHE ends
In the largest effort of its kind, across the country, Medicaid (Medi-Cal in California) and the Children’s Health Insurance Program (CHIP) will soon begin the process of redetermining eligibility for about 85 million people who use these programs to access the health care they need.
HRSA identifies allowable extenuating circumstances for late reporting of provider relief funds
As previously reported, the Health Resources and Services Administration (HRSA) has decided to reopen the reporting time for recipients of Period 1 Provider Relief Funds. Physicians who received more than $10,000 in provider relief funds and failed to submit their Period 1 report should act immediately.
HRSA to reopen provider relief fund reporting on April 11
Physicians across the country who accepted federal COVID-19 relief funds but failed to meet the Period 1 Provider Relief Fund reporting requirements will now have another opportunity to come into compliance.
Organized medicine urges HRSA to reopen provider relief reporting period
Some providers across the country who accepted federal COVID-19 relief funds but failed to meet reporting requirements are now facing demands to return all or part of the money they were given.
Feds approve COVID-19 vaccine admin rate for FQHCs, RHCs and Tribal FQHCs
In March 2021, the California Department of Health Care Services (DHCS) submitted a State Plan Amendment (SPA 21-0020) to the Centers for Medicare and Medicaid Service
PHC launches new grant program to support physicians providing pediatric COVID-19 vaccines
Noting the continued importance of community vaccinators in the efforts to increase vaccine uptake
Second Provider Relief Fund reporting deadline is March 31
Physicians are reminded that the U.S. Department of Health and Human Services (HHS) Provider Relief Fund (PRF) reporting portal is open for providers who need to report on the use of funds in Reporting Period 2.
Next Virtual Grand Rounds to focus on pediatric COVID and emerging variants
As we enter the spring with our lowest COVID case rates in two years and roll back various recommendations and requirements on masking and gathering, many cautiously hope for a new phase of the pandemic.
State lifts indoor mask mandate for unvaccinated; Masks still required in health care settings for all
Effective March 1, 2022, masks are no longer required for unvaccinated individuals in California
CMS extends deadline for physician groups seeking MIPS waivers
CMS recently announced it would be giving physician groups participating in MIPS more time to apply for an extreme and uncontrollable circumstance waiver due to the ongoing disruptions the COVID-19 public health emergency.
HHS distributing additional $560 million in provider relief fund payments
On February 24, 2022, HHS announced it was making more than $560 million in additional Provider Relief Fund payments to more than 4,100 providers across the country.
Webinar: Using social media to effectively communicate about COVID-19 vaccines
Please join #ThisIsOurShot physicians, Vicki Chan, M.D., and Alex McDonald, M.D., for a webinar training for health care professionals on using social media to effectively communicate about COVID-19 vaccines. The one hour webinar is Wednesday, February 16, 2022, at 12:30 pm.
Webinar: COVID-19 Testing: During and After the Omicron Surge
This one-hour webinar— COVID-19 Testing: During and After the Omicron Surge —is free to all interested parties. No CME credit will be given for participation and the webinar will not be recorded.
California health care workers given one more month to get booster shots
Individuals working in health care facilities now have until March 1, 2022, to get their shot. If they are not eligible for a booster by March 1, they must get their booster shot within 15 days of becoming eligible.
Webinar: Reconsidering Priorities and Practical Strategies for Addressing Clinician Well-Being in Omicron’s Wake
AMA is hosting a webinar on Thursday, January 27, 2022, exploring strategies for addressing clinician well-being in the wake of the coronavirus’ Omicron variant.
HHS distributing $2B more in Provider Relief Fund payments
HHS announced the imminent distribution of another $2 billion in Provider Relief Fund payments to health care providers
Moss Adams hosts free webinar to help physicians navigate HHS Provider Relief Fund reporting
As providers prepare for the second round of reporting, there are many compliance concerns to consider.
Bill introduced to close personal exemption loophole for COVID-19 school vaccinations
Senator Richard Pan, M.D., has introduced a bill—the Keep Schools Open and Safe Act—to close the personal belief exemption loophole for school-based vaccination requirements for COVID-19.
Legislators form vaccine work group to boost public health policies
California legislators recently announced the formation of the legislative Vaccine Work Group, which is developing cohesive and comprehensive evidence-based policies to stop the spread of COVID-19 and other diseases, while battling misinformation.
Anthem continues to reprocess more than $2.8 million in pediatric vaccine claim underpayments
Anthem Blue Cross continues to reprocess more than $2.8 million in underpayments tied to the COVID-19 vaccine for 5–11-year-olds.
Biden administration expands access to at-home COVID tests
The website for Americans to order free home COVID tests officially launched today after the site went live in a limited “beta phase” on Tuesday morning,
CDPH hosting two webinars this week to equip physicians to talk to patients about COVID-19 vaccines
CDPH is hosting two webinars this week to equip trusted medical professionals with tools and techniques
US extends "public health emergency" due to the COVID-19 pandemic.
HHS has extended the COVID-19 Public Health Emergency for an additional 90 days. This means that the telehealth and other waivers and flexibilities that have been implemented during the PHE will remain in effect until at least April 16, 2022.
Anthem Blue Cross clarifies recent telehealth reimbursement policy update
Anthem Blue Cross has clarified that for California providers, it will continue to reimburse telehealth services billed with either POS 02 or POS 10 at the in-office place of service rate, as currently required by the California Department of Managed Health Care (DMHC).
State and federal government issue new guidelines and support to fight COVID-19, including mandatory boosters for California health care workers
With the highly transmissible omicron variant now accounting
Next Virtual Grand Rounds to focus on COVID-19 therapeutics
As we enter a new year, a new variant has emerged, winter conditions are pushing people indoors, and holiday gatherings and travel are increasing potential virus exposure and movement. With this in mind, we are eagerly watching to see how the state of the pandemic evolves as we begin 2022.
Anthem Blue Cross implements fix for pediatric COVID-19 vaccine underpayments
Anthem Blue Cross has reported progress in addressing underpayments tied to the newly approved COVID-19 vaccine for the 5–11-year-old pediatric population.
Medi-Cal to cover pediatric COVID-19 vaccine counseling by health care providers
CMS is now requiring states to cover COVID-19 vaccine counseling visits in which health care providers talk to families about the importance of kids’ vaccination.
CMA survey finds 70% of practices worried about practice viability after 19 mo of sustained losses
Almost two years into the pandemic, CMA’s third follow-up survey to reevaluate practice viability found
Phase 4 Provider Relief Fund payments to be distributed this week
Today, HHS announced the imminent distribution of approximately $9 billion in Provider Relief Fund Phase 4 payments to health care providers.
CDPH issues universal, statewide indoor mask mandate
Faced with rising COVID-19 cases, the California Department of Public Health (CDPH) announced today it will require universal masking beginning Wednesday, December 15, 2021, in all indoor public settings regardless of vaccine status.
CDPH publishes fact sheet on Omicron variant
CDPH is monitoring for the presence of the variant in California through the California SARS-CoV-2 Whole Genome Sequencing Initiative, known as COVIDNet . This is a public-private partnership that provides California with genomic sequencing to help understand and control the spread of COVID-19.
Anthem Blue Cross underpaying pediatric COVID-19 vaccine claims
Anthem is reimbursing the newly approved COVID-19 vaccine for the 5–11-year-old pediatric population at unreasonably low rates—less than 20% of the CMS rate.
Clearinghouse corrects problem causing rejection of COVID-19 vaccine claims for children
Shortly after federal approval of the COVID-19 vaccine for children age 5-11, the California Medical Association (CMA) began receiving reports that clearinghouse Office Ally was rejecting the claims for 5-11 year olds with a message code stating the CPT codes were invalid.
60-day Provider Relief Fund grace period ends November 30
Providers who fail to meet this reporting deadline will be required to return their PRF payments by December 30, 2021, and will be subject to further enforcement actions such as exclusion from future PRF payments.
CMS to hold physicians harmless from 2023 MIPS penalties amid COVID-19 pandemic
CMS recently announced that it will again this year be granting automatic exceptions from reporting requirements for clinicians and providers participating in Medicare quality reporting programs due to the ongoing disruptions the COVID-19 public health emergency is having on physician practices.
UnitedHealth will repay providers underpaid for COVID-19 vaccine administration
UnitedHealthcare has said it will reprocess claims for COVID-19 vaccine administration after federal investigators found the insurer had underpaid “millions” of providers—paying 40% less than the Medicare rate for administering the COVID-19 vaccine.
Next Virtual Grand Rounds to focus on COVID-19 and the holidays
Join us on Tuesday, December 7, 2021, for the 18th installment of our monthly Virtual Grand Rounds — COVID-19 and the Holidays - Where do we stand and Updates on Testing and Outpatient Treatment.
CMA-sponsored law requires payors to cover cost of COVID-19 testing and vaccine admin
Ensuring physicians can administer tests and vaccines is critical to putting the COVID-19 pandemic behind us. This is why the California Medical Association (CMA) sponsored legislation that requires health plans and insurers to cover COVID-19 testing and vaccinations during the pandemic without barriers like patient cost-sharing or prior authorizations.
CMS requires health care workers at participating facilities be vaccinated
CMS issued an Interim Final Rule mandating that health care workers at facilities participating in the Medicare and Medicaid programs be fully vaccinated.
Change coming to Medicare Advantage claims for vaccine administration services
Effective January 1, 2022, CMS will change the way physicians bill for COVID-19 vaccine administration for Medicare Advantage enrollees.
California physicians encourage caregivers to get children vaccinated against COVID-19
In the wake of the U.S. Food and Drug Administration’s (FDA) emergency-use approval of the Pfizer-BioNTech vaccine against COVID-19 for kids ages 5 through 11, a coalition of physician groups and immunization experts is urging parents and caregivers to get all eligible children vaccinated as soon as possible.
PHC requesting proposals to increase CalVaxGrant awareness and applications
PHC is soliciting proposals from organizations to conduct outreach to physician practices between November 8 – December 15, 2021.
COVID-19 Webinar: How to Have Effective Conversations about COVID-19 Vaccines and Pregnancy and Fertility
Please join ob-gyns LaTanya Hines, M.D., and Michael Policar, M.D., for a webinar training on how to effectively communicate with your patients about COVID-19 vaccines, fertility and pregnancy. The free one-hour webinar is Thursday, November 18, 2021, at 12:30 p.m
Join us on November 9 for Virtual Grand Rounds—Spotlight on COVID-19 Vaccines
As we head into the winter, the U.S. Food and Drug Administration (FDA) continues to meet to discuss some major questions and developments around the COVID-19 vaccines.
DMHC urges payors to proactively prepare for pediatric COVID-19 vaccine admin claims
DMHC recently issued an all-plan letter encouraging plans to take steps now so they can proactively prepare for the administration of COVID-19 vaccines to children between age 5 to 11 years as soon as the vaccine is approved for use in that population.
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