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SAN FRANCISCO CHILD HEALTH &
DISABILITY PREVENTION
(CHDP) PROGRAM NEWSLETTER
F a l l 2 0 1 7V o l u m e X , I s s u e I I
Outbreaks of hepatitis A virus (HAV) are currently ongoing in two California counties. The San Francisco Department of Public Health (2017) reports that “To date, no related cases have been identified in San Francisco. As of August 29th, San Diego County has identified at least 378 cases and 15 deaths have been reported since November 2016; Santa Cruz County has reported 62 cases since April 2017.” Transmission is presumed to occur person-to-person; no commercial product has been identified as being contaminated. Based on current information, all populations who are homeless or using injection and non-injection illicit drugs can be considered at risk of outbreaks if exposed to HAV. The San Francisco Department of Public Health is preparing for a possible outbreak.
All San Francisco CHDP Clients should be vaccinated against HAV.
ACTIONS REQUESTED OF CLINICANS: 1. Routinely identify and immediately vaccinate non-HAV immunepatients. Patients who have received 2 doses of monovalent HAV vaccineor 3 doses or combined hepatitis A/B vaccines are considered immune. Noserologic testing is required.
Routine vaccination: Initiate the 2–dose Hep A vaccine series at ages 12 through 23 months;separate the 2 doses by 6 to 18 months. Children who have received 1 dose of Hep A vaccine before age 24months should receive a second dose 6 to 18 months after the first dose.
Catch–up vaccination: For any person aged 2 years and older who has not already received theHepA vaccine series, 2 doses of Hep A vaccine separated by 6 to 18 monthsmay be administered.
Continued on page 2 1
HEALTH ADVISORY: Hepatitis A Outbreaks
© 2017 Tina Panziera
In this issue
Hepatitis A Outbreaks……..1
Autism Referrals……………2
Juice Recommendations…..2
Therapeutic Formula & Enteral Nutrition Products....3
Health Assessment Guidelines…………………..3
Inter-professional Oral Health Clinical Domains & Competencies………………4
Effectiveness on Early Childhood Caries of an Oral Health Promotion Program for Medical Providers.. ......5
Dental Transformation Initiative .............................5
Dr. Nguyen Retires ...........6
2017 CHDP Gateway Income Eligibly Guidelines.6
CHDP provider information notices ..............................7
Additional Hepatitis A information:
California Department ofPublic Health Hepatitis AQuicksheet: https://archive.cdph.ca.gov/programs/immunize/Documents/CDPHHAVQuicksheet.pdf
Post exposure prophylaxis:https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/HepatitisA-PEPQuicksheet.pdf
ACIP Birth-18 YearsRecommended ImmunizationSchedule:https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent-shell.htmlACIP Birth-18 Years Catch-upImmunization Schedule:https://www.cdc.gov/vaccines/schedules/hcp/imz/child-indications-shell.html
References: 1. Heyman, M. B., & Abrams,S.A. (2017) Fruit juice in infants,children, and adolescents:current recommendations.Pediatrics, 139(6).http://pediatrics.aappublications.org/content/139/6/e201709672. Fruit juice and your child’sdiet. Healthchildren.org.https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Fruit-Juice-and-Your-Childs-Diet.aspx
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Continued from page 1
2. Suspect Acute Hepatitis A in homeless and/or drug-using individuals whopresent with consistent symptoms (abdominal pain, nausea, vomiting,fever, jaundice, and significant elevation in LFTs). Confirm via serumhepatitis A IgM testing.
3. Report cases of symptomatic, lab confirmed hepatitis A infection byphone to SFDPH Communicable Disease Control Unit at (415) 554-2830.After hours follow instructions to contact the On-Call Physician. Promptreporting may allow patient interview to be conducted while patient is stillin the treatment facility so individuals are not lost to follow up.
Reference: Communicable Disease Control & Prevention, San Francisco Department of Public Health. (2017, September 6). Health Advisory: Hepatitis A Outbreaks in California: Prevention Recommendations for San Francisco Providers. Retrieved from: http://www.sfcdcp.org/document.html?id=1198
In accordance with the American Academy of Pediatrics (AAP)
recommendation, CHDP now requires that all children receive autism screening at 18 and 24 months of age (using an AAP recommended tool such as the M-CHAT). So what’s the next step after you identify a patient with suspected Autism? Where can you refer these patients for behavioral therapy?
For children of any age with suspected or known Autism Spectrum Disorder (ASD) including a Pervasive Developmental Delay (PDD), refer the family to GGRC. For patients ages 3 years and up, in addition to the GGRC referral, make a concurrent referral to SFUSD. ABA Services are available through the Medi-Cal Managed Care Plans. Furthermore, Multidisciplinary centers can assist with Diagnosis and Case Management, as well as provide additional services. Please see insert for where to refer.
In a policy statement published in the June 2017 issue of
Pediatrics, AAP now recommends no juice for infants and has decreased the amount of juice recommended for older children and adolescents.
As juice can be drunk more quickly than eating a piece of fruit, juice allows children to consume calories more rapidly. In addition, juice lacks the dietary fiber found in fruit. Families should be encouraged to give whole fruit instead of juice.
Current Juice Recommendations
Autism Referrals
Age Recommendations
< 12 months Do not routinely give fruit juice to infants younger than 12
months since it offers no nutrition benefit at this age.
1-3 years Limit fruit juice to a maximum of 4 ounces per day (1/2 cup). Do
not allow child to carry a cup or box of juice throughout the
day.
4-6 years Limit fruit juice to a maximum of 4-6 ounces per day (1/2 –3/4
cup). Do not allow child to carry a cup or box of juice
throughout the day.
7-18 years Limit juice to 8 ounces per day (1 cup).
Updated 9/18/17 Page 1
Autism Referrals
Insurance Provider Referral Process/ documentation
San Francisco Health Plan/ Beacon Behavioral Health 855-371- 8117
Provider may initiate referral with PCP referral form / attached consent form: http://www.sfhp.org/providers/provider-resources/mental-health-resources/ Fax form to: 800.596.2712 OR secure email: [email protected] OR Parents or Providers can also initiate a referral by calling 855-371- 8117. **Referrals are routed to Autism Spectrum Case Managers who link patients to needed behavioral health services
Anthem Blue Cross 888-321-2246
Families or Providers may call 1-888-321-2246, option 1 then option 2. An intake representative will either provide referrals or refer patient to Behavioral Health Case Management Providers complete an Autism Treatment Plan Request and fax to 1-866-582-2287 https://www11.anthem.com/ca/provider/f0/s0/t0/pw_e226526.pdf?refer=provider
Fee for Service Medi-Cal Finding resources for this patient population is challenging. Please contact CHDP office for assistance 415-575-5712. Note: The Senate Bill 75 (SB75), approved in October 2015, expanded the Medi-Cal health coverage in California to all low-income children younger than 19 years of age that meets the income guidelines of less than 266% of the Federal Poverty Level (FPL) regardless of immigration status. Most patients are now eligible for Managed Care Plans. Pt families should be encouraged to apply as soon as possible.
Resource Ages Eligibility / Services Insurance Language Timeline Referral Process Medical Information
Golden Gate Regional Center (GGRC)
1355 Market St, #220 San Francisco, CA 94103 415-546-9222
Intake Line: 888-339-3305 Fax: 888-339-3306 Email: [email protected]
<3 yo 3+ yo
Evaluation for all children with suspected developmental delay or autism spectrum disorder. Significant impairment due to mental retardation, epilepsy, autism, cerebral palsy, or similar condition
All English Spanish Cantonese Other languages by request
45 days max, by law
Fax “Early Start Referral Form” to 888-339-3306 Tel: 888- 339-3305 Email: [email protected] After the request is received, an Intake worker will conduct a basic screening to determine if further assessment and diagnostic services are appropriate. Parents can also self-refer by completing the “Early Start Parent Intake Form”
Updated 9/18/17 Page 2
Resource Ages Eligibility / Services Insurance Language Timeline Referral Process Medical Information SFUSD SFUSD - Early Childhood Special Education 3045 Santiago Street San Francisco, CA 94116 Phone (preschool): (415) 759-2214 School Age: Contact child’s school Fax: (415) 242-2528 http://www.sfusd.edu/en/programs-and-services/special-education/pre-school-special-education-services.html
3-5 yo School Age
Developmental assessment for all children with suspected or known developmental or behavioral issues (including Autism). Ongoing services for students who will receive educational benefit from Special Education services.
All All Once the USD receives a completed packet they have 15 days to respond to request , then 60 days to perform initial evaluation (but does not include the Summer!) Refer before mid- March if possible.
Refer to Preschool Intake Unit: Family must complete and submit the Preschool Intake questionnaire. Available from link: http://www.sfusd.edu/en/programs-and-services/special-education/pre-school-special-education-services.html If attending SFUSD, family must submit a letter to their child’s school requesting an evaluation.
Parents must bring a copy of the child's birth certificate and two proofs of residency to initial interview and submit. written verification of hearing and vision screenings results (within the last 12 months) Be sure to include all documentation in packet – for fastest evaluation
Multidisciplinary Centers Kalmanovitz Child Development Center 1625 Van Ness, 3rd Floor San Francisco, CA 94109 Tel. 415-600-6200 1580 Valencia Street #701 San Francisco, CA 94110 Tel. 415-641-3345
0-18 OT, PT, Speech language SFHP
Anthem BlueCross
English Spanish
3-6 month waitlist depending on the service
Provider sends referral form for OT/PT or Speech evaluation
Parents must call to initiate intake process
Insurance info CPMC Questionnairre packet
Updated 9/18/17 Page 3
Resource Ages Eligibility / Services Insurance Language Timeline Referral Process Medical Information Multi-disciplinary Assessment Center (MDAC) at San Francisco General Hospital (SFGH) San Francisco General Hospital Building 5 (main grey hospital building) on the 6th floor, Ward 6B. (415) 206-6129.
0-5 6-18 (case by case basis)
Assessment for all children under age 6 years who reside in San Francisco. Children insured by Medi-Cal who have their primary care in the San Francisco Health Network (DPH Clinics) ONLY
SFHP
Anthem BlueCross
English Spanish Interpretor Available for other languages)
Provider emails or faxes MDAC Referral Form [pdf] to start intake process
Medical records ( if not seen at SFGH)
Evaluation report(s) (e.g., IFSP, testing by other providers)
School documents (e.g., SST, IEP)
SNAP Cognitive and Behavioral Pediatric Neurology Clinic
Phone numbers: Nursing Assistance: (415) 353-2859 New Patient Appointments: (415) 514-5863 Pediatric Brain Center main line: 1 (855) PBC-UCSF Fax: (415) 353-2400
UCSF Pediatric Brain Center Child Neurology (San Francisco/Mission Bay location): UCSF Ron Conway Family Gateway Medical Building 1825 Fourth St., Fifth Floor, 5A San Francisco, California
all Provide investigation into the underlying cause child’s neurodevelopmental differences, as well as behavioral/educational guidance and basic pharmacologic management. Work collaboratively with providers at UCSF and in the community for comprehensive care
SFHP
Anthem BlueCross
FFS Medi-Cal
All – interpretor services available
Evaluation typically within 2 weeks
Provider initiates referral. Prior authorization (if required), pertinent medical information, insurance card and demographics should be faxed to 415-353-4485. SNAP clinic will call family to schedule appointment once referral documentation is complete.
Depending on your patient’s type of Medi-Cal, there are several ways to prescribe therapeutic formula or enteral nutrition products (ie premature/low birth weight product, extensively hydrolyzed product, higher calorie product, etc). Medi-Cal managed care plan patients need to have a filled out Prior Authorization Form submitted to their respective health plan: San Francisco Health Plan (SFHP) Prior Authorization Requests: http://www.sfhp.org/providers/formulary/prior-authorization-requests/ Anthem BlueCross Prior Authorization Requests: https://mediproviders.anthem.com/ca/Pages/request-prior-authorization.aspx Fee-for-Service Medi-Cal patients may be referred to a medical supply company specializing in third-party insurance billing for the therapeutic formula on the patient’s behalf. Companies not limited to: Coram CVS: https://www.coramhc.com/referrals/default.aspx or contact San Francisco’s liaison, Sarah Lind at [email protected] or cell phone (415) 314-8254 or fax (949) 462-8181. Shield HealthCare: http://www.shieldhealthcare.com/contact/ or fax prescription to 800-765-8775. Women, Infants, and Children (WIC) may provide the needed therapeutic formula or enteral nutrition product for eligible patients while insurance processes. Please: 1. Fill out a WIC Referral Form https://archive.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph247AFull.pdf 2. Refer the patient to any of the San Francisco WIC locations (https://www.sfdph.org/dph/comupg/oprograms/NutritionSvcs/WIC/WIClocations.asp) or call (415) 575-5788. The CHDP HAGs set standards for pediatric health assessments. Several have been updated and are consistent with the new AAP Bright Futures (BF) Guidelines. The HAGs provide guidance to ensure compliance with California state specific and Medicaid regulations, which supersede BF. New and/or updated CHDP HAGs include: blood lead test & anticipatory guidance, health education & the process of anticipatory guidance, nutritional assessment & anticipatory guidance, substance use: alcohol & drugs, tuberculosis, and vision screening. Please see HAGs at the state CHDP Health Assessment Guidelines website http://www.dhcs.ca.gov/services/chdp/Pages/HAG.aspx. All CHDP providers are required to comply with the most recent AAP Bright Futures Guidelines and the AAP Bright Futures Recommendations for Preventive Pediatric Health Care (periodicity table). In addition, CHDP providers are also required to comply with any additional state and/or Medicaid regulatory requirements for risk assessments and testing as outlined in the CHDP HAG.
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Documentation Requirements for both Medi-Cal managed care or Fee-for-Service patients include:
Physician name, address, and telephone number
Patient health insurance information
Medical diagnosis name related to the product requested
Patient age, height (length), weight, body mass index (BMI) of patient
Biochemical, clinical and/or dietary indicators related to the request for product
Daily caloric requirements
Estimated duration of need for the therapeutic formula or enteral nutrition product and/or nutrition care plan
Route of administration
Product package size (ml or gm)
Product caloric density (kcal/ml or kcal/gm)
Product 11-digit Medi-Cal billing number
Questions or comments? Please contact CHDP Nutritionist Teresa Chan, RD, MPH (415) 575-5731 or [email protected]
Therapeutic Formula & Enteral Nutrition Products
CHDP Health Assessment Guidelines (HAG) Updates
References: 1. Jackson, S.L., Vann, Jr, W.F., Kotch, J.B., Pahel, B.T., & Lee, J.Y. (2011). Impact of Poor Oral Health on Children's School Attendance and Performance. American Journal of Public Health, 101(10), 1900-1906. http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2010.200915 2. Douglass, J.M. & Clark, M.B. 2015.Integrating Oral Health Into Overall Health Care to Prevent Early Childhood Caries: Need, Evidence, and Solutions. Pediatric Dentistry, 37(3), 266-274. https://www.ncbi.nlm.nih.gov/pubmed/26063555 v37n3/s7.pdf?expires=1504051311&id=91310841&titleid=75004753&accname=Guest+User&checksum=66D0C5E073BB886287BFF0CD4E29BD84
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Oral health is an integral part of overall health. Poor oral health has many consequences, including poor nutrition, pain, progression of decay across newly erupting teeth, risk for a lifetime of dental problems and increased school absences.1 The presence of oral disease eventually impacts systemic disease processes such as diabetes, cardiovascular health, and preterm birth. Lack of access to oral health care contributes to profound and enduring oral health disparities among children of color in San Francisco. “Medicaid data shows that few one-to-two-year-olds receive a preventive dental visit, indicating limited success of dental home establishment by 1 year of age. Few pediatricians refer children for early dental care. Few dentists are comfortable seeing children younger than two-years-old, fewer still provide restorative care, and many dentists do not accept Medicaid insurance. These realities mandate new strategies to meet the needs of children and families and effectively tackle early childhood caries (ECC).” 2 Although EPSDT requirements have included oral health assessment, referral and anticipatory guidance, only recently has the integration of oral health been recognized as essential to effectively addressing this disease. In 2013, Health Resources and Services Administration developed the Inter-professional Oral Health Core Clinical Domains and Competencies http://www.nnoha.org/nnoha-content/uploads/2015/01/IPOHCCC-Users-Guide-Final_01-23-2015.pdf for medical providers to increase integration of oral health care into primary health care. See Table 1 for examples.
Inter-professional Oral Health Core Clinical Domains and Competencies for Primary Care Providers
Table 1: Oral Health Core Clinical Domains & Competencies
Domains Purpose Examples
1: Risk Assessment Identify factors that impact oral health and overall health (AAP has developed a simple risk assessment form https://www.aap.org/en-us/Documents/oralhealth_RiskAssessmentTool.pdf)
Ask about risk factors: Previous/current decay Parent/sibling with decay (now or in previous year) Frequent sipping/snacking on sugary drinks, foods Children with special health care needs
2: Oral Health Evaluation
Perform oral health evaluations linking patient history, risk assessment, and clinical presentation and identify and prioritize strategies to prevent or mitigate risk impact for oral and systemic diseases.
Perform an oral assessment
3: Preventive Intervention
Implement appropriate patient-centered preventive oral health interventions and strategies to mitigate risk factors when identified.
Apply Fluoride Varnish
4: Communication and Education
Provide targeted patient education about importance of oral health and how to maintain good oral health, which considers oral health literacy, nutrition, and patient’s perceived oral health barriers.
Recommend: Brush with rice grain size fluoride toothpaste 2x day No bottle after 1 years old
5: Inter-professional Collaborative Practice
Facilitate patient navigation in the oral health care delivery system through collaboration and communication with oral health care providers, and provide appropriate referrals.
Refer to appropriate dentist Every 6 mos Start by age One
Reference: Braun, P.A., Widmer-Racich, K.,
Sevick, C., Starzyk, E.J.,
Mauritson, K., & Hambidge, S.J.
(2017). Effectivess on Early
Childhood Caries of an Oral
Health Promotion Program for
Medical Providers. American
Jounrnal of Public Health, 107
(S1),S97-S103. https://
www.ncbi.nlm.nih.gov/
pubmed/28661802
\
Research by Braun et al. (2017) indicates that an oral health promotion
(OHP) program significantly reduced early childhood caries (ECC) among program
participants. Utilizing the Cavity Free at Three program, medical professionals were
trained in caries risk assessment, oral examination, oral health instruction, fluoride
varnish application (FVA), and dental referral. After the four-year study, researchers
found children with 4+ FAVs before age of 3 had significantly fewer decayed tooth
surfaces and no difference in number of decayed teeth among children with only 1
FVA before age 3 and children with no FVAs. With the OHP intervention,
improvements were seen in oral health behaviors including increased dental visits,
weaning off bottle, drinking tap water, and brushing of child’s teeth with fluoride
toothpaste.
San Francisco Department of Public Health (SFDPH) is the lead entity for a
local collaboration that has received a grant of $6 millon over 4 years to
improve the oral health of San Francisco’s children as part of the California
Department of Health Services’ Dental Transformation Initiative (DTI), Local
Dental Pilot Projects (LDPP). The goal of the SFDPH LDPP is to improve
dental health of SF Denti-Cal/Medi-Cal beneficiaries 0 to 5 years of age by
increasing access to dental care and use of preventive dental services.
CHDP is collaborating with the SFDPH DTI by hiring two bilingual
Health Workers to assist in linking CHDP Managed Care Medi-Cal clients
(ages 0-5 years old) to Dental Homes. The SFDPH DTI application used the
San Francisco Children’s Oral Health Strategic Plan as the foundation for five
pilot projects. More information can be found at http://assets.thehcn.net/
content/sites/sanfrancisco/
Final_document_Nov_2014_20141126111021.pdf
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Positive Impact of Medical Provider Oral Health
Promotion on Early Childhood Caries
Dental Transformation Initiative
Dr. Tin Nguyen
FQHC/RHC/IHS-MOA Local Code Conversion Webinars in October and November 2017 Webinars will be presented live through the Medi-Cal website onThursday, October 19, at 11am and Wednesday, November 1, at 9am. First-time webinar attendees MUST register online at the Medi-Cal Learning Portal at https://learn.medi-cal.ca.gov/ prior to attending. Once registered, select “Course catalog” from the menu and then select “Calendar View” to locate the appropriate webinar.
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The CHDP team would like to thank Dr. Tin Nguyen for his many years of
service to the San Francisco community. Dr. Nguyen served the Tenderloin
community for over 30 years. His compassion, kindness and exceptional
pediatric care has touched the lives of thousands. His achievements will not
be forgotten. Please join us in wishing him the best in the next steps of his
journey!
Effective January 1, 2017, through December 31, 2017, providers are to use
the following income guidelines when determining recipient eligibility for pre-
enrollment in Medi-Cal through the Child Health and Disability Prevention
(CHDP) Gateway program. Providers should disregard all previous CHDP
income eligibility guideline charts.
Income Eligibility Guidelines 266 Percent of the 2017 Federal Poverty Guidelines
Effective January 1, 2017, through December 31, 2017
(For determination of CHDP Gateway aid codes 8W and 8X only) http://www.dhcs.ca.gov/services/chdp/Pages/CHDPPLPIN.aspx PIN # 17-03 6-27-17. CHDP Health Assessment Guidelines Additional Revisions. New and updated changes include Blood Lead Test & Anticipatory Guidance; Health Education & the process of Anticipatory Guidance; Nutrition Assessment & Anticipatory Guidance; Substance Use: Alcohol & Drugs; Tuberculosis; Vision Screening. Revisions to the CHDP Guidelines will be posted to the CHDP Health Assessment Guidelines (HAG) webpage at http://www.dhcs.ca.gov/services/chdp/Pages/HAG.aspx as they become available.
Continued on page 7
Dr. Nguyen Retires
Number of Persons in the Household
Monthly Income Annual Income
1 $2,674 $32,080
2 $3,600 $43,199
3 $4,527 $54,318
4 $5,453 $65,436
5 $6,380 $76,555
6 $7,307 $87,674
7 $8,233 $98,793
8 $9,160 $109,912
9 $10,086 $121,030
10 $11,013 $132,149
For households of more than 10 persons, for each
additional person, add
$927
$11,119
2017 CHDP Gateway Income Eligibly Guidelines
CHDP Provider Information Notices
Continued from page 6 CHDP NewsFlash http://www.medi-cal.ca.gov/ – released June 22, July 5, 19, August 3, 2017. Update to the FQHC/RHC/IHS-MOA Code Conversion - The Provider Readiness Checklist will guide providers in the transition from 2-digit local codes to HIPAA-compliant billing code sets. The Checklist provides a timeline outlining the actions providers should be taking so they are ready for FQHC/RHC/IHS-MOA code conversion. Code crosswalks for this conversion are available at http://files.medi-cal.ca.gov/pubsdoco/hipaa/articles/codeconversionsnews_25407_02.asp New code sets will be billable for services on and after October 1, 2017; failure to comply by October 1, 2017 may result in delayed claim reimbursement. Providers have 3 options to handle a denied claim: i) Submit a new claim with corrected info if the dates of service are within the 6-month billing limit; ii) Submit an appeal within 90 days of the date on a Remittance Advice Details (RAD) form showing the claim denial; iii) Submit a Claims Inquiry Form (CIF) within 6 months of the date on the RAD form showing the claim denial. CHDP Bulletin highlights – for details, please use the following link. http://www.medi-cal.ca.gov/, click on Provider Bulletins, scroll to bottom. Click on CHDP Gateway to Health Coverage under Specialty Programs Bulletin # 152 – June 2017 CHDP Phase 2 HIPAA Code Conversion: Corrected Crosswalk and Manual Updates: The CHDP Code Conversion Table released in both April and May, 2017 Medi-Cal Update bulletins has been corrected. CPT-4 90632 (hepatitis A vaccine, adult dosage) with modifier SL (state-supplied vaccine) has been removed from page 10. Medi-Cal does NOT reimburse for this code combination. To view the full code conversion and additional instructions, providers may refer to the CHDP Code Conversion Table @ https://files.medi-cal.ca.gov/pubsdoco/newsroom/25768_Cd_Conv_Table.pdf CHDP Manual Updates: The CHDP Transition to National Standards section in the CHDP Provider Manual has been updated with lists of CPT-4 and HCPCS codes providers use when billing qualified CHDP/EPSDT services to Medi-Cal. Medi-Cal Manual Updates: Policy reflecting the changes occurring under the CHDP transition is updated in several Medi-Cal Part 1 and Part 2 provider manual sections. For example, the range of codes reimbursable for preventive medicine services for children in the Evaluation and Management (E&M) section has been expanded to include CPT-4 codes 99385 and 99395.Billing: Providers are recommended to bill electronically. If not feasible at this time, providers should order a supply of national claim forms and work with a credible vendor to purchase forms with “drop-out” ink that meet Centers for Medicare & Medicaid (CMS) standards. Note: To bill, CHDP providers must have an active Medi-Cal NPI. Reimbursement: CHDP/EPSDT services billed with national codes on the CMS-1500, UB-04 or electronic equivalent are reimbursable at Medi-Cal rates. The Medi-Cal rates table may be accessed from the Medi-Cal website. Under the References tab, providers click on “Medi-Cal Rates” OR access http://files.medi-cal.ca.gov/pubsdoco/rates/rateshome.asp Payment will be made on providers’ Medi-Cal warrant for claims processed with dates of service on or after February 1, 2017 (laboratory-only services) or on or after July 1, 2017 (other CHDP services). Email Address for Questions/Concerns: Providers may submit questions or concerns regarding the CHDP code conversion and claim form transition to [email protected] Bulletin # 153 – July 2017 Accelerated Enrollment Aid Code Restricted to Children: Effective for dates of service on or after August 1, 2017, aid code 8E restricts benefits to include only children under 19 years of age. The complete description for aid code 8E is now: Accelerated Enrollment, Provides immediate, temporary, fee-for-service, full-scope Medi-Cal benefits for children under 19 years of age. Bulletin # 154 – August 2017 ACA’s Nondiscrimination Policy Applies to Medi-Cal: Section 1557 of Patient Protection and Affordable Care Act (ACA) prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs or activities. Effectively July 18, 2017, the Health and Human Services (HHS) Office for Civil Rights issued its final rule implementing Section 1557 which applies to any health program or activity, any part of which receives federal financial assistance. In addition, other requirements are: i) Language assistance services requirements and ii) Specific requirements for interpreter and translation services. For more info, please go to https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html
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CHDP Deputy Director Greg Cutcher, RN, PHN, MS 415-575-5712 [email protected] Medical Director C. Jeanne Lee, MD, MPH 415-575-5712 [email protected] Nurse Manager Dorothy Quan, RN, PHN, MPA 415-575-5712 [email protected] Billing Inquiry & PM160 ordering Tina Panziera 415-575-5712 [email protected]
Public Health Nurses Kathy Shumaker, RN, PHN, MSN 415-575-5736 [email protected] Alicen Kershaw, RN, MSN 415-575-5707 [email protected] Dental Hygienist Margaret Fisher, RDHAP, BS 415-575-5719 [email protected] Nutritionist Teresa Chan, RD, MPH 415-575-5731 [email protected] Oral Health Program Coordinator Prasanthi Patel, MPH 415-575-5706 [email protected]
Child Health & Disability Prevention Program
C H D P
San Francisco Department of Public Health
30 Van Ness Avenue, Suite 210
San Francisco, CA 94102
415-575-5712
Fax—415-558-5905
Toll-Free Line—1-800-300-9950
San Francisco CHDP Staff
