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Family PACT Program Benefits Overview

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Family PACT Program Benefits Overview

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    1. Family PACT Program Benefits Overview March 31, 2011 Patty Cason MS, FNP-BC UCLA School of Nursing Office of Family Planning Good afternoon everyone and welcome to the “Family PACT Program Benefits” webcast. I am Gracie Askew from CHT Resource Group and I will be facilitating the session today. CHT Resource Group, under a contract with the California State Department of Public Health, Office of Family Planning, are sponsoring today’s event. This session will start with a presentation by our speaker, Patty Cason. (Pause) Before I turn the presentation over to Ms. Cason, I want to orient you to some of the WebEx Features we will be using today. For those of you that have full computer access to this session, you will be able to ask question later on in the presentation. Let’s briefly go through how you can use some of the interactive features now. (Should already be in participant view) First, let’s look at how your screen is organized. On the left side you will see the presentation slides, on the right side are the interactive panels. (Click) The interactive panels that we will be using today are the participant panel, the Q & A panel, the Chat and Polling panels. You can open these panels by clicking on the panel’s name in a light blue bar on the top right. To close a panel, click the small minus sign on the upper right corner of that panel. Right now your participant panel should be open. Now, let’s look at the Feedback toolbar located below the attendee list. To the left, you will see a hand icon. During the Q & A period, click the hand to indicate that you have a question. The hand will appear next to your name and we will know that you have a question so that during the question and answer period we can open your line. If your question gets answered, you click it again to remove it. Let’s give this a try… could everyone please raise your hand. Now, click it again to put your hand down. Thank you! We will not be using any of the other features during today’s webcast. Good afternoon everyone and welcome to the “Family PACT Program Benefits” webcast. I am Gracie Askew from CHT Resource Group and I will be facilitating the session today. CHT Resource Group, under a contract with the California State Department of Public Health, Office of Family Planning, are sponsoring today’s event. This session will start with a presentation by our speaker, Patty Cason. (Pause) Before I turn the presentation over to Ms. Cason, I want to orient you to some of the WebEx Features we will be using today. For those of you that have full computer access to this session, you will be able to ask question later on in the presentation. Let’s briefly go through how you can use some of the interactive features now. (Should already be in participant view) First, let’s look at how your screen is organized. On the left side you will see the presentation slides, on the right side are the interactive panels. (Click) The interactive panels that we will be using today are the participant panel, the Q & A panel, the Chat and Polling panels. You can open these panels by clicking on the panel’s name in a light blue bar on the top right. To close a panel, click the small minus sign on the upper right corner of that panel. Right now your participant panel should be open. Now, let’s look at the Feedback toolbar located below the attendee list. To the left, you will see a hand icon. During the Q & A period, click the hand to indicate that you have a question. The hand will appear next to your name and we will know that you have a question so that during the question and answer period we can open your line. If your question gets answered, you click it again to remove it. Let’s give this a try… could everyone please raise your hand. Now, click it again to put your hand down. Thank you! We will not be using any of the other features during today’s webcast.

    2. To the left, you will see a hand icon. During the Question & Answer period, click the hand to indicate that you have a question. The hand will appear next to your name (listed in the Participant’s panel) and we will know that you have a question so that during the question and answer period we can open your line. If your question gets answered, you click it again to remove it. Let’s give this a try… could everyone please raise your hand. Thank you. Now, can everyone click the hand icon again to put your hand down. Thank you! You can also use the “Emoticons” to give feedback to the presenter especially the clapping icon if you think they are doing a fabulous presentation or the light icon if something they say was a great idea. This will show up in the “Feedback” column next to your name listed in the participant’s panel as well. We will not be using any of the other features in today’s webcast To the left, you will see a hand icon. During the Question & Answer period, click the hand to indicate that you have a question. The hand will appear next to your name (listed in the Participant’s panel) and we will know that you have a question so that during the question and answer period we can open your line. If your question gets answered, you click it again to remove it. Let’s give this a try… could everyone please raise your hand. Thank you. Now, can everyone click the hand icon again to put your hand down. Thank you! You can also use the “Emoticons” to give feedback to the presenter especially the clapping icon if you think they are doing a fabulous presentation or the light icon if something they say was a great idea. This will show up in the “Feedback” column next to your name listed in the participant’s panel as well. We will not be using any of the other features in today’s webcast

    3. Next, let’s review the floating Toolbar. This will be located at the bottom right of the screen if you are in full screen view (click on full screen icon to show). This is full screen view. The next icon – with the little people- opens up the participant list so that you can view the feedback toolbar. The next icon – the question mark- opens the Q&A panel for questions. The round blue button (click it) takes you back to the split screen view, which is the view you see now Next, let’s review the floating Toolbar. This will be located at the bottom right of the screen if you are in full screen view (click on full screen icon to show). This is full screen view. The next icon – with the little people- opens up the participant list so that you can view the feedback toolbar. The next icon – the question mark- opens the Q&A panel for questions. The round blue button (click it) takes you back to the split screen view, which is the view you see now

    4. Q&A Panel The Q&A panel can be used in 2 ways: by clicking on the question mark when you are in full screen view, or if you are in split screen view, click the light blue bar that says Q&A. Type your questions in the lower Q & A area as indicated and then click the send button. We will take questions at the conclusion of the presentation, but you can send questions at any time. We will answer written questions first and then if time permits, we will open the line for verbal questions from those that used the hand icon to indicate you have a question. Unfortunately, if you are listening by phone only, without computer access, we cannot identify that you have a question. The Q&A panel can be used in 2 ways: by clicking on the question mark when you are in full screen view, or if you are in split screen view, click the light blue bar that says Q&A. Type your questions in the lower Q & A area as indicated and then click the send button. We will take questions at the conclusion of the presentation, but you can send questions at any time. We will answer written questions first and then if time permits, we will open the line for verbal questions from those that used the hand icon to indicate you have a question. Unfortunately, if you are listening by phone only, without computer access, we cannot identify that you have a question.

    5. Evaluation and Sign-in At the conclusion of session complete: Evaluation Form or Zoomerang Survey Sign-in Sheet Please fax these items to 510-625-9307 Those without web access can get forms by calling 1-877-FAMPACT The evaluation and continuing education forms were available prior to the start of this session for download. Now that the session has started, the forms are no longer available on WebEx. If you have already downloaded them, you can use those to complete and fax back to us. Those who are listening today without web access can get forms by calling 1-877-FAMPACT. At the conclusion of today’s session, you will also be shown a link to a Zoomerang Survey where you can complete the evaluation on-line!The evaluation and continuing education forms were available prior to the start of this session for download. Now that the session has started, the forms are no longer available on WebEx. If you have already downloaded them, you can use those to complete and fax back to us. Those who are listening today without web access can get forms by calling 1-877-FAMPACT. At the conclusion of today’s session, you will also be shown a link to a Zoomerang Survey where you can complete the evaluation on-line!

    6. File Transfer All individual participants are asked to fax in an evaluation form and sign in sheet. You can download the forms that we just discussed using the File Transfer feature. We will review how you will use the File Transfer at the conclusion of today’s session. I’d also like to remind you all that this program is being recorded and will be posted on the Family PACT web site All individual participants are asked to fax in an evaluation form and sign in sheet. You can download the forms that we just discussed using the File Transfer feature. We will review how you will use the File Transfer at the conclusion of today’s session. I’d also like to remind you all that this program is being recorded and will be posted on the Family PACT web site

    7. Introduction Patty Cason, RN, MS, FNP-BC Family PACT Program Benefits Ask the Experts Webcast Now I’d like to introduce today’s speaker: Patty Cason is a family nurse practitioner with a specialty in gynecology. She has practiced for 29 years in a wide variety of clinical settings. She has an appointment as Assistant Clinical Professor and lecturer at the University of California at Los Angeles (UCLA) School of Nursing. Patty has lectured and conducted trainings across the USA on each of the LARC methods. She currently works at Planned Parenthood Los Angeles, in a private practice at UCLA and she conducts clinical training for the Family Pact Program for the California State Office of Family Planning. She is also teaches colposcopy for the American Society of Colposcopy and Cervical Pathology (ASCCP) Comprehensive Colposcopy courses. In today’s webcast, Ms Cason will provide an overview of the Family PACT benefits and provide an opportunity for you to ask questions about the Family PACT program. This session is designed to help you as clinicians, health educators and counselors insure that client's are receiving the full benefit of the Family PACT program. (Pause) We are very pleased to have Patty Cason as our “Ask The Expert” speaker today. I’d like to now turn it over to Patty.Now I’d like to introduce today’s speaker: Patty Cason is a family nurse practitioner with a specialty in gynecology. She has practiced for 29 years in a wide variety of clinical settings. She has an appointment as Assistant Clinical Professor and lecturer at the University of California at Los Angeles (UCLA) School of Nursing. Patty has lectured and conducted trainings across the USA on each of the LARC methods. She currently works at Planned Parenthood Los Angeles, in a private practice at UCLA and she conducts clinical training for the Family Pact Program for the California State Office of Family Planning. She is also teaches colposcopy for the American Society of Colposcopy and Cervical Pathology (ASCCP) Comprehensive Colposcopy courses. In today’s webcast, Ms Cason will provide an overview of the Family PACT benefits and provide an opportunity for you to ask questions about the Family PACT program. This session is designed to help you as clinicians, health educators and counselors insure that client's are receiving the full benefit of the Family PACT program. (Pause) We are very pleased to have Patty Cason as our “Ask The Expert” speaker today. I’d like to now turn it over to Patty.

    8. Objectives Identify updates to the primary and secondary benefits available through the Family PACT program Discuss common misconceptions about Family PACT benefits Clarify questions they have about the Family PACT program benefits. Thank you, Gracie. Good afternoon and thank you for joining us for this webcast. Today’s webcast will provide you with an overview of the Family PACT benefits and give you, the providers opportunity to ask questions about the Family PACT program. The Objectives for today’s session are: READ from SLIDE Again, I want to emphasize that this session is designed for participants to have enough time for their questions after the presentation. Thank you, Gracie. Good afternoon and thank you for joining us for this webcast. Today’s webcast will provide you with an overview of the Family PACT benefits and give you, the providers opportunity to ask questions about the Family PACT program. The Objectives for today’s session are: READ from SLIDE Again, I want to emphasize that this session is designed for participants to have enough time for their questions after the presentation.

    9. What is Family PACT 1996 - California Legislature established Family PACT to provide comprehensive clinical family planning and reproductive health services at no cost to low income residents who are of reproductive age 1999 - CMS granted an 1115 Family Planning Medicaid Waiver Read slideRead slide

    10. Comprehensive Family Planning Scope of services includes: Family planning methods Selected reproductive health conditions Delivered with client-centered education and counseling Read slide, explain primary focus is family planning with counseling a large focus because that is how family planning is best accomplishedRead slide, explain primary focus is family planning with counseling a large focus because that is how family planning is best accomplished

    11. Benefits Package Benefits package is organized into: Primary family planning benefits Secondary benefits for related reproductive health conditions Services to manage pre-selected complications that may arise from the primary or secondary benefits services (these require an approved TAR) Benefits under the Family PACT Program include: Primary Benefits; Secondary Benefits and services to manage complications. Primary, secondary and complications related to each method are listed together. [read slide] Benefits under the Family PACT Program include: Primary Benefits; Secondary Benefits and services to manage complications. Primary, secondary and complications related to each method are listed together. [read slide]

    12. Benefits: Primary Contraceptive Services Family planning method services, including periodic health screening and problem-oriented visits E&M office visits E&C office visits Outpatient method-specific procedures Prescription contraceptives Emergency contraception Spermicides, male/female condoms, lubricants IUCs Contraceptive implants Sterilization Primary benefits include: [read slide] Primary benefits include: [read slide]

    13. Benefits: Primary Contraceptive Services (cont’d.) Urine pregnancy testing Screening tests for breast and cervical cancer per policy Screening tests for specific STIs (Syphilis, HIV, Chlamydia, Gonorrhea) and their corresponding confirmatory tests Collection and handling of blood specimens Services for the management of complications arising from the use of a contraceptive method Primary benefits include: [read slide] Primary benefits include: [read slide]

    14. Family PACT Approved Contraceptive Methods Oral Contraceptives Contraceptive Transdermal Patch Contraceptive Vaginal Ring Emergency Contraceptives Contraceptive Implants Contraceptive Injections Intrauterine Contraceptives Diaphragm Cervical Cap Spermicides Male/Female Condoms Fertility Awareness Methods (FAM) Lactation Amenorrhea Method (LAM) Male Sterilization Female Sterilization Abstinence Benefits Overview of Clinical and Preventive Services Make sure that these talking points are addressed in the discussion Section 9, page 13 has list of all methods.. Additions to that list Sometimes there are new oral BCPs Brand name products Lea’s Shield (diaphragm) and Fem Cap not on this list but on the formulary Implanon is the current contraceptive implant available Please note that there may be a time lag between FDA approval of a new method and its addition to the Family PACT formulary. Be sure you have received a provider letter or Family PACT update that announces the inclusion of a new method. (Per OFP edits: “Implanon is already a FPACT Benefit (7/08). Replaced the word “Medi-cal” with “Family PACT” update…” ECP – any problems in your community?Benefits Overview of Clinical and Preventive Services Make sure that these talking points are addressed in the discussion Section 9, page 13 has list of all methods.. Additions to that list Sometimes there are new oral BCPs Brand name products Lea’s Shield (diaphragm) and Fem Cap not on this list but on the formulary Implanon is the current contraceptive implant available Please note that there may be a time lag between FDA approval of a new method and its addition to the Family PACT formulary. Be sure you have received a provider letter or Family PACT update that announces the inclusion of a new method. (Per OFP edits: “Implanon is already a FPACT Benefit (7/08). Replaced the word “Medi-cal” with “Family PACT” update…” ECP – any problems in your community?

    15. Family Pact Primary Diagnosis S-codes Required for billing all program services Categories of S-codes relate to the family planning method selected by the client Explain ALL aspects of FPACT require an S code for anything to be paid.Explain ALL aspects of FPACT require an S code for anything to be paid.

    16. Explain how S501 and S502 include all “other” methods. Emphasize that S601 should only be used if PT is positive. If pregnancy testing is the only service the client is seeking this code can also be used. Explain the limited benefits with S601/S602. We strongly suggest that in the sprit of the FPACT program if a client comes for a pregnancy test and it’s negative and the client is not attempting pregnancy, that we counsel the client about BCM and the pt leaves the office with a method. Explain how S501 and S502 include all “other” methods. Emphasize that S601 should only be used if PT is positive. If pregnancy testing is the only service the client is seeking this code can also be used. Explain the limited benefits with S601/S602. We strongly suggest that in the sprit of the FPACT program if a client comes for a pregnancy test and it’s negative and the client is not attempting pregnancy, that we counsel the client about BCM and the pt leaves the office with a method.

    17. Family Planning Methods Primary Benefits Explain use of grid and footnoted numbersExplain use of grid and footnoted numbers

    18. Other Primary Services All available screening mammograms including digital mammograms are billable under FPACTAll available screening mammograms including digital mammograms are billable under FPACT

    19. Screening Tests: Pap Smears 88142 LBC, manual screen 88143 LBC, manual screen and re-screen 88147 Smear, automated screen 88148 Smear, automated screen, manual re-screen 88164 Smear, Bethesda, manual screen 88165 Smear, Bethesda, manual screen, re-screen 88167 Smear, Bethesda, manual/computer re-screen 88174 LBC, automated screen 88175 LBC, automated screen, manual re-screen All available validated tests are billable under FPACT both conventional and LBCAll available validated tests are billable under FPACT both conventional and LBC

    20. Screening Tests: STIs All available validated tests are billable under FPACT. Point out that NAAT tests are preferred due to better sensitivity and no need for cx or penile swab. Note first 30cc of urine, not clean catch, >1 hour after last void is ideal but not required.All available validated tests are billable under FPACT. Point out that NAAT tests are preferred due to better sensitivity and no need for cx or penile swab. Note first 30cc of urine, not clean catch, >1 hour after last void is ideal but not required.

    21. Benefits: Secondary Related Reproductive Health Conditions Secondary benefits cover the following (when the care is provided coincident to a family planning visit): Male and Female Diagnosis and treatment of specified STIs Female only Diagnosis and treatment of UTI and pre-invasive cervical lesions Many STI screening tests are included as the core screening services under a primary diagnosis code. This includes HIV, gonorrhea, chlamydia and syphilis screening tests. Some STIs and vaginal infections are not routinely screened for. If you wish to run a viral culture for suspected herpes, a wet mount for vaginitis, or do a biopsy of an atypical wart you must use a Secondary Diagnosis. Note that some tests are further limited by gender and/or certain diagnosis codes. Many STI screening tests are included as the core screening services under a primary diagnosis code. This includes HIV, gonorrhea, chlamydia and syphilis screening tests. Some STIs and vaginal infections are not routinely screened for. If you wish to run a viral culture for suspected herpes, a wet mount for vaginitis, or do a biopsy of an atypical wart you must use a Secondary Diagnosis. Note that some tests are further limited by gender and/or certain diagnosis codes.

    22. Benefits: Secondary Related Reproductive Health Conditions (cont’d.) Claims for outpatient services must include a secondary ICD-9-CM diagnosis code that identifies a symptom or condition being treated Secondary benefits: Specified outpatient procedures and treatments Specified laboratory testing Limited formulary of prescription drugs The secondary diagnosis codes are used for treatment of identified STIs and vaginitis. STI screening tests for HIV, gonorrhea, chlamydia and syphilis screening are included as the core screening services under a primary diagnosis code so therefore a 2nd ICD 9 code is not necessary unless treatment is going to be required. Testing for other STIs and all testing for vaginal infections are not included as covered services under the primary benefits in FPACT therefore a 2nd ICD 9 code is necessary. For example, if you wish to run a viral culture for suspected herpes, a wet mount for vaginitis, or do a biopsy of an atypical wart you must use a Secondary Diagnosis. Note that some tests are further limited by gender and/or certain diagnosis codes. For example, the only ICD 9 code which will allow re-imbursement for a HSV culture is a penile or vulvar ulcer. No oral lesions are covered. The secondary diagnosis codes are used for treatment of identified STIs and vaginitis. STI screening tests for HIV, gonorrhea, chlamydia and syphilis screening are included as the core screening services under a primary diagnosis code so therefore a 2nd ICD 9 code is not necessary unless treatment is going to be required. Testing for other STIs and all testing for vaginal infections are not included as covered services under the primary benefits in FPACT therefore a 2nd ICD 9 code is necessary. For example, if you wish to run a viral culture for suspected herpes, a wet mount for vaginitis, or do a biopsy of an atypical wart you must use a Secondary Diagnosis. Note that some tests are further limited by gender and/or certain diagnosis codes. For example, the only ICD 9 code which will allow re-imbursement for a HSV culture is a penile or vulvar ulcer. No oral lesions are covered.

    23. Secondary Benefits (Management of STIs) Note various codes based on sx prior to definitive dxNote various codes based on sx prior to definitive dx

    24. Secondary Benefits (Management of Cervical Abnormalities) Note leukoplakia code is needed to justify colpo if pap WNL and there is a visible lesion on the cx. Note that the modifier for supplies changed from ZM to UA as per the Family PACT Update of October 2010Note leukoplakia code is needed to justify colpo if pap WNL and there is a visible lesion on the cx. Note that the modifier for supplies changed from ZM to UA as per the Family PACT Update of October 2010

    25. Urinary Tract Infection READ SLIDE / Explain GraphREAD SLIDE / Explain Graph

    26. Urinary Tract Infection Female Clients Only A detailed history is necessary to differentiate lower UTIs from pyelonephritis Preferred treatments for UTIs are TMP-SMX or ciprofloxacin given as a three-day regimen Nitrofurantoin is no longer on the formulary Read slideRead slide

    27. Urinary Tract Infection Female Clients Only 1st line: TMP-SMX (DS) BID for 3 days 2nd line: Ciprofloxacin 250 mg BID for 3 days… Concern re: Development of quinolone resistant strains of uropathogens 3rd line: Cephalexin 500 mg BID or 250 QID for seven days…Concern re: Increasing rates of cephalosporin resistance Lower completion rates than three day therapies Read slideRead slide

    28. Urinary Tract Infection Nitrofurantoin While used frequently in pregnant women with UTIs, it has no safety advantage in non-pregnant pts Lower completion rates than 3 day therapies Cost is 5-7 times higher than other regimens now that many generic companies have stopped manufacturing it Nitrofurantoin can (rarely ) induce hemolytic anemia in patients with G6PD Not useful in pyelonephritis Poor adherence with longer regimens. This medication was available in generic forms for may years but recently many manufacturers stopped making Nitrofurantoin and the price increased dramatically. Leaving it on the formulary would have cost the program approx 1 million/yr. A consensus decision was made among the FPACT medical advisors not to offer a medication that was not superior (and in many cases inferior) to the first line medications at 5-7 Xs the cost. Since this change to the formulary was made, there have been minimal-no complaints to the program from FPACT providers.Poor adherence with longer regimens. This medication was available in generic forms for may years but recently many manufacturers stopped making Nitrofurantoin and the price increased dramatically. Leaving it on the formulary would have cost the program approx 1 million/yr. A consensus decision was made among the FPACT medical advisors not to offer a medication that was not superior (and in many cases inferior) to the first line medications at 5-7 Xs the cost. Since this change to the formulary was made, there have been minimal-no complaints to the program from FPACT providers.

    29. Urinary Tract Infections in Women How should UTI visits in women be coded? Restricted to female clients All claims for UTI services must contain a primary diagnosis (S-code) and a secondary diagnosis code If diagnosis of UTI, use code 595.0 (acute cystitis) If a UTI is presumptively treated, code for the presenting symptom 599.71 Gross hematuria 788.1 Dysuria 788.41 Urinary frequency 789.09 Abdominal pain, other specified site Read SlideRead Slide

    30. Sources and References for UTI Treatment These are the references used in developing the formulary medications for UTIs.These are the references used in developing the formulary medications for UTIs.

    31. Education & Counseling Visits Staff Abilities E&C may be offered by clinicians or by trained and supervised non-clinician staff Knowledge about reproductive health Psychosocial and medical aspects Behavior change and client-centered counseling Communication skills Recognize intense counseling needs Non-clinician counseling staff must be directly supervised onsite by a licensed practitioner Read slide Emphasize concept of aggregate time. Describe need for initial and continued training for counselorsRead slide Emphasize concept of aggregate time. Describe need for initial and continued training for counselors

    32. Office Visit Codes Education & Counseling Visits Explain graph and difference between these “one time only” codes and other E & C codesExplain graph and difference between these “one time only” codes and other E & C codes

    33. Office Visit Codes Education & Counseling Visits Explain graph Explain graph

    34. Office Visit Codes Evaluation & Management Visits Family PACT E&M codes include: 99201 – 99204 (new clients) 99211 – 99214 (established clients) Family PACT defers to Medi-Cal policy regarding use of CPT, E&M and modifiers Use either time or the 3 “key components” (history, physical, medical decision making) A new patient has not been seen in your practice for at least 3 years Introduce concept of two ways to decide on which code to use; either time or complexity of visit. Emphasize documentation!Introduce concept of two ways to decide on which code to use; either time or complexity of visit. Emphasize documentation!

    35. E&M or E&C Visit? Explain graphExplain graph

    36. Family PACT is Not… Family PACT is not a comprehensive primary care program Family PACT does not cover Gynecologic evaluation or treatment for conditions unrelated to contraception or STIs Pregnancy care Abortion services Immunizations Infertility Dx and Tx, except fertility awareness Diagnostic mammogram HIV or hepatitis treatment Hepatitis laboratory testing or vaccine Services beyond stated FPACT benefits Read slide. Explain that there are other programs for other services and in particular PE for pregnancyRead slide. Explain that there are other programs for other services and in particular PE for pregnancy

    37. Reminder…Not A Benefit Gardasil – Not a Family PACT benefit Gardasil Vaccine for HPV are not reimbursed by Family PACT. Pt assistance programs through Merck may be available. Ask Merck rep. Gardasil Vaccine for HPV are not reimbursed by Family PACT. Pt assistance programs through Merck may be available. Ask Merck rep.

    38. Drugs and Supplies Not new but new for complications use Heparin, Warfarin (Coumadin) – Jan, 2010 Update Cephalexin – Jan, 2010 Update Clindamycin – Jan, 2010 Update Imiquimod – Dec., 2009 Update Cephalexin - Dec., 2009 Update Clindamycin Hydrochloride - Dec., 2009 Update Tinidazole - Dec., 2009 Update No drug substitutions, Code 1, TAR for specific drugs, etc. – Dec, 2009 Update Review Slide Heparin, Warfarin (Coumadin) – added per the January, 2010 update. Deep vein thrombosis or pulmonary embolism. Cephalexin – Jan, 2010 Update Contraceptive implant – infection at insertion/removal site. Clindamycin – Jan, 2010 Update Female sterilization – operative site infection (within 30 days postoperative) Vasectomy – acute infection at operative site (within 30 days postoperative) Imiquimod – Dec., 2009 Update Treatment of genital warts. Cephalexin - Dec., 2009 Update Treatment of urinary tract Infection in females. Clindamycin Hydrochloride - Dec., 2009 Update Treatment of bacterial vaginosis. Tinidazole - Dec., 2009 Update Treatment of trichomoniasis in case of treatment failure or adverse affects (not allergy) with prior use of metronodiazole. Effective January 1, 2010, the Program will not allow any drug substitutions. Treatment Authorization Requests (TARs) will no longer be approved for drug substitutions and end-dated drugs.Review Slide Heparin, Warfarin (Coumadin) – added per the January, 2010 update. Deep vein thrombosis or pulmonary embolism. Cephalexin – Jan, 2010 Update Contraceptive implant – infection at insertion/removal site. Clindamycin – Jan, 2010 Update Female sterilization – operative site infection (within 30 days postoperative) Vasectomy – acute infection at operative site (within 30 days postoperative) Imiquimod – Dec., 2009 Update Treatment of genital warts. Cephalexin - Dec., 2009 Update Treatment of urinary tract Infection in females. Clindamycin Hydrochloride - Dec., 2009 Update Treatment of bacterial vaginosis. Tinidazole - Dec., 2009 Update Treatment of trichomoniasis in case of treatment failure or adverse affects (not allergy) with prior use of metronodiazole. Effective January 1, 2010, the Program will not allow any drug substitutions. Treatment Authorization Requests (TARs) will no longer be approved for drug substitutions and end-dated drugs.

    39. Drugs and Supplies NDC reporting requirements effective April 1, 2009 National Drug Code (NDC) Reporting: drugs subject to the federally established 340B Drug Pricing Program must be billed with modifier UD. Also, there are exceptions to NDC reporting requirements (e.g., X1500 & Z7610)* Deficit Reduction Act mandates that all physician-administered drug claims require a National Drug Code (NDC).* NDCs for physician-administered drugs must be paired with the appropriate HCPCS codes.* *Information in bullets 2, 3 and 4 were initially noted in FPACT Aug 2008 Update with reminder articles in Sep/08, Oct/08, Nov/08, Dec/08, Mar/09 and Jul/09 Updates. NDC Reporting: drugs subject to the federally established 340B Drug Pricing Program must be billed with modifier UD (March, 2009 Update) Effective for Dates of service on or after April 1, 2009. Why bill with UD modifier? Billing with the UD modifies enables Medi-Cal to exclude 340B services from rebate collection. Also, there are exceptions to NDC reporting requirements (e.g., X1500 & Z7610) (March, 2009 Update) All physician-administered drug claims require a National Drug Code (NDC) (March, 2009 Update) This is mandated by the Deficit Reduction Act (DRA), and all claims with dates of service on or after April 1, 2009 that do not meet the NDC reporting requirements by including a valid NDC with a HCPCP code will be denied. NDCs for physician-administered drugs must be paired with the appropriate HCPCS codes (July, 2009 update) Claims will be denied if they are not submitted with a valid NDS paired with the appropriate HCPCS Level I, II< or III code as mandated by the NDC reporting requirement guidelines for dates of service on or after 4/1/2009. NDC Reporting: drugs subject to the federally established 340B Drug Pricing Program must be billed with modifier UD (March, 2009 Update) Effective for Dates of service on or after April 1, 2009. Why bill with UD modifier? Billing with the UD modifies enables Medi-Cal to exclude 340B services from rebate collection. Also, there are exceptions to NDC reporting requirements (e.g., X1500 & Z7610) (March, 2009 Update) All physician-administered drug claims require a National Drug Code (NDC) (March, 2009 Update) This is mandated by the Deficit Reduction Act (DRA), and all claims with dates of service on or after April 1, 2009 that do not meet the NDC reporting requirements by including a valid NDC with a HCPCP code will be denied. NDCs for physician-administered drugs must be paired with the appropriate HCPCS codes (July, 2009 update) Claims will be denied if they are not submitted with a valid NDS paired with the appropriate HCPCS Level I, II< or III code as mandated by the NDC reporting requirement guidelines for dates of service on or after 4/1/2009.

    40. Drugs and Supplies (cont.) For physician-administered drugs, unit of measure qualifier and numeric quantity are optional, (See July, 2009 Update) Medi-Cal will not pay claims for bulk drugs. (See Aug., 2009 Update) Physician-administered drugs, unit of measure qualified and numeric quantity are optional (July, 2009 Update) Effective immediately. Previously these were required on claims in connection with the NDC. Providers are encouraged to included these measurements. It is expected they will be required by Medi-Cal in the future. Absence of these 2 elements will not result in claim denial. Medi-Cal will not pay claims for bulk drugs. (Aug., 2009 update) Bulk drugs are pharmaceutically active products that are distributed in a form (eg: a kilogram of powder) that has not been deemed an approved drug product by the FDA. EXAMPLE OF HOW THIS IS RELEVANT TO F. PACT? For example, use of a large vial of Depo Provera which dosed differently and is meant for use for an indication other than contraception. Physician-administered drugs, unit of measure qualified and numeric quantity are optional (July, 2009 Update) Effective immediately. Previously these were required on claims in connection with the NDC. Providers are encouraged to included these measurements. It is expected they will be required by Medi-Cal in the future. Absence of these 2 elements will not result in claim denial. Medi-Cal will not pay claims for bulk drugs. (Aug., 2009 update) Bulk drugs are pharmaceutically active products that are distributed in a form (eg: a kilogram of powder) that has not been deemed an approved drug product by the FDA. EXAMPLE OF HOW THIS IS RELEVANT TO F. PACT? For example, use of a large vial of Depo Provera which dosed differently and is meant for use for an indication other than contraception.

    41. Drugs and Supplies (cont.) Clinic dispensing of diaphragms limited to 1 per 365 days per client. (March, 2009 Update) Family PACT has set minimum and maximum quantities for dispensing by pharmacies for FPACT drugs and contraceptive supplies that are different from Medi-Cal. (Nov., 2009 Update) Clinic dispensing of diaphragms limited to 1 per 365 days per client (March, 2009 Update) F. PACT will set min. and max. quantities for dispensing by pharmacies for F. PACT drugs and contraceptive supplies that are different from Medi-Cal. (Nov., 2009 Update) Effective Jan. 1, 2010. For a complete list of drugs and contraceptives reimbursable under the Family PACT Program, including dispensing limits and restrictions, providers may refer to the Pharmacy and Clinic Formulary section and the “Treatment and Dispensing Guidelines for Clinicians” in the Benefits Grid section of the Family PACT manual. Clinic dispensing of diaphragms limited to 1 per 365 days per client (March, 2009 Update) F. PACT will set min. and max. quantities for dispensing by pharmacies for F. PACT drugs and contraceptive supplies that are different from Medi-Cal. (Nov., 2009 Update) Effective Jan. 1, 2010. For a complete list of drugs and contraceptives reimbursable under the Family PACT Program, including dispensing limits and restrictions, providers may refer to the Pharmacy and Clinic Formulary section and the “Treatment and Dispensing Guidelines for Clinicians” in the Benefits Grid section of the Family PACT manual.

    42. Drugs and Supplies (cont.) Effective for dates of service on or after June 1, 2010, the following drugs are no longer reimbursed as benefits under the Family PACT: (May 2010 Update) • Ciprofloxacin 500 mg • Ciprofloxacin XR 500 mg • Nitrofurantoin (Macrobid) 100 mg • Nitrofurantoin SR 100 mg The maximum quantity of Ciprofloxacin HCL 250 mg dispensable to Family PACT Program recipients will change from 12 tablets to six tablets effective June 1, 2010. Benefit Changes for UTI Treatment Drugs Effective for dates of service on or after June 1, 2010, the following drugs used for the treatment of urinary tract infection (UTI) will no longer be reimbursed as benefits under the Family PACT Program: • Ciprofloxacin 500 mg • Ciprofloxacin XR 500 mg • Nitrofurantoin (Macrobid) 100 mg • Nitrofurantoin SR 100 mg The maximum quantity of Ciprofloxacin HCL 250 mg dispensable to Family PACT Program recipients will change from 12 tablets to six tablets effective June 1, 2010. Benefit Changes for UTI Treatment Drugs Effective for dates of service on or after June 1, 2010, the following drugs used for the treatment of urinary tract infection (UTI) will no longer be reimbursed as benefits under the Family PACT Program: • Ciprofloxacin 500 mg • Ciprofloxacin XR 500 mg • Nitrofurantoin (Macrobid) 100 mg • Nitrofurantoin SR 100 mg The maximum quantity of Ciprofloxacin HCL 250 mg dispensable to Family PACT Program recipients will change from 12 tablets to six tablets effective June 1, 2010.

    43. Procedure Codes (February, 2010 Update) CPT-4 Code 88305 Used to Bill for Genital Wart Surgical Pathology. Code 88304 is no longer reimbursable for this purpose, 88305 - Should be submitted for surgical pathology of biopsies to confirm vulvar, vaginal or genital warts. 88305 is reimbursable if billed in conjunction with the following secondary diagnosis ICD-9-CM codes: 078.0 Molluscum contagiosum 078.10 Viral warts 078.11 Condylomata CPT-4 Code 88305 Used to Bill for Genital Wart Surgical Pathology Effective for dates of service on or after March 1, 2010, CPT-4 code 88305 (Level IV – surgical pathology, gross and microscopic examination; skin, other than cyst/tag/debridement/plastic repair) should be submitted for surgical pathology of biopsies to confirm vulvar, vaginal or genital warts. Code 88304 is no longer reimbursable for this purpose, effective for the same dates of service. When submitted to confirm genital warts, code 88305 is reimbursable if billed in conjunction with the following secondary diagnosis ICD-9-CM codes: ICD-9-CM Code Description 078.0 Molluscum contagiosum 078.10 Viral warts 078.11 Condylomata There are no age restrictions for CPT-4 code 88305 and it is reimbursable for both male and female clients.CPT-4 Code 88305 Used to Bill for Genital Wart Surgical Pathology Effective for dates of service on or after March 1, 2010, CPT-4 code 88305 (Level IV – surgical pathology, gross and microscopic examination; skin, other than cyst/tag/debridement/plastic repair) should be submitted for surgical pathology of biopsies to confirm vulvar, vaginal or genital warts. Code 88304 is no longer reimbursable for this purpose, effective for the same dates of service. When submitted to confirm genital warts, code 88305 is reimbursable if billed in conjunction with the following secondary diagnosis ICD-9-CM codes: ICD-9-CM Code Description 078.0 Molluscum contagiosum 078.10 Viral warts 078.11 Condylomata There are no age restrictions for CPT-4 code 88305 and it is reimbursable for both male and female clients.

    44. Procedure Codes CPT Code 11975 (insertion, implantable contraceptive capsules) - not reimbursable with modifier UA or UB when billed in conjunction with HCPCS code J7307 (Estonogestrel contraceptive implant system, including implant and supplies) (See October 2010 Update) HCPCS Code A4264 replaces CPT-4 code 58565 (hysteroscopic surgical placement of micro-insert(s). Billed with modifier 50 and 52. (See July, August, November, & December, 2010 Updates) CPT Code 11975 (insertion, implantable contraceptive capsules) is not reimbursable with modifier UA or UB, when billed in conjunction with HCPCS code J7307 (Estonogestrel contraceptive implant system, including implant and supplies) (October 2009 Update) This is because surgical supplies are included in code J7307 Per OFP: HCPCS Code A4264 not CPT A4264. DEFINE Code A4264: HCPCS code A4264 (permanent implantable contraceptive intratubal occlusion device[s] and delivery system) – use to bill for the device CPT code 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants – use to bill for procedure (For more information, see FPACT Updates: July 2010, Aug 2010, Nov 2010, and Dec 2010) Note the use of these codes modifiers 50 or 52: A4264 – with modifier 50 (bilateral placement) OR 52 (unilateral placement). 58565 – with modifier 50 (for bilateral procedure to insert the device) OR 52 (for unilateral procedure) A Sterilization Consent Form (PM 330) is required.CPT Code 11975 (insertion, implantable contraceptive capsules) is not reimbursable with modifier UA or UB, when billed in conjunction with HCPCS code J7307 (Estonogestrel contraceptive implant system, including implant and supplies) (October 2009 Update) This is because surgical supplies are included in code J7307 Per OFP: HCPCS Code A4264 not CPT A4264. DEFINE Code A4264: HCPCS code A4264 (permanent implantable contraceptive intratubal occlusion device[s] and delivery system) – use to bill for the device CPT code 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants – use to bill for procedure (For more information, see FPACT Updates: July 2010, Aug 2010, Nov 2010, and Dec 2010) Note the use of these codes modifiers 50 or 52: A4264 – with modifier 50 (bilateral placement) OR 52 (unilateral placement). 58565 – with modifier 50 (for bilateral procedure to insert the device) OR 52 (for unilateral procedure) A Sterilization Consent Form (PM 330) is required.

    45. Did You Know??? E&C for IUC or implant placement To compensate for counseling time To encourage same day insertion Plan B® One-Step is now on the formulary Review Slide Next Choice (Oct., 2009 Update) Effective retro to Sept 2009, the Next Choice EC packets is a benefit to be dispensed by physicians and pharmacists. Next Choice is a packet containing 2 tablets of .75 mg levonorgestrel and is billable by clinics with HCPCS code X7722 Next choice contact info: www.mynextchoice.com or 1-866-9watson. Plan B One Step Effective for dates of service on or after June 1, 2010, Plan B ® One-Step (levonorgestrel 1.5 mg) emergency contraceptive packet is a new Family PACT (Planning, Access, Care and Treatment) Program benefit. The packet is billed with HCPCS code X7722. Pharmacy dispensing is limited to one tablet per dispensing for a total of six tablets in any 12-month period and for females only. Clinic dispensing is limited to two tablets per dispensing for a total of six tablets in any 12-month period and for females only. Review Slide Next Choice (Oct., 2009 Update) Effective retro to Sept 2009, the Next Choice EC packets is a benefit to be dispensed by physicians and pharmacists. Next Choice is a packet containing 2 tablets of .75 mg levonorgestrel and is billable by clinics with HCPCS code X7722 Next choice contact info: www.mynextchoice.com or 1-866-9watson. Plan B One Step Effective for dates of service on or after June 1, 2010, Plan B ® One-Step (levonorgestrel 1.5 mg) emergency contraceptive packet is a new Family PACT (Planning, Access, Care and Treatment) Program benefit. The packet is billed with HCPCS code X7722. Pharmacy dispensing is limited to one tablet per dispensing for a total of six tablets in any 12-month period and for females only. Clinic dispensing is limited to two tablets per dispensing for a total of six tablets in any 12-month period and for females only.

    46. Questions & Answers This concludes our webcast on Family PACT Program Benefits. It was a pleasure speaking with you all today. I’ll now turn it back over to Gracie to see if you have any questions. This concludes our webcast on Family PACT Program Benefits. It was a pleasure speaking with you all today. I’ll now turn it back over to Gracie to see if you have any questions.

    47. The program evaluation, the participant sign-in sheet, the PowerPoint slides and slide handouts AND REFERRAL TOOLKIT were available on the Webex site listed under course materials, prior to the beginning of this session. However, now that the session is in progress, these documents are no longer available on Webex. Those with computer access can download them now by using the File Transfer feature. I’ll open that now and will start posting the documents in the File Transfer screen. You must save the documents one by one. So it may take a few minutes for you to download all the files. To download each file, Click on the file name of the document, and then click the ‘Download’ button to save it directly to your computer. Participants without web access should have received the forms and presentation materials with your registration confirmation. If you cannot download the forms now, please call 1 877 FAMPACT and we can get them to you. I will continue with some closing remarks as you download and save your documents.The program evaluation, the participant sign-in sheet, the PowerPoint slides and slide handouts AND REFERRAL TOOLKIT were available on the Webex site listed under course materials, prior to the beginning of this session. However, now that the session is in progress, these documents are no longer available on Webex. Those with computer access can download them now by using the File Transfer feature. I’ll open that now and will start posting the documents in the File Transfer screen. You must save the documents one by one. So it may take a few minutes for you to download all the files. To download each file, Click on the file name of the document, and then click the ‘Download’ button to save it directly to your computer. Participants without web access should have received the forms and presentation materials with your registration confirmation. If you cannot download the forms now, please call 1 877 FAMPACT and we can get them to you. I will continue with some closing remarks as you download and save your documents.

    48. Please have each individual participant at your site fill out an Evaluation form. You may also complete the evaluation using link to Zoomerang that will be provided at the conclusion of the session. We also ask that each site complete a sign-in sheet. The sign-in sheet is important so that we can obtain an accurate count of all who attended today. We appreciate your feedback via the evaluation form, which will ensure that future training events meet your needs as enrolled Family PACT providers. If you choose to complete the evaluation form and not use the on-line survey, Please fax the hard copies of the evaluation and sign-in documents to 510-625-9307. Once again, There is a wealth of Family PACT information at the website, www.familypact.org. Go to the Provider Training section to see when we have upcoming Orientations, Webcasts in this Ask the Experts series, and other Special Interest Trainings as well. Next month’s webcast are “Client Eligibility and Enrollment” on April 12th and “Using the Family PACT Customer Service Toolkit” will be on April 20th; both will be held at noon. Please check www.familypact.org often for other upcoming events. This concludes today’s webcast. Thanks to all of you for your participation and many thanks to our speaker, Patty Cason. Have a great day! Goodbye. Please have each individual participant at your site fill out an Evaluation form. You may also complete the evaluation using link to Zoomerang that will be provided at the conclusion of the session. We also ask that each site complete a sign-in sheet. The sign-in sheet is important so that we can obtain an accurate count of all who attended today. We appreciate your feedback via the evaluation form, which will ensure that future training events meet your needs as enrolled Family PACT providers. If you choose to complete the evaluation form and not use the on-line survey, Please fax the hard copies of the evaluation and sign-in documents to 510-625-9307. Once again, There is a wealth of Family PACT information at the website, www.familypact.org. Go to the Provider Training section to see when we have upcoming Orientations, Webcasts in this Ask the Experts series, and other Special Interest Trainings as well. Next month’s webcast are “Client Eligibility and Enrollment” on April 12th and “Using the Family PACT Customer Service Toolkit” will be on April 20th; both will be held at noon. Please check www.familypact.org often for other upcoming events. This concludes today’s webcast. Thanks to all of you for your participation and many thanks to our speaker, Patty Cason. Have a great day! Goodbye.

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