January 2021
Governor’s Proposed Budget Maintains Health Spending
Governor Gavin Newsom released his 2021-22 State Budget proposal today, marking the beginning of a five-month long budget negotiation with the State Legislature. Despite dire predictions last year of a significant budget shortfall, California’s fiscal outlook looks strong for 2021-22 with a multibillion-dollar surplus. The Governor has proposed maintaining or augmenting many health care programs, including $33 million in ongoing funding for the Song-Brown Primary Care Physicians Training Program. The budget also includes:
- $300 million for COVID-19 vaccine distribution, including a public awareness campaign to increase vaccine adoption.
- $94.8 million to expand and make permanent certain telehealth flexibilities authorized during COVID-19 for Medi-Cal providers, and to add remote patient monitoring as a new covered benefit (a more comprehensive statewide telehealth plan will be proposed in early February).
- $3 million to grow and diversify the pipeline for the geriatric medicine workforce.
- $63 million for the Office of Health Care Affordability – the Office seeks to increase quality and cost transparency, develop cost targets, and evaluate consequences for entities that fail to meet the targets.
- $12.9 million to support and expand UC Programs in Medical Education (PRIME) and to establish a new PRIME program focused on Native American communities.
- $1.1 billion to implement the California Advancing and Innovating Medi-Cal (CalAIM) program that seeks, among other goals, to improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems, and payment reform.
- $1.7 million to conduct an analysis of the intersection of COVID-19, health disparities, and health equity.
Programs slated to be suspended have received at least a one-year reprieve including:
- Proposition 56 Medi-Cal provider supplemental payments (until July 1, 2022).
- Medi-Cal post-partum eligibility extension (until December 31, 2022).
- Medi-Cal Adult Optional Benefits, including audiology and speech therapy services, incontinence creams and washes, optician and optical lab services, and podiatric services (until December 31, 2022).
Immunization and Prescription Updates
The first 2 SARS-CoV-2 vaccines have been released, using a new mRNA technology allowing fast development speed: Pfizer/BioNTech (BNT-162b2) and Moderna (mRNA-1273). Both Pfizer & Moderna vaccines require 2 doses. Required storage temperatures are -94°F for Pfizer’s (must be used within 5 days) and -4°F for Moderna’s (must be used within 30 days). Minimum purchase orders are 975 doses for Pfizer’s and 100 doses for Moderna’s. It is unknown whether vaccination will prevent non-symptomatic transmission. Several “allergic” reactions have been reported from the Pfizer vaccine, although both seem much safer than a COVID-19 infection.
Other SARS-CoV-2 vaccine technologies include DNA (Inovio), Viral Vector (Astra-Zenica/Oxford U and Johnson & Johnson), and Protein Subunit (Novavax). (See AAFP: COVID Vaccines)
Two new COVID-19 testing CPT Codes have been added (hopefully covered by payers):
- 87635 to report COVID-19 antigen (infectious agent) detection;
- 86318 to report COVID-19 antibody (immunity) detection.
New ICD-10 Codes include:
- U07.1 for All COVID-19 Cases (dx by test, sx, &/or exposure)
- Z20.828 for Contact/Exposure to Other Viral Communicable Diseases
(Add Symptom Codes)
- B94.8 for Sequelae of Other Specified Infectious & Parasitic Diseases
Starting January 2021, new medical immunization exemptions for children can only be issued using the CAIR-ME website, California Immunization Registry – Medical Exemption (CAIR-ME), after registering there. State law requires medical exemptions to meet the criteria of the CDC Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP).
Starting January 2021, controlled substance prescription pads must have security features including a 12-character serial number and barcode (available from California-approved Security Prescription Printers). (Electronic prescriptions are not affected.) Prescribers and pharmacists who dispense controlled substances must report them to CURES within one working day. For more information, see the Board’s CURES webpage.
Starting January 2021, Medi-Cal pharmacy benefits are transitioned to “Medi-Cal Rx”, a fee-for-service delivery system administered by Magellan Medicaid Administration, Inc.
Other News
CMS has revised the E/M documentation and coding guidelines beginning January 1.
The new AB 890 law creates two new classifications of nurse practitioners that may alter their supervision requirements, pending regulatory guidance. CAFP has a factsheet to help explain the law.
Beginning April 5, the “Open Charts Law” requires giving patients access without charge to their EMR health information, such as by web portal (except sensitive or psychotherapy notes).
