Biweekly Briefing Articles

5 Things To Know: Pharmacy Fraud Scheme, Behavioral Health Access, Vaccine Administration Claims

SAN DIEGO COUNTY BOARD OF SUPERVISORS: On June 28, the County of San Diego Board of Supervisors unanimously adopted a $7.36 billion budget for the 2022-23 fiscal year, with significant investments in behavioral health, homelessness, equity, racial justice, and climate change. Additionally, the board unanimously declared fentanyl as a public health crisis, which will direct county staff to develop a comprehensive strategy to address this crisis and devote more resources to fentanyl education, treatment, recovery, and harm reduction strategies. Board Chair Nathan Fletcher also indicated the county is expected to receive $100 million from a lawsuit settlement with opioid manufacturers, and funding could be directed toward the effort. From August to October, the county will host workshops to get feedback from the community on how to prioritize settlement dollars, and the board will meet in October to consider a framework. Lastly, the board unanimously approved all recommendations and actions to enhance human trafficking prevention and service coordination efforts to support survivors. With this action, the county also authorized procurement to establish peer support navigation services for adult survivors

VACCINE ADMINISTRATION CLAIMS: The Department of Health Care Services 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 the under 5 age range. Physicians are urged to hold Medi-Cal claims for vaccine administration for children under age 5 until further notice. 

PHARMACY FRAUD SCHEME: The California State Board of Pharmacy is warning hospitals about a sophisticated fraud scheme to obtain pharmacy account numbers and other sensitive information and unlawfully divert quantities of pharmaceutical goods in transit. In some cases, scammers telephoned to request pharmacies’ Drug Enforcement Administration number and account purchasing information for their principal distributor by pretending to represent the state’s Board of Pharmacy or employees. The Healthcare Distribution Alliance Pharmaceutical Cargo Security Coalition has released a report about this problem. It discusses methods being used to divert drug shipments and tips for protecting distributors and pharmacies. The Board of Pharmacy urges drug distributors and pharmacists to read the report and learn how to spot fraudulent activity and prevent drug diversion. More details are available in this CHA News article.  

BEHAVIORAL HEALTH: Two All Plan Letters (APL) from the Department of Health Care Services are designed to provide guidance on new laws related to behavioral health access. APL 22-005 is related to the No Wrong Door for Mental Health Services policy. As of July 1, enrollees with mental health needs should be able to get services without bouncing between systems — no matter which system they encounter first. Providers will be reimbursed for services delivered before a formal diagnosis is made. This policy ensures that members receive timely mental health services without delay regardless of the delivery system where they seek care and that members are able to maintain treatment relationships with trusted providers without interruption. Corresponding guidance to county mental health plans is contained in Behavioral Health Information Notice No: 22-011. A soon-to- be-released APL related to timely access outlines the new requirements in Health and Safety Code section 1367.03 as set forth by Senate Bill (SB) 221, which took effect July 1. The bill requires Medi-Cal managed care health plans to comply with the requirement for non-urgent follow-up appointments with a non-physician mental health provider within 10 business days of the prior appointment for members undergoing a course of treatment for an ongoing mental health condition.  

NON-FATAL STRANGULATION TRAINING: The Health Subcommittee of the San Diego Human Trafficking and CSEC Advisory Council is providing a free online training on Aug. 3 for medical providers on Assessing Non-Fatal Strangulation. The training will be provided by the Training Institute on Strangulation Prevention. Attendees will learn to recognize the signs of non-fatal strangulation to prevent stroke and death and evaluate the connection between strangulation and exploitation. This activity has been awarded two American Medical Association Physician’s Recognition Award Category 1 credits and two American Nurses Credentialing Center nursing contact hours. Accreditation information is available in this document