ACA’s Nondiscrimination Policy Applies to Family PACT
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. In effect since 2010, Section 1557 builds on long-standing federal civil rights laws: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975.
Effective July 18, 2016, the Health and Human Services (HHS) Office for Civil Rights issued its final rule implementing Section 1557 at Title 45 Code of Federal Regulations (CFR) Part 92. The rule applies to any health program or activity, any part of which receives federal financial assistance, an entity established under Title I of the ACA that administers a health program or activity, and HHS. In addition to other requirements, Title 45 CFR Part 92.201, requires:
• Language assistance services requirements
Language assistance services required under paragraph (a) of Part 92.201 must be accurate, timely and provided free of charge, and protect the privacy and independence of the individual with limited English proficiency
• Specific requirements for interpreter and translation services
Subject to paragraph (a) of Part 92.201:
• A covered entity shall offer a qualified interpreter to an individual with limited English proficiency when oral interpretation is a reasonable step to provide meaningful access for that individual with limited English proficiency
• A covered entity shall use a qualified translator when translating written content in paper or electronic form
For more information about the application and requirements of the final rule implementing Section 1557, providers should contact their representative professional organizations. They may also visit the Section 1557 of the Patient Protection and Affordable Care Act page of the HHS website to find sample materials and other resources.
An article published in the July 2017 Medi-Cal Update bulletin titled KX Modifier Facilitates Claims for Transgender Services which informed providers that modifier KX (requirements specified in the medical policy have been met) may be used to facilitate claim processing in instances where the patient's gender conflicts with the billed procedure code. The patient's medical record must support medical necessity for the procedure.
Providers may already override a gender conflict with an approved Treatment Authorization Request (TAR) when the gender on the claim conflicts with the billed procedure code. Use of modifier KX introduces an alternative method to facilitate claims processing without requiring an approved TAR. The use of modifier KX will not override other policy requirements for an approved TAR.
This policy also applies to the Family Planning, Access, Care and Treatment (Family PACT) Program. The Family PACT manual updates will be published in a future Family PACT Update bulletin.
Family PACT Launches New Provider Orientation Process
Effective May 1, 2017, the Family Planning, Access, Care and Treatment, (Family PACT) program will implement a new online Provider Orientation process. Family PACT Provider Orientation will be delivered in two parts. Part one will consist of online modules that must be completed prior to attending an in-person training (part two). Medi-Cal providers who wish to enroll in the Family PACT program will be required to complete the online overview prior to attending the in-person training. Registrants will create a profile, complete the online overview, and register for the in-person orientation through our new Learning Management System which will go live May 1. Please re-visit the Family PACT website on or after May 1 for further details.
Information Related to Insurance Affordability Programs
An informational video for providers
ACA Requirements for ORP Providers Available on ORP Web Page Read more...
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