HEALTHmattersMD

In their annual Medicaid Health Plan Ratings report, the National Committee for Quality Assurance (NCQA) awarded HPSM’s Medicaid (Medi-Cal) line of business 4.5 out of 5 stars. This represents an improvement of half a star for HPSM since 2023, when NCQA named HPSM one of California's top-rated Medicaid Plans. 

NCQA accreditation is the healthcare industry’s “seal of approval,” indicating that HPSM meets the highest quality standards. 4.5 out of 5 stars is the highest rating any Medicaid (Medi-Cal) plan achieved this year. NCQA calculates Health Plan ratings using each plan’s comparative performance on a number of quality of care and member experience metrics and accreditation status. Out of 201 plans with a numeric rating, only 14 earned a 4.5. This is further recognition that HPSM’s service and clinical quality meets or exceeds rigorous requirements for consumer protection and quality improvement.   

HPSM CEO Patrick Curran said that “Being one of the highest-rated Medicaid plans in the nation demonstrates our commitment to continuous quality improvement. Achieving high ratings across many categories of patient experience, prevention, equity and treatment helps ensure our members have access to high-quality health care in our community.” 

Each year, NCQA rates more than 1,000 health plans in all 50 states, U.S. territories and the District of Columbia. The results are then posted to NCQA’s Health Plan Report Cards website to help consumers, employers and others better understand the quality of care health plans provide to their members. 

As part of our ongoing commitment to improving our website user experience (UX), in August 2024 we launched a database-driven search tool that makes it easier to determine whether services require prior authorization. Now, to find out whether you need to request prior authorization before providing a service, simply:

1. Visit the Prior Authorization webpage.

2. Scroll down to the search tool.

3. Type a keyword, description or five-digit Current Procedural Terminology (CPT) code into the text field.

4. Choose an option. If you see no options below your query, then the service does not require prior authorization. If you see options, choose the one that most closely matches what you are looking for. For example:

5. Check the results. If the result shows a green "Y" or "C" on the "PA requirement status (Yes/Conditional)" line, then prior authorization is required. For example: 

If you prefer the previous search method of viewing or downloading a PDF, pressing the Ctrl+F keys simultaneously and typing your search query into the popup box, you still have that option on the webpage. 

The California State Department of Public Health’s (CDPH’s) Childhood Lead Poisoning Prevention Branch has released updated guidance for medical providers. In summary:

• Test all children at one and two years old. However, you should also test children older than two who haven’t been tested. 
• The lead test must be venous.
• Children who test positive for elevated blood lead level (BLL) need treatment: see instructions.

Screening other patient populations 

For recently arrived refugees six months to six years old, the Centers for Disease Control and Prevention (CDC) offers this lead screening guidance:   

• Test for BLL within 90 days of arrival to the US (and preferably within 30 days). 
• Conduct a follow-up lead test within three to six months post-resettlement, regardless of initial BLL screening results.    

For patients who are pregnant, CDC guidelines recommend conducting a blood lead test when there has been potential lead exposure. Also explain the importance of avoiding lead exposure during pregnancy due to the dangers, which include:

• Increased risk of miscarriage, premature birth and low birth weight.  
• Harm to the baby’s brain, kidneys and nervous system.  
• Childhood learning and/or behavior problems.