HEALTHmattersMD

A strong primary care network is critical for a healthy community. The years since the COVID-19 global health crisis have provided many unprecedented challenges, but through it all, HPSM’s  mission has remained the same – healthy is for everyone – and primary care is the frontline of that work.

To help our network move from crisis toward progress, we’ve made two meaningful investments into primary care: Primary Care ACT and Primary Care Provider Grants.

Earlier this year HPSM launched Primary Care ACT to help practices build their population health management capabilities through assessments, coaching, and technical assistance.

The Primary Care ACT team has completed the assessment phase of the program. 45 primary care practices, representing more than half of HPSM’s primary care network and 92% of assigned members, completed assessments evaluating their population health management capabilities.

HPSM’s program partners, PopHealth Learning Center and UCSF Center for Excellence in Primary Care, have now begun the coaching and technical assistance phases of the program. From June 2026 to June 2028, 15 participating practices will receive hands-on support to boost their population health skills, strengthen practice culture, close care gaps on key HEDIS measures, and raise quality scores. Practice tracks build learning communities with a tier-based curriculum, peer-to-peer sharing and technical assistance, while 1:1 coaching offers practices tailored support for particular needs.

Additionally, through our Primary Care Provider Grants program, HPSM has allocated $10 million over the last 18 months to augment primary care teams . To date, $7.5 million in grant funding has been approved, with the remaining funding available through 2028 or until all funds have been awarded.

We encourage our primary care organizations take advantage of the grant funding available through the Primary Care Provider Grants program together with the technical assistance available through Primary Care ACT. These resources are designed to help turn improvement plans into action and accelerate your journey toward advanced primary care.

These next couple of years could be amongst some of the most challenging. Together, we can build a stronger, more sustainable primary care network that is essential to a high-performing health care system.  Together, we can make sure that healthy is for everyone.  

Effective January 1, 2027, Health Plan of San Mateo (HPSM) members with unsatisfactory immigration status (UIS) will transition to the Medi-Cal Fee-for-Service (FFS) delivery system. This change is due to changes in Medi-Cal eligibility requirements.

Many HPSM members and their families will be impacted by this change. As a Medi-Cal provider, HPSM wants to make sure you have the information you need to minimize harm to HPSM members and their families and help avoid disruptions in their care. Here are three important ways you can support HPSM members: 

1. Encourage members to check their mail and voicemail regularly and respond to communications promptly. Members affected by this change may have already been contacted via mail and automated phone calls with critical information about their health benefits. If they have not been contacted yet, encourage them to continue checking.
2. Support your patients with any necessary referrals. HPSM members transitioning to FFS Medi-Cal will need transitional care plans. Schedule needed specialty care visits before January 1, 2027. Members with complex specialty needs, members currently using the Enhanced Care Management benefit, or those using Community Supports may especially be impacted by this transition.
3. Refill prescriptions ahead of January 1. HPSM members transitioning to FFS Medi-Cal may not have access to a provider who can prescribe their medications. HPSM recommends providers write 90-day prescriptions with four refills, which will last a member one year, when clinically appropriate. Please note: members transitioning to Medi-Cal FFS will continue to have Medi-Cal Rx for medication coverage.

Primary care providers: please contact HPSM if you have specific questions about your assigned panel and how you can best support them. You may reach us at PSInquiries@hpsm.org. 

To learn more about immigration status and changes to eligibility please visit the Department of Health Care Services (DHCS) website.

Have additional questions?

HPSM will provide additional information as DHCS finalizes transition updates, including:

• Care management applicable billing codes in Medi-Cal FFS
• Member support pathways
• Contact information for DHCS or MCP support channels

In the interim, please direct any questions to HPSM Provider Services at PSInquiries@hpsm.org.

Alzheimer’s disease (AD) and other dementias are under-recognized and under-diagnosed in the community. Primary care practitioners are the most likely provider to detect early symptoms of AD and other dementias in older adults. In primary care settings, providers can expect 11% of people 65 and older and 32% of those 85 and older to have AD, with the incidence expected to rise due to the increasing number of people aged 65 and older. Screening to identify older adults early in the disease process is important to offer treatment and future planning for the patient and their family caregivers.

Medi-Cal benefits include an annual cognitive assessment for Medi-Cal members who are 65 years of age and older. Members with CareAdvantage are excluded from this policy as cognitive assessments are already covered as part of the Medicare Annual Wellness Visit (AWV).

The annual cognitive health assessment is intended to detect early signs of memory or thinking changes, identify potential cognitive impairment, and guide patients toward comprehensive diagnostic evaluations or specialized care when necessary.

Providers are no longer required to complete a cognitive health assessment training in order to receive payment for conducting a cognitive health assessment.

Medi-Cal Providers must use validated tools recommended by the Department of Health Care Services (DHCS).

For billing, use CPT II code 1494F - Cognitive health assessment performed. 1494F has a frequency limit of once per year, per same provider. Do not report CPT code 99483 (Assessment of and care planning for patients with any cognitive impairment, like dementia, including Alzheimer’s disease, at any stage of impairment) with CPT code 1494F.

Any licensed health care professional who is enrolled as a Medi-Cal Provider, is acting within their scope of practice, and is eligible to bill Evaluation and Management (E&M) codes is eligible to conduct and bill for cognitive health assessments.

Provider Billing Requirements

• Administer the annual cognitive health assessment as a component of an E&M visit including, but not limited to an office visit, consultation, or preventive medicine service (elements of the cognitive health assessment can be conducted by non-billing team members acting within their scope of practice and under the supervision of the billing Provider);
• Document all of the following in the Member’s medical records and have such records available upon request:
  • The screening tool or tools that were used (at least one cognitive assessment tool listed below is required);
  • Verification that screening results were reviewed by the Provider;
  • The results of the screening;
  • The interpretation of the results; and
  • Details discussed with the Member and/or Authorized Representative and any appropriate actions taken in regards to screening results.

Cognitive Assessment Tools

At least one cognitive assessment tool listed below is required. Cognitive assessment tools used to determine if a full dementia evaluation is needed include, but are not limited to:

• Patient assessment tools
  • Mini-Cog
  • General Practitioner assessment of Cognition (GPCOG)
  • Recommended: The DHCS Dementia Care Aware cognitive health assessment training
• Informant tools (family members and close friends)
  • Eight-Item Informant Interview to Differentiate Aging and Dementia
  • General Practitioner assessment of Cognition (GPCOG)
  • Short Informant Questionnaire on Cognitive Decline in the Elderly

Based on the scores from these assessments, additional assessment or a specialist referral may be appropriate. For the CareAdvantage patient, refer to the CMS Cognitive Assessment & Care Plan Services webpage.

View the DHCS All Plan Letter 26-014 Responsibilities for Annual Cognitive Health Assessment for Eligible Members 65 Years of Age or Older.