Medi-Cal Pharmacy (Rx) – Coordination of Benefits (COB) Billing Updates for Skilled Nursing Facilities
| Date: | April 29, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Skilled Nursing Facilities |
| Type: | Informational/Educational |
| Subject: | Medi-Cal Pharmacy (Rx) – Coordination of Benefits (COB) Billing Updates for Skilled Nursing Facilities |
| Business: | Medi-Cal Managed Care/Medicare Dual Special Needs Program (D-SNP) |
Effective May 8, 2026, diabetic testing supplies, such as blood glucose test strips and lancets, are covered under Medicare Part B only when used in the member’s home. Members residing in a Skilled Nursing Facility (SNF) do not meet the definition of “home”. Therefore, diabetic testing supplies for dual eligible Medicare and Medi-Cal members residing in SNFs are to be billed to and covered by Medi-Cal Rx.
Pharmacies
This applies to dual eligible Medicare and Medi-Cal members residing in SNFs. Claims submission with a date of service on or after October 1, 2025 should be billed directly to Medi-Cal Rx.
- Enter the Patient Residence Code 2 (Skilled Nursing Facility)
- Refer to the “List of Contracted Diabetic Testing Supplies” on the “Contract Drugs & Covered Products Lists” page on the Medi-Cal Rx Web Portal at: https://www.medi-calrx.dhcs.ca.gov/home/cdl/
- Prior Authorization (PA) submission may be required. You may submit a PA via one of the following methods from this weblink: https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider /bulletins/2022.05_A_PA_Submission_Reminders.pdf
Further details and resources can be found via this Medi-Cal Rx weblink: https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/ provider/2026/04_A_Coming_Soon_COB_Billing_Process_Updates_SNF.pdf
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
