COVID-19 CMSP access to care

The County Medical Services Program Governing Board (CMSP) has issued instructions regarding access to care because of COVID-19.  Counties must delay discontinuances and negative actions for CMSP because of COVID-19.  This delay is effective for 90 days.

Denied Medi-Cal applicants who are age 21-64, not disabled and over income for MAGI-based Medi-Cal should be screened for CMSP eligibility and provided the CMSP Supplemental Application.  The CMSP Supplemental Application may be signed by telephonic signature.

Covered California’s special enrollment period because of COVID-19 will not be considered open enrollment for purposes of CMSP eligibility determinations.

CMSP will provide coverage for COVID-19 testing for all CMSP members at no cost.  Share of Cost requirements will be waived for any provider office, urgent care center, and emergency room visits to receive COVID-19 testing at contracted and non-contracted providers within California.  (CMSP Letter 20-02, March 31, 2020.)

COVID-19 temporary suspension of all consultative examinations

The Social Security Administration has temporarily suspended all consultative examinations (CEs) until further notice because of COVID-19.  All pending CEs should be temporarily cancelled and no new CEs should be scheduled or rescheduled until further notice.  (Disability Determination Services Administrators’ Letter No. 998, undated, no link because unable to locate online.)

COVID-19 and CalWORKs Home Visiting Program

The California Department of Social Services (CDSS) has issued guidance regarding COVID-19 and the CalWORKs Home Visiting Program (HVP).

CDSS is temporarily allowing home visitors to provide services remotely if possible.  When possible, home visits can be done using a telehealth platform that is HIPPA compliant.  To the extent allowable under each model of home visiting, other communications platforms can be used.

Each home visiting model has specific guidelines regarding virtual contact with clients that are outlined.  (ACWDL, April 7, 2020.)

Changes to CalWORKs Home Visiting Program

The California Department of Social Services (CDSS) informs counties of changes to the CalWORKs Home Visiting Program (HVP) because of passage of SB 80.  HVP provides home visits to families with children under 24 months and pregnant persons to support positive health, development and well-being outcomes.

Counties may now serve families that are not first time parents.  Any family with a child under age 24 months can now be provided HVP.  Pregnant persons who have applied for CalWORKs within 60 days of reaching the second trimester of pregnancy and would be eligible for CalWORKs except for not having reached the second trimester of pregnancy also now can receive HVP.   Individuals who have applied for and are apparently eligible for CalWORKs can now receive HVP.

Counties now have the option to incorporate participation of the non-custodial parent into HVP upon agreement by both the custodial and non-custodial parents.  Counties must ensure privacy of case information between the parents is protected.

A CalWORKs applicant who started receiving HVP and then withdrew their application can continue receiving HVP if no other home visiting program is available.

Counties are no longer required to serve the eligible population before serving additional individuals.

Individuals in the Cal-Learn program are eligible for HVP.  (ACL 20-23, February 10, 2020.)

COVID-19 telehealth services

The Department of Managed Health Care (DMHC) issues instructions to covered health plans regarding telehealth services.  During the COVID-19 state of emergency, a health plan may not exclude coverage for certain types of services or categories of services because they are provided via telehealth, if the provider determines the services can be delivered effectively by telehealth.  During the COVID-19 state of emergency, a health plan may not place limits on covered services because they are provided by telehealth if such limits would not apply if the services were provided in person.

A health plan may not require enrollees to use the plan’s telehealth vendor or a different provider from the one the enrollee usually sees if the provider agrees to deliver services via telehealth and the enrollee consents to receiving services via telehealth.

Plans cannot impose credentialing or approval requirements specific to telehealth if the provider is otherwise appropriate to deliver services and the health plan would cover the provider’s services if the provider had provided services in person.

Health plan cannot require providers to use a particular platform or modality to deliver services via telehealth.  However, providers must consider their obligation to protect confidentiality of their patients.  (APL 20-013, April 6, 2020.)

COVID-19 Medi-Cal annual redeterminations

The Department of Health Care Services (DHCS) instructs counties to delay processing of annual redeterminations and delay discontinuances and negative actions for Med-Cal, Medi-Cal Access Program, Medi-Cal Access Infant Access Program, and County Children’s Health Initiative Program for 90 days.

Counties should immediately stop processing annual renewals.  Counties can exceed the timeliness standards for Medi-Cal and Children’s Health Insurance Program for 90 days.

Counties must delay discontinuances and negative actions as a result of renewals and changes in circumstances to ensure beneficiaries remain eligible for Medi-Cal for 90 days.  Counties must process determinations or redeterminations which will cause individuals to gain access to health care coverage and resolve barriers to access to care such as new applications, intercounty transfers, adding a person, a decrease income or processing 90 day cure period restorations.  (MEDIL I-20-07, March 16, 2020.)