This week, DHCS issued new guidance to Medi-Cal managed care plans about new treatment guidelines for recent FDA-approved treatments for Hepatitis C. The updated policy, effective July 1, 2015, looked at recent medical evidence and practice guidelines to determine who would be eligible for treatment.
DHCS APL 15-016 (6/29/15); Treatment Policy for the Management of Chronic Hepatitis C
DHCS issued this letter to clarify managed care plan requirements to cover inpatient psychiatric services. Plans are supposed to cover medically necessary covered services when contacted by specialty mental health providers post-admission to psychiatric inpatient hospitals. The letter lists the requirements.
Plans do not need to cover room and board charges. However, they do need to cover medically necessary covered nursing facility services when the services are provided to those who are less than age 22 or greater than age 64.
DHCS APL 15-015 (6/12/15).
DHCS updated the MC 216 Pre-Populated Renewal form to replace a question about fluctuating income. The forms are available in all threshold languages. DHCS MEDIL I 15-14 (5/19/15).
DHCS provided an update on the batching process for dealing with processing Medi-Cal applications in a more timely manner in the wake of the Rivera decision. DHCS was to issue a Notice of Inaction mailer for individuals who have not received a final Medi-Cal determination and NOA. The letter describes the different batches and what counties must do.
DHCS provides weekly results files to SAWS counties, which includes individuals whose applications are nearing the 45 days. Counties must review these files for the Rivera mailing.
The batch process to transition beneficiaries from Covered California to Medi-Cal will continue on a monthly basis until the process is automated.
DHCS MEDIL I 15-13 (5/15/15).
DHCS issued instructions on the coverage of IV sedation and general anesthesia services in connection with dental services. Medi-Cal beneficiaries are entitled to dental services under IV sedation and general anesthesia when medically necessary in an appropriate setting. The letter lists the requirements for MCPs to cover general anesthesia services. All Plan Letter 15-012 (5/14/15).
In July 2014, the Social Security Administration (SSA) announced the availability of SSA benefit verification letters and other SSA verification processes, via its My Social Security site. CDSS has now issued updated instructions (along with a few pointed reminders) to counties about the changes in the SSA processes for verification of Social Security account information, and how they relate to largely unchanged CDSS requirements for a client’s submission of Social Security numbers and income information. The specifics for verification of Social Security account information vary somewhat in the CalWORKs, Medi-Cal and and CalFresh programs, highlighted here. There is language here that is horatory but still helpful to the client’s cause, where CDSS reminds counties that “the CWD shall make every effort to assist the individual in obtaining the documents necessary to submit a complete application for a SSN card” and “strongly recommends that counties ensure that the forms they are using are adequate in providing all necessary information to clients.” ACIN I-24-15 (April 13, 2015).