Medi-Cal

Changes to federal Public Charge rule

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The Department of Homeland Security will not enforce the 2019 public charge rule. As a result, the 1999 interim field guidance on the public charge inadmissibility provision will now apply.  Under the 1999 Interim Guidance, the Department of Homeland Security and United States Citizenship and Immigration Services will not consider receipt of Medi-Cal (except for long-term care, public housing or CalFresh as part of determining public charge inadmissibility.  Public cash assistance for income maintenance, including CalWORKs, Supplemental Security Income (SSI), Cash Assistance Program for Immigrants and general assistance/general relief.

However, receipt of benefits alone will not automatically cause a public charge determination.  Receipt of benefits is only one factor among several considered as part of the totality of circumstances determination for whether someone is likely to become a public charge.  Receipt of benefits by family or household members is not considered for public charge purposes.

Medical testing, treatment, and preventative services for COVID-19, including vaccines, is not considered for public charge purposes. (ACL 21-32, March 15, 2021.)

COVID-19 Medi-Cal managed care guidance

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The California Department of Health Care Services (DHCS) has issued information to Medi-Cal managed care plans (MCP) about changes because of COVID-19.  Several fee-for-service policies already issued apply to Medi-Cal including providing care in alternative settings, pharmacy, transporation and telehealth.  MCPs must waive prior authorization requirements, including screening and testing, for services related to COVID-19.  MCPs are strongly encouraged to implement expedited authorization procedures during the COVID-19 public health crisis.

For Health Homes, DHCS encourages MCPs and their contracted Community-Based Care Management Entities to use telephone and video conference assessments.  In-person requirements are suspended until the COVID-19 emergency declaration is rescinded.

The requirement for an Initial Health Assessment for newly enrolled members within 120 days is temporarily suspended.  MCPs can deter Initial Health Assessments until the COVID-19 emergency declaration is rescinded.  However, Initial Health Assessments must be done for these members when the public health emergency is over.  (APL 20-004, April 27, 2020.)

COVID-19 CCS guidance

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The California Department of Health Care Services (DHCS) has issued guidance regarding California Childrens Services and Special Care Centers during the COVID-19 public health emergency.  Policies issued by DHCS regarding Medi-Cal services apply to CCS when Medi-Cal beneficiaries are seeking services from CCS paneled providers.

All DHCS telehealth policies for Medi-Cal services apply to CCS.  Medically necessary CCS services can be delivered in-person or by telehealth.  CCS providers and SCCs should implement telehealth to provide remote consultation during the public health emergency.  DHCS and managed care plans must reimburse CCS providers at the same rate whether services are provided in person or by telehealth if the service is the same regardless of how it is delivered.

The requirement for an in-person Annual Team Conference for SCCs is suspended for the duration of the public health emergency.  DHCS has waived the requirement for an Annual Team Conference as a precondition for authorization of other new or re-authorized services for CCS clients.

CCS hearings may be conducted by phone or video conference.

DHCS is temporarily suspending prior authorization requirements.  Treatment Authorization Requests (TAR) and Service Authorization Requests (SAR) are still required but may be submitted after the date of service.

Telehealth may be used for visits related to a durable medical equipment order, including repairs and supplies.  TAR/SAR can be submitted retrospectively.

DHCS is providing flexibility for High Risk Infant Follow-up (HRIF) services for clinic to use individual approaches for follow-up services.  The age-out limit for HRIF is extended so that the third and final standard visit may be performed up to age 42 months.  (DHCS notice, April 28, 2020.)

COVID-19 Medi-Cal subacute care programs

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The California Department of Health Care Services (DHCS) has issued guidance Medi-Cal subacute care programs because of COVID-19.  DHCS will not waive Medi-Cal subacute staffing minimums.  DHCS has placed a hold on the lifting of Bans of Admission, bed increases, and new applications until further notice.

Ongoing training requirements are suspended.

Providers can cover CNA staffing hour shortages with excess licensed staffing hours as long as the hour shortages and excesses occur on the same day.

At pediatric subacute care units only, programs can reduce the number of Service Coordinator/Social Worker staffing hours.  (PPL 20-01, April 10, 2020.)

COVID-19 provision of care in alternative settings and hospital capacity

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The California Department of Health Care Services (DHCS) has issued guidance regarding several waivers in effect because of COVID-19.  Inpatient facilities can be fully reimbursed for services provided in an unlicensed facility (during an emergency evacuation or because of other need to relocate residents) provided that the California Department of Public Health makes a reasonable assessment that the facility meets minimum standards.

The three day prior hospitalization for coverage of a skilled nursing facility stay is waived for people who need to be transferred because of a disaster or emergency.

The limit of 25 beds and 96 hour stays for Critical Access Hospitals is waived.

Acute care hospitals can house acute care inpatients in excluded distinct part units if the distinct part unit’s bends are appropriate for acute care inpatients.

Acute care hospitals can relocate inpatients from an excluded distinct part psychiatric unit to an acute care bed and unit.

Acute care hospitals can relocate inpatients from an excluded distinct part inpatient rehabilitation unit to an acute care bed and unit.

Ambulance transportation may include any destination that is able to provide treatment in a manner consistent with state and local Emergency Medical Systems protocols.  (DHCS notice, April 22, 2020.)