The California Department of Health Care Services (DHCS) will cover and reimburse for Fee-for-Service Medi-Cal beneficiaries off-label and/or investigational drugs for use in COVID-19.  A Treatment Authorization Request (TAR) or Service Authorization Request (SAR) is not required.

FDA-approved drugs being used off label to treat COVID-19 must either be used as part of a registered clinical trial, or the treating physician must put appropriate documentation in the medical record.  Non-FDA-approved drugs must be used as part of a registered clinical trial or be used in accordance with the FDA’s Expanded Access pathway (sometimes called compassionate use).

Because of its need for other uses, DHCS is limiting Hydoxychloroquinine to 120 tablets per prescription and Chloroquinine to 60 tablets per prescription.  If a beneficiary needs a larger quantity, a TAR or SAR establishing medical necessity will be required.  (DHCS notice, April 3, 2020.)

The California Department of Health Care Services (DHCS) suggests that well-child care should be done in person when possible.  Where community circumstances requiring limiting in-person visits, clinicians are encouraged to prioritize in-person newborn care, and well visits and immunizations of infants and young children through 24 months of age when possible.  DHCS encourages providers to discuss with beneficiaries/parent caregivers attending well-child visits in person to receive necessary immunizations and screenings, and providing other services by telehealth.

Med-Cal policies allow providers to provide medical care by telehealth or telephone.  Providers should inform beneficiaries/parent caregivers of the option to have some elements of well-child visits completed via telehealth and explain that some parts of the physical exam and/or immunization must be done in person.  (DHCS notice, April 24, 2020.)

The California Department of Health Care Services (DHCS) is allowing telephonic signatures Every Woman Counts and Family Planning, Access, Care and Treatment program providers enrolling individuals for Breast and Cervical Cancer Treatment Program.  A copy of the final pathology report with the qualifying diagnosis must be submitted.  (DHCS notice, April 17, 2020.)

The Presumptive Eligibility for Pregnant Women program allows qualified individuals immediate access to temporary, no cost Medi-Cal for conditions related to pregnancy while applying for permanent Medi-Cal or other coverage.  The California Department of Health Care Services (DHCS) is allowing telephonic signatures for Presumptive Eligibility for Pregnant Women.  If the individual is not experiencing an urgent prenatal care event which requires immediate care, the individual can apply for Medi-Cal online using the Covered California portal.  (DHCS notice, April 16, 2020.)