The Hospital Presumptive Eligibility Program (HPE) allows qualified individuals immediate access to temporary, no cost Medi-Cal while applying for permanent Medi-Cal or other coverage.  The California Department of Health Care Services (DHCS) is allowing telephonic signatures for Medi-Cal Hospital Presumptive Eligibility.  If the individual is not at the hospital and not experiencing an urgent health event which requires immediate care, the individual can apply for Medi-Cal online using the Covered California portal.  (DHCS notice, April 2, 2020.)

The California Department of Health Care Services (DHCS) has temporarily suspended prior authorization requirements for Medi-Cal Fee-for-Service for all Medi-Cal covered benefit categories covered in the state plan that are currently subject to prior authorization.  Providers must still submit Treatment Authorization Requests (TAR) and Service Authorization Requests (SAR).  Providers should state “Patient impacted by COVID-19” on the TAR or SAR.  These TARs and SARs can be submitted after services have been provided, and will be expedited and approved as appropriate.  Providers must still submit supporting documentation to justify the need or medical necessity.

For TARs that have already been authorized that need an extension, providers can update the TAR with the statement “Patient impacted by COVID-19.”  (DHCS Letter, April 2, 2020.)

The California Department of Health Care Services (DHCS) has waived the requirement for a prescription from a provider for beneficiaries to be able to use non-emergency medical transportation.  A Treatment Authorization Request (TAR) is still required for non-emergency medical transportation.   Providers are instructed to state “Patient impacted by COVID-19” on the TAR.

Ambulance transportation may temporarily include any destination that can provide treatment to the patient in a manner consistent with state and local Emergency Medical Services protocols. (DHCS Letter, April 22, 2020.)

The California Department of Health Care Services (DHCS) has suspended the requirement to have a record of the signature of the person receiving a drug or device by mail or delivery.  DHCS will allow any form of delivery service tracking or electronically documented proof of delivery to suffice as proof of receipt of a drug or device by a Medi-Cal or Family PACT beneficiary or authorized representative.

If attempts to communicate with the beneficiary fail, the delivery carrier may leave the drug or device at the beneficiary’s door.  (DHCS Letter, April 24, 2020.)

Because of COVID-19, until further notice, the California Department of Health Care Services (DHCS) will allow a dental consultation services by telephone or video to be provided to remote Medi-Cal members.

Dentists should only perform procedures that are needed to treat dental emergencies.  (Smile California Provider Bulletin, April, 2020.)

Because of the ongoing public health emergency, COVID-19 testing and related medically necessary treatment, including services provided outside of a hospital emergency department, rae deemed to be emergency services.  All enrolled Medi-Cal beneficiaries, regardless of scope of coverage or documentation status, are entitled to all inpatient and outpatient services necessary for testing and treatment of COVID-19.  Continuation of medically necessary impatient services and follow-up care after the emergency is resolved is not authorized or reimbursed for undocumented beneficiaries enrolled only for restricted scope benefits.

There is no co-pay for emergency services, including testing, evaluation and treatment of COVID-19.  (DHCS Letter, April 8, 2020.)