COVID-19 telehealth services

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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

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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.)

COVID-19 implementation of new UI programs

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The Employment Development Department (EDD) has issued information about implementation of the Unemployment Insurance provisions of the CARES Act.

EDD is working on programming for the additional $600 per week payment.  That programming cannot be completed until states receive guidance from the United States Department of Labor.  EDD hopes that the payments can start the week of April 13, 2020.

New applications will continue to take about three weeks to process.

EDD is also waiting for final details about the 13-week extension benefits for people who exhaust current benefits before programming it.

EDD is working with California Department of Technology to develop a new application for the new Pandemic Unemployment Assistance program which will provide benefits to people who do not qualify for regular Unemployment Insurance, including self-employed persons.  EDD hopes the program will be similar to the Disaster Unemployment Assistance programs that were available for recent disasters.  (News Release 20-09, April 2, 2020.)

Limitations period for collecting CalFresh overissuances

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The California Department of Social Services (CDSS) informs counties that they must stop all noticing and collection efforts for CalFresh overissuances except for Treasury Offset Program, when a claim has been delinquent for three consecutive years.  This letter supercedes Manual of Policy and Procedure Section 63.801.53 which does not comply with federal regulations.  This applies to all CalFresh overissuance types.

A CalFresh overissuance claim is delinquent if the claim has not been paid by the due date and payment arrangements have not been made, or a repayment agreement has been made and a payment not made.  A claim is established when the initial notice of action is sent to the household.  When the claim is established, the household has 30 days to respond to state how they have chosen to pay or to request a hearing.  If a household that is no longer receiving aid does not respond in 30 days, the claim is delinquent.

A claim is not delinquent if it is being paid through a repayment agreement or through allotment adjustment.  A claim is delinquent on the date of a missed installment payment.  A claim remains delinquent until either a repayment agreement is established or resumed, a payment is made by a former recipient, payment is received in full, or the recipient reenrolls in CalFresh and allotment reduction begins.

Once a claim is delinquent for three years, the only allowable collection method is the federal Treasury Offset Program.  All other collection efforts by the county or county revenue and recovery department must stop.  (ACL 20-24, March 26, 2020.)

CalWORKs Stage One child care informing notices

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The California Department of Social Services (CDSS) has issued instructions regarding frequency of providing the Child Care Request Form and Child Care Payment Rules (CCP 7).  This notice must be provided by counties when there is 1) new participation in a program activity, 2) an increase of 20 hours of participation or more in a program activity, 3) new earned income, and 4) new employment.

The welfare department computer systems will look back 30 days from the date of the participant’s report to determine if the CCP 7 has been sent.  If a CCP 7 has not been sent in the last 30 days, it will be sent.  (All County Welfare Directors Letter, February 3, 2020.)