CDSS issues new instructions about Protective Supervision

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In this letter, CDSS states several policies about several aspects of eligibility for In Home Supportive Services Protective Supervision, which is 24 hour supervision to safeguard against injury, hazard or accident. (MPP § 30-757.17.) These policies include:

  • A person must be both mentally ill and non-selfdirecting to be eligible for Protective Supervision. CDSS states it will amend MPP Section 30-757.17 to reflect this policy.
  • A person must be physically able to harm themselves to be eligible for Protective Supervision. This can include observation of persons who are bedridden but who are able to harm themselves. CDSS gives the example of a bedridden person who can pull out a G-tube.
  • While Protective Supervision is not available to guard against deliberate self-destructive behavior, a recipient who engages in deliberate self-destructive behavior and other behavior that is a basis for Protective Supervision such as wandering can be eligible for Protective Supervision to prevent the wandering.
  • Environmental modifications such as removing knobs from stoves or adding safety latches can eliminate the need for Protective Supervision.
  • Fluctuating or episodic behavior can be a basis for Protective Supervision if the behavior is unpredictable. However, if the behavior is predictable, IHSS should only be authorized for the time when the behavior occurs.
  • Leaving a recipient for fixed short periods of time is not, by itself, a reason to deny Protective Supervision
  • Actual injury is not required for Protective Supervision eligibility. A history of a propensity for the recipient to place themselves in danger is sufficient for Protective Supervision eligibility.

The letter also restates criteria for assessing children for eligibility for Protective Supervision. ACL 15-25.

CDSS directs counties to discontinue use of promissory notes for overpayment collection

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Acknowledging that inclusion of promissory notes along with CalWORKs overpayment notices of action constituted an unlawful demand in violation of its regulations (MPP Section 44-351.1), CDSS directed counties to stop sending such agreements to reimburse. Recipients may still voluntarily request a reimbursement agreement, which must be in writing and clearly indicate that repayment is voluntary. CDSS further instructed counties to begin using a new form, CW 2217 “CalWORKs Request for Voluntary Repayment,” which they may provide upon request as long as the recipient has asked if he or she may voluntarily repay, the overpayment was already explained to the recipient, the county did not initiate or request the repayment, and the recipient understands he or she may suspend the repayment at any time. ACL 15-13.

Medi-Cal managed care coverage of inpatient psychiatric facilities

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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).

More guidance about Medi-Cal application batches for Rivera, Covered CA transition

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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).

Coverage of anesthesia services for Medi-Cal dental services

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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).