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Information Regarding Disaster Relief

November 14, 2018

In response to the fires in Butte, Los Angeles and Ventura counties, the Department of Health Care Services (DHCS) recognizes the need to dispense replacement medication to beneficiaries impacted by these fires.

Pharmacies are advised to submit a Treatment Authorization Request (TAR) using the Special Handling of “Six Prescription Limit” and incorporate the statement “Patient impacted by [identify specific county] county fire” within the Miscellaneous Information field on the TAR.

If a pharmacy receives a real-time claim denial for frequency limitation, the pharmacy is advised to submit a TAR using the Special Handling of “Exceeded Billing Frequency Limit” and incorporate the statement “Patient impacted by [identify specific county] county fire” within the Miscellaneous Information field on the TAR.

DHCS has authorized reimbursement of a 72-hour supply of covered Medi-Cal drugs in an emergency situation. California Welfare and Institutions Code (W&I Code), Sections 14133.37 and 14185 requires pharmacies to dispense up to a 72-hour supply of covered medication(s) at no charge to Medi-Cal beneficiaries in an emergency situation. This includes prescriptions waiting for a TAR approval.

Claims for the emergency supply must be submitted for reimbursement through the completion of the Pharmacy Claim Form (30-1) and include the submission of an Emergency Certification Statement as described in the Pharmacy Claim Form (30-1) Completion section of the Pharmacy provider manual. Providers must incorporate the following statement within the general emergency statement: “Patient impacted by [identify specific county] county fire.”

For more information about program coverage in an emergency, please review the statutes mentioned below.

References to this requirement may be found in the following federal and state laws:

  • Social Security Act, Section 1927(d) (5)
  • California W&I Code, Section 14133.37
  • California W&I Code, Section 14185

Emergency Services are defined in California Code of Regulations (CCR), Title 22, Section 51056. For the purposes of providing treatment of an emergency medical condition, “emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following conditions:

  • Placing the patient’s health in serious jeopardy
  • Serious impairment to bodily functions
  • Serious dysfunction of any bodily organ or part

Providers are encouraged to monitor the Medi-Cal website for future updates.