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Updated Designation of Categorical Risk Levels for LA County Pharmacies

April 29, 2020

This regulatory provider bulletin supersedes the bulletin entitled, “Designation of Categorical Risk Levels for Pharmacy Providers in Los Angeles County,” published on the Department of Health Care Services (DHCS) Medi-Cal website.

Notwithstanding Welfare and Institutions Code (W&I Code), Section 14043.75 or any other provision of law (including, but not limited to, the Administrative Procedure Act, Government Code section 11340 et seq.), pursuant to Executive Order (EO) N-55-20, DHCS may, for the purpose of responding to the effects of coronavirus disease 2019 (COVID-19), issue bulletins or guidance related to provider enrollment without advance notice or public hearing. As such, this bulletin makes specific the requirements of W&I Code, Section 14043.38 and has the full force and effect of law.

Effective the date of this bulletin, until EO N-55-20 is lifted, any pharmacy applicant located in Los Angeles County who is: (1) seeking enrollment in Medi-Cal for the first time; (2) submitting an application for continued enrollment; (3) submitting an emergency enrollment application pursuant to the article entitled, “Requirements and Procedures for Emergency Medi-Cal Provider Enrollment,” dated March 24, 2020, or (4) has an application that is currently under review with the Provider Enrollment Division (PED), will be screened at the “limited” categorical risk level through the remainder of the national emergency and not be screened at the “high” categorical risk level as outlined in the bulletin entitled, “Designation of Categorical Risk Levels for Pharmacy Providers in Los Angeles County.”

Thus, these pharmacies will be exempt from:

  • Criminal background checks
  • Submission of a set of fingerprints for a criminal background check for all individuals who have 5 percent or greater direct or indirect ownership interest in the provider, and
  • Mandatory onsite inspections (DHCS reserves the right to conduct an onsite inspection under the limited categorical risk).

In addition to the enrollment requirements for a pharmacy provider, pharmacy applicants will still be subject to the “limited” categorical risk level screening requirements, which include but are not limited to:

  • Verification that a provider meets any applicable federal regulations or State requirements for the provider type prior to making an enrollment determination,
  • Verification of applicable licensure, including State license verifications in states other than where the provider is enrolling,
  • Database checks on a pre- and post-enrollment basis to ensure that providers continue to meet the enrollment criteria for their provider type and
  • Discretionary onsite inspection under the limited categorical risk.