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Additional Guidance on Presumptive Eligibility (PE) for Coronavirus (COVID-19)

Originally published May 4, 2020 and updated on May 12, 2020

The Presumptive Eligibility (PE) for Coronavirus (COVID-19) was implemented on April 8, 2020. PE for COVID-19 allows individuals to seek the necessary diagnostic testing, testing-related services, and treatment services, including all medically necessary care as a result of COVID-19. PE for COVID-19 uses the new aid code (V2) to identify this coverage group.

Effective immediately, if an individual goes to a qualified provider (QP) and requests COVID-19 related medically necessary care, which includes diagnostic testing services, testing-related services, and treatment services, and does not meet the eligibility criteria of the PE program in which the QP oversees, DHCS is instructing QPs to send application referrals directly to DHCS for processing. For guidance on how to process the PE for COVID-19 Application when an individual does not meet the eligibility criteria of the PE program, please reference the Additional Guidance to Presumptive Eligibility (PE) for Coronavirus (COVID-19) Application Step-by-Step Guide for Qualified Providers.

Providers are to render the COVID-19 diagnostic testing, testing-related services, and treatment services, including all medically necessary care for the individual at the time of the individualís visit to the office, clinic, or hospital.

Questions

Questions concerning PE for COVID-19 should be sent COVID19Apps@dhcs.ca.gov.

Reference

New Presumptive Eligibility for COVID-19: Aid Code – V2