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Medi-Cal Update

Inpatient Services | August 2021 | Bulletin 563

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1. HPE Off–Premise Flexibilities

Hospital Presumptive Eligibility (HPE) providers may complete HPE determinations off the premises of hospitals and clinics, such as in mobile clinics, street teams or other locations. In addition, hospitals may choose to use third-party vendors, contractors or subcontractors to help individuals complete the paper version of the HPE application off the premises outside of the hospital or clinic setting. Paper HPE applications completed off the premises however, must be given to the HPE provider for online submission through the HPE Application Portal.

Only employees registered under a hospital’s or clinic’s NPI who have completed the HPE Provider Computer Based Training may submit determinations through the HPE Application Portal.

Note: PE coverage begins on the day in which the HPE determination is made via submission through the HPE Application Portal. For activation of real-time HPE benefits, it is important that all paper applications completed off the premises of hospitals and clinics be given to the HPE provider daily for online submission into the HPE Application Portal immediately.

An HPE determination result must be relayed to the applicant immediately and a paper BIC provided if the applicant is determined eligible. If it is not possible to provide a paper BIC, the Client Identification Number (CIN) may be provided to the beneficiary verbally. All existing HPE requirements apply, whether the determination is made at a hospital or off-site.

HPE providers/employees are not permitted to delegate HPE determinations or use of the HPE Application Portal to non-hospital staff. Whether at the hospital or off-site, third-party vendors, contractors, subcontractors or county owned/operated clinic employees are not permitted to make HPE determinations or use the HPE Application Portal.

If HPE providers choose to use third-party vendors, contractors or subcontractors, the HPE providers must complete the HPE Provider Assistor Form and keep one on file. HPE providers may use third-party vendors, contractors or subcontractors to staff presumptive eligibility (PE) operations by staffing welcome desks, meeting with applicants and helping them complete the paper version of the HPE Application. However, third-party vendors, contractors or subcontractors are not permitted to make the PE determinations or use the HPE Application Portal.

Questions concerning off-premises HPE determinations should be sent to DHCSHospitalPE@dhcs.ca.gov.

2. Correction: Pathology Benefit Article with Incorrect Effective Date Removed

The article New Pathology Benefits for Gene Analysis posted briefly on the Medi-Cal website on August 16, 2021. It was discovered the effective date in the article was inaccurate. The article was removed from the website and will publish at a later, more appropriate time with the correct effective date for the following services.

Code Description
81340 TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using amplification methodology (eg, polymerase chain reaction)
81341 TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using direct probe methodology (eg, Southern blot)
81342 TRG@ (T cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population(s)

We are sorry for any inconvenience this has caused.

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4. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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