Medi-Cal Update

Long Term Care | April 2020 | Bulletin 518

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1. Presumptive Eligibility for COVID-19 Testing Guidelines

Originally published April 16, 2020 and updated on April 23, 2020 and April 24, 2020

As the State of California responds to coronavirus disease 2019 (COVID-19), the Department of Health Care Services (DHCS) is creating aid code V2 to allow individuals to seek the necessary diagnostic testing, testing-related services and treatment services, including all medically necessary care such as the associated office, clinic or emergency room visit related to COVID-19 at no cost to them.

Presumptive Eligibility (PE) for COVID-19 was implemented on April 8, 2020 and is available to individuals with no insurance or who currently have private insurance that does not cover diagnostic testing, testing-related services and treatment service, including all medically necessary care for COVID-19, that do not qualify for any Medi-Cal programs (with the exception of individuals who have not met their Medi-Cal Share of Cost obligation) and are a California resident.

Aid code V2 will provide access to COVID-19 diagnostic testing, testing-related services and treatment services, including all medically necessary care for COVID-19 including the associated office, clinic or emergency room visit, without regard to immigration status, income, or resources and will have date specific eligibility. A Qualified Provider (QP) will enroll the individual on the date of application and their PE eligibility period will end on the last calendar day of the month in which the 60th day falls from the date of the PE application. This program will utilize existing QP(s) currently in PE programs.

Below is the aid code definition and messaging providers will see:

V2 Presumptive Eligibility (PE) for Coronavirus (COVID-19) Diagnostic Testing, Testing-Related and Treatment Services Only – Limited. Limited benefits to COVID-19 diagnostic testing, testing-related services and treatment services. There are no age, income or resource limits. Satisfactory immigration status not required. Limited to three months. 100% FFP.

Provider message will read: “Limited scope Medi-Cal, limited to COVID-19 testing, testing-related services, and treatment services with no SOC/spend down.”

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

Billing Instructions for PE for COVID-19 were published on April 24, 2020.

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2. Changes to NCCI Quarterly Update for January 2020

An article published in the December 2019 Medi-Cal Update, titled “National Correct Coding Initiative Quarterly Update for January 2020”, informed providers that certain codes would go into effect January 1, 2020. On February 4, 2020, the Centers for Medicare & Medicaid Services (CMS) notified the states about updates to National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) codes effective January 1, 2020.

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

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3. Assisted Living Waiver Nursing Facility Transition Rate Increase

Effective retroactively for dates of service on or after March 1, 2019, the Assisted Living Waiver (ALW) program reimbursement rate for nursing facility transition care coordination is updated.

Nursing Facility Transitional Care Coordination Rate Increase
HCPS Code Description Previous Rate Rate Effective March 1, 2019 Provider Type Impacted Waiver(s)
G9001 Coordinated Care Initial Rate $1,000 (one-time reimbursement) $1,600 (one-time reimbursement) Care Coordination Agency ALW

The nursing facility transition benefit was designed primarily to address the increased need for care coordination prior to a successful transition of an individual from a hospital, skilled nursing or institutional setting into an assisted living setting.

The figure of $1,600 is derived from the estimation that a nursing facility transition is the equivalent of five months of care coordination. Care coordination is estimated to cost $320/month.

For more information on ALW program nursing facility transition care coordination, visit the Assisted Living Waiver Member Enrollment page of the Department of Health Care Services website.

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required of providers.

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4. The Medi-Cal Learning Portal Will Soon Be Upgraded

The Medi-Cal Learning Portal (MLP) will soon be upgraded and users will experience a new look, feel and navigational changes. The MLP is hosted using a commercial off-the-shelf software application that automates the administration, tracking and reporting of training events. The MLP publishes training material and curriculum on the internet and manages the training programs for the provider and billing communities.

The functions of the upgraded MLP are easy to navigate, and users will have logical, straight-forward access to much of what they need. The new MLP enables a blended approach to learning, combining classroom delivery, business and technical workshops, virtual classrooms, e-learning and one-on-one mentoring.

The refreshed Medi-Cal Learning Portal page will continue to be accessible from either its original location or from the Outreach & Education page of the Medi-Cal website. There will be no changes to how users will reach the upgraded MLP.

With some of the new or improved features, users will be able to:

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5. June 2020 Medi-Cal Provider Training Webinars

Beginning June 2, 2020, and continuing throughout the month of June, Medi-Cal providers may participate in provider training webinars:

To register and participate in the live webinars, providers must access training through the Medi-Cal Learning Portal (MLP). Providers will be able to print class materials and ask questions during the training sessions. Recorded webinars will be archived and available for on-demand viewing from the MLP. To view the webinars, providers must have Internet access and a user profile in the MLP. Detailed instructions about the one-time registration process and how to access webinar classes is available on the Outreach & Education page of the Medi-Cal website.

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6. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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