Medi-Cal Update

In response to the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) have approved State Plan Amendment (SPA) 20-0024, which temporarily adds Associate Clinical Social Worker (ACSW) and Associate Marriage and Family Therapist (AMFT) services at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) as billable visits. ACSWs and AMFTs are not licensed practitioners, per the California Board of Behavioral Sciences. Therefore, services are billed under the supervising licensed, billable behavioral health practitioner of the FQHC or RHC. The licensed behavioral health practitioners must supervise and assume the professional liability of services furnished by the unlicensed ACSWs and AMFTs. Additionally, the licensed practitioner must also comply with supervision requirements established by the Board of Behavioral Sciences.

During the public health emergency declaration, an FQHC or RHC can be reimbursed at the Prospective Payment System (PPS) rate for a visit between a FQHC or RHC patient and an ACSW or AMFT. The visit may be conducted as a face-to-face encounter or, if it meets all relevant requirements, via telehealth.

Payment for ACSW or AMFT services is as follows:

• ACSW or AMFT services provided by FQHCs and RHCs that meet visit criteria and are provided on or after March 1, 2020 may be eligible for reimbursement at the PPS rate.


• Services are billed under the supervising licensed, billable behavioral health practitioner of the FQHC or RHC.


• These services are billed using existing claiming processes that include billing managed care plans first, followed by billing DHCS for the PPS rate wrap payment. Note that the services are billed using the appropriate billing code set.

Please refer to the Federally Qualified Health Centers/Rural Health Clinics Provider Manuals for additional billing guidelines.

As California continues to respond to coronavirus disease 2019 (COVID-19), the Hospital Presumptive Eligibility (HPE) Program will temporarily expand presumptive eligibility (PE) coverage to a new coverage group of individuals who are 65 or older and whose income is below 138 percent of the Federal Poverty level (FPL), effective immediately. This new coverage group is referred to as the “Aged” HPE group. This coverage group is allowed two (2) periods of PE in a twelve-month period and will be assigned aid code 7D. This expansion will be in effect through the end of the COVID-19 public health emergency.

DHCS is also expanding presumptive eligibility periods through HPE for adults that are age 19 years and over. HPE will now provide two (2) periods of presumptive eligibility in a twelve-month period for adults age 19 and over. This change is effective immediately and will be in effect through the end of the COVID-19 public health emergency.

DHCS has received federal approval on these new policy changes through California State Plan Amendment 20-0024.

It is critical that HPE Providers monitor the Hospital PE Program Medi-Cal website for future articles and materials scheduled to publish during May and June 2020.

Questions concerning the HPE expansion should be sent to DHCSHospitalPE@dhcs.ca.gov.

The Department of Health Care Services (DHCS) reminds providers to bookmark their specific provider community page(s) for each of the provider communities they render services and benefits to as part of the Medi-Cal program. Each of the current and available 25 provider community-dedicated web pages are listed below with direct links to each web page.

Providers are also encouraged to reference the Navigating Medi-Cal and Specialty Programs chart to help identify the specific provider communities they each align to, as well as to locate which claim form(s) each provider community utilizes for billing.

Provider Community web pages serve as primary source for Medi-Cal News, Provider Bulletins, Provider Manuals, References and Featured Links.

Within each provider community web page, providers will find the following principal information resources:

• Medi-Cal News articles


• Medi-Cal Update Provider Bulletins – both Part 1 and Part 2


• Provider Manuals – both Part 1 and Part 2


• References – including direct links to Transaction Services, Outreach & Education, Medi-Cal Subscription Service (MCSS), System Status Alerts, and reference materials


• Featured Links – including direct links to Billing Tips, Computer Media Claims, Frequently Asked Questions (FAQs), Medi-Cal Forms, HIPAA, Medi-Cal Rates and References


• System Status Alert – In addition, the new System Status Alert banner will continue to appear at the top of each provider community page any time a System Status Alert is active

Provider Community-Dedicated Web Pages
The following is a complete list of the 25 current and available provider community-dedicated web pages:

The September Medi-Cal provider seminar is scheduled for September 15 – 16, 2020, at the Long Beach Marriott Hotel in Long Beach, California. Providers can access a class schedule for the seminar by visiting the Provider Training web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the California MMIS Fiscal Intermediary, conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

• Changes to Medi-Cal billing


• Basic and advanced billing issues


• Provider-specific billing questions


• Specialty subject matter such as Home Health Agencies (HHA) and Home & Community-Based Services (HCBS), Hospice Care, Medi-Cal Resources 101 and Family Planning, Access, Care and Treatment (Family PACT) Program

Providers must register by August 28, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After August 28, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web page of the Medi-Cal Provider website.

Wi-Fi will not be provided at the seminar. Please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. To contact the regional representative for your area, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a regional representative.

Providers are encouraged to bookmark the Provider Training page and refer to it often for current seminar information.

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.