Originally published March 18, 2020 and updated on April 30, 2020
The Department of Health Care Services (DHCS) continues to closely monitor the emerging COVID-19 situation and encourages Medi-Cal Indian Health Care providers to stay updated on COVID-19 developments. As the number of confirmed COVID-19 cases in California rises, it is critical that providers assess their respective policies and follow recommended general healthcare facility safety procedures and protocols from the federal Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH) to help prevent spread of the virus. Generally, Indian Health Care Providers are encouraged to adhere to the CDC’s recommendations, including but not limited to the following steps, to prevent the spread of illness:
- Avoid close contact with people who are sick.
- Cover your cough or sneeze with a tissue, then throw the tissue away in the trash.
- Avoid touching your eyes, nose, and mouth.
- Clean and disinfect frequently touched objects and surfaces.
- Stay home when you are sick, except to get medical care.
- Wash your hands often with soap and water for at least 20 seconds
Please note that in light of both the federal Health and Human Services (HHS) Secretary’s January 31, 2020 public health emergency declaration, as well as the President’s March 13, 2020 national emergency declaration, DHCS has requested flexibilities to the California State Plan from the Centers for Medicare and Medicaid Services (CMS).
The following Federal demonstration requests made by DHCS have been approved by CMS:
- First Wave of California 1135 Waiver Flexibilities Related to COVID-19:
- Temporarily Suspend Medicaid Fee-For-Service Prior Authorization Requirements: DHCS is authorized to waive or modify the state plan prior authorization requirements and processes for benefits administered through the fee-for-service delivery
- Extending Pre-Existing Prior Authorizations: DHCS is authorized to extend pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health
- State Fair Hearing Requests and Appeal Timelines: DHCS is authorized to temporarily delay scheduling of Medicaid fair hearings and issuing fair hearings decisions during the emergency
- Provider Enrollment: DHCS is authorized to temporarily enroll certain providers and to reimburse out-of-state providers not enrolled in California Medicaid program for the duration of the public health
- Provisions of Services in Alternative Settings: Certain facilities are allowed to be fully reimbursed for services rendered to an unlicensed facility (during an emergency evacuation or due to other need to relocate residents where the placing facility continues to render services).
For additional details please see the California 1135 Waiver approval letter.
In addition, the following demonstrations and State Plan Amendment (SPA) requested by DHCS are currently under review by CMS:
Indian Health Care providers should share current COVID-19 information and discuss preparedness strategies with their staff. To enhance the health and safety of Indian Health Care provider offices, DHCS encourages Indian Health Care providers to visit the webpages for CDC and CDPH for their recommended COVID-19 preparations. Some helpful preparedness strategies include but are not limited to the following:
Indian Health Care providers can also find helpful resources to download, print, and display in their clinics and offices to educate their patients on the best preventative-practices and to enhance awareness of COVID-19. These resources are available in select threshold languages on the Communications Resources page of the CDC website.
Indian Health Care Provider Operational Reminders
Indian Health Care Providers should be aware of the following Medi-Cal related information that may be of assistance in the provision of care for Medi-Cal patients potentially impacted by COVID-19:
- Out-of-Network Services: American Indian/Alaskan Natives enrolled in a Medi-Cal Managed Care Plan are eligible to receive services from out-of-network Indian Health Care Providers. Indian Health Care providers have the right to receive their applicable encounter rate, for the provision of covered services to American Indian/Alaskan Native enrollees, regardless of whether they participate in the network of a Managed Care Plan entity or not.
- Telehealth: Indian Health Care providers may utilize DHCS telehealth as an alternative modality for delivering covered services when medically appropriate, as a means to limit patients’ exposure to others who may be infected with COVID-19, and to increase provider capacity. Please refer to DHCS’ existing policies relative to telehealth, which are outlined in the following sections of the Medi-Cal Provider Manual: “Medicine: Telehealth,” Federally Qualified Health Centers/Rural Health Clinics, and Indian Health Services Memorandum of Agreement 638 Clinics. Please also refer to DHCS’ telehealth Frequently Asked Questions document on the public website.
- Billing Inquiries: For questions regarding Medi-Cal billing, please contact Telephone Service Center (TSC): 1-800-541-5555.
For additional COVID-19 information and resources, DHCS encourages you to review the following federal and state resources: