April 3, 2020
The Department of Health Care Services (DHCS) continues to closely monitor the emerging COVID-19 pandemic, and encourages EWC providers to stay updated on COVID-19 developments. As the number of confirmed COVID-19 cases in California rises, it is critical that EWC providers assess their office policies and follow recommended safety procedures and protocols from the federal Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH) to help prevent the spread of the virus.
EWC PCPs should share current COVID-19 information and discuss preparedness strategies with their staff. To enhance the health and safety of EWC PCP offices, DHCS encourages providers to adhere to the CDC and CDPH recommendations to prepare for COVID-19. Some helpful preparedness strategies include but are not limited to:
- Screen patients and visitors for symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing) before entering your healthcare facility. Providers can refer to the CDC’s Guidelines for patient testing and Infection Prevention and Control Recommendations for more information.
- Ensure proper use of personal protection equipment (PPE)
Healthcare personnel who come in close contact with confirmed or possible patients with COVID-19 should wear the appropriate personal protective equipment.
- Encourage sick employees to stay home
Personnel who develop respiratory symptoms (e.g., cough, shortness of breath) should be instructed not to report to work. Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
- Encourage adherence 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 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.
EWC PCPs can also find helpful resources to download, print, and display in their clinics and offices to educate their patients on preventive best practices and to enhance awareness of COVID-19. These resources are available in select threshold languages. Buttons and badges, videos, and news links can also be found on the Communications Resources page of the CDC website.
Please note that if you suspect a possible COVID-19 case, DHCS asks that you please report it immediately to your local health jurisdiction.
EWC Client Enrollment and Re-Certification
To slow the spread of COVID-19, during this emergency, EWC providers may temporarily enroll and recertify clients through telephonic modalities. Please note that these temporary client enrollment and re-certification flexibilities are only in place during the COVID-19 emergency, and will end upon termination of the public health emergency.
During the telephonic communication, providers may complete the Recipient Application form (DHCS 8699) on behalf of the applicant/client. EWC PCP staff should perform the following steps:
- Obtain verbal consent from the client and note, “Per COVID-19 Protocol, information and consent captured verbally by “(provider or designee’s name)” in the signature line 73 and include the date on line 74 of page.6.
- Complete each field of the application, on behalf of the client, based on the applicant/client’s verbal response/consent.
- Sign and date the witness field of the EWC eligibility paperwork to confirm eligibility on lines 71, 72, 75 and 76 on page 6.
- Sign and date lines 17-19 on page 10.
- Place and maintain a copy of the application in the client’s medical file.
Due to the nature of telephonic modalities, the EWC provider must arrange for the client to receive their identification card along with pages 1, 2 and 3 of the application. To ensure clients have continued access to EWC covered services, but also to adhere to local executive orders for sheltering in place. PCP staff must receive the client’s consent to mail their identification card and application to them, and confirm the address. EWC PCP may also fax or e-mail a copy of the identification card to the referral provider(s) along with the referral, so the referral providers can verify enrollment.
Breast and Cervical Cancer Screening and Diagnostic Services
As part of routine care, breast and cervical cancer screening for non-essential issues may be postponed and reestablished once the COVID-19 outbreak is contained.
EWC PCPs may utilize existing telehealth and virtual/telephonic communication modality policies as alternatives for delivering EWC 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 the DHCS notice on non-essential-essential procedures on the Medi-Cal COVID-19 website.
- Please refer to DHCS’ existing policies relative to telehealth, which are outlined in the Medi-Cal Provider Manual: “Medicine: Telehealth” section.
- The telehealth Frequently Asked Questions document is posted to DHCS’ website.
Management of EWC clients with abnormal breast and cervical cancer screening and/or diagnostic tests require case-by-case review, and the approach and clinical decisions should be based on medical necessity and should not negatively affect the client’s health. DHCS expects that EWC PCPs will continue to utilize tracking protocols to ensure that clients with abnormal results receive timely and appropriate care.
Further guidance can be found on the American Society for Colposcopy and Cervical Pathology (ASCCP) website, where they recently released important “Interim Guidance for Timing of Diagnostic and Treatment Procedures for Patients with Abnormal Cervical Screening Tests” in light of the current unprecedented COVID-19 pandemic.
For additional COVID-19 information and resources, we encourage you to review the following resources: