COVID-19 Uninsured Group Program Off-Premise Flexibilities

October 21, 2021

Presumptive Eligibility (PE) providers may complete COVID-19 Uninsured Group Program 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 COVID-19 Uninsured Group Program application (MC 374) off the premises outside of the hospital or clinic setting. Paper COVID-19 Uninsured Group Program applications completed off the premises must be given to the PE provider for online submission through the COVID-19 Uninsured Group Program Application Portal. Instructions on how to access and navigate the COVID-19 Uninsured Group Program Application Portal can be found in the COVID-19 Uninsured Group Program Application Portal User Guide.

Only employees registered under a hospital’s or clinic’s National Provider Identifier (NPI) who have completed the PE Provider Computer Based Training may submit determinations through the COVID-19 Uninsured Group Program Application Portal.

Note: COVID-19 Uninsured Group Program coverage begins on the day in which the determination is made via submission through the COVID-19 Uninsured Group Program Application Portal. For activation of real-time benefits, it is important that all paper applications completed off the premises of hospitals and clinics be given to the PE provider daily for online submission into the COVID-19 Uninsured Group Program Application Portal immediately.

A 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 COVID-19 Uninsured Group Program requirements apply, whether the determination is made at a hospital or off-site.

PE providers/employees are not permitted to delegate to non-hospital staff the authority to make eligibility determinations or use of the COVID-19 Uninsured Group Program Application Portal. Whether at the hospital or off-site, third-party vendors, contractors, subcontractors or county owned/operated clinic employees are not permitted to make determinations or use the COVID-19 Uninsured Group Program Application Portal.

If PE providers choose to use third-party vendors, contractors or subcontractors, the PE providers must complete the PE Provider Assistor Form (DHCS 7011) and keep one on file. PE providers may use third-party vendors, contractors or subcontractors to staff PE operations by staffing welcome desks, meeting with applicants and helping them complete the paper version of the COVID-19 Uninsured Group Program Application. However, third-party vendors, contractors or subcontractors are not permitted to make the determinations or use the COVID-19 Uninsured Group Program Application Portal.

Questions

Questions concerning the COVID-19 Uninsured Group Program should be sent to COVID19Apps@dhcs.ca.gov.