CA-20-0024

This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new COVID-19 testing group; expand eligibility by disregarding income up to 138% FPL for certain individuals; expand Hospital Presumptive Eligibility (HPE) to certain groups and expand the number of HPE periods in a 12-month period to two HPE periods for certain groups; suspend cost-sharing for COVID-19 testing and treatment services; suspend enrollment fees, premiums, and similar charges for certain groups; allow physicians and other licensed practitioners (OLPs) to order Medicaid home health services; modify the rehabilitative services benefit in the Drug Medi-Cal State Plan to expand the uses for individual counseling visits; remove utilization controls on covered benefits to the extent such limits can’t be exceeded based on medical necessity; use telehealth by modifying the face-to-face requirement for State Plan benefits/services to be provided via all forms of telehealth, regardless of originating or distant site; adjust day supply or quantity limits for covered outpatient drugs; include non-legend acetaminophen-containing drugs, non-legend cough, and cold drugs that are covered outpatient drugs in the pharmacy benefit; and allow prior authorizations for medications to be expanded by automatic renewal without clinical review, or time/quantity extensions. This amendment also will add COVID-19 diagnostic tests and corresponding payment increases for these tests up to the corresponding Medicare level; increase current per diem rates by 10 percent to Nursing Facilities and ICF/DDs; modify the face-to-face requirement for virtual communications and allow for reimbursement as appropriate using HCPCS code G0071 at the Medicare rate; suspend requirements for face-to-face contact in the Drug Medi-Cal state plan program and treat non-face-to-face contacts as equivalent to face-to-face contacts; and pay for ancillary costs for Drug Medi-Cal services only.
Other temporary payment changes will allow the In-Home Supportive Services (IHSS) Individual Provider Rate to include payment for paid time off of IHSS providers related to COVID-19 sick leave benefits for a limited time period; and update the State-approved county governmental, contracted, and private individual provider rates fee schedule to reflect the additional sick leave mandated pursuant to the Emergency Paid Sick Leave Act. For the Drug Medi-Cal and Specialty Mental Health programs in the state plan, the amendment will increase interim rates by 100%, and remove charges as a limit in cost settlement; exempt the clinical lab COVID-19 testing procedure codes from the 10 percent payment reduction mandated by state law; and add Associate Marriage and Family Therapists/Associate Clinical Social Workers (AMFTs/ACSWs) as billable provider types in FQHCs/RHCs.