UPDATE APRIL 28, 2020
This is an update to the alert published on March 20, 2020, California authorities issue wide range of COVID-19 rules and guidelineswhat was previously updated March 29, 2020 And April 10, 2020. Accordingly, these are developments that became public between April 10, 2020 and April 27, 2020.
This alert is part of a series of advisories, podcasts and webinars from Ropes & Gray covering a wide range of topics related to COVID-19. These resources can be found on our Coronavirus Resource Center.
EXECUTIVE ORDERS OF THE GOVERNOR
- Executive Decree N-55-20 (April 22, 2020). This executive order provides additional regulatory flexibilities for DHCS and Medi-Cal providers. The key elements are:
- Section 4 suspends the requirement that in-person signatures and printed names be collected upon delivery of certain medications covered by Medi-Cal.
- Section 6 allows DHCS to issue COVID-19-related bulletins or guidance on provider registration without notice or a public hearing.
- Section 11 suspends the regulation that requires a patient’s physical signature to receive psychiatric medication.
- Section 13 authorizes DHCS to delay or temporarily suspend, and may permit Medi-Cal managed care plans to delay or temporarily suspend, audit or review activities. Note that this requires additional actions by DHCS or Medi-Cal managed care plans to implement.
OTHER NEWS FROM THE GOVERNOR’S OFFICE:
- Governor Newsom announcement on April 22, 2020, it plans, in conjunction with other Western States Compact states, to allow hospitals to resume certain elective surgical procedures, including heart valve replacement and tumor removal, as well as important services preventive measures, such as colonoscopies.
GUIDELINES FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH (“CDPH”)
- Resumption of deferred and preventative health care in California (April 27, 2020). This letter establishes general considerations and guidelines for hospitals and clinics as they prepare to resume preventive care and other elective medical procedures. He emphasizes the need to consult with local public health officers in neighboring counties, as areas across the state will operate on varying timelines.
- Draft Letter on COVID-19 Crisis Care Guidelines (April 23, 2020). This letter establishes a framework for prioritizing COVID-19 testing and treatment when resources are limited or insufficient to meet the medical needs of all patients. The letter says it is in draft form and revisions are being considered to ensure the guidelines “reflect (California’s) values as a state.” The letter further states that a revised version will be released soon.
- CDPH originally released crisis care guidelines on April 20, 2020, but has since removed the April 20 document and replaced it with the April 23 draft.
- Expanding Access to Testing: Updated Interim Guidance on Prioritizing Laboratory Tests for COVID-19 (April 19, 2020). This letter contains guidelines for prioritizing COVID-19 testing, including four tiers of categories of individuals based on testing needs. Priority individuals include hospitalized patients, symptomatic health care workers, individuals identified for testing through public health contact investigations and disease control activities in high-risk settings, and those living in collective accommodation or correctional facilities.
CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE (“DMHC”) GUIDELINES
DHCS REQUESTS TO CMS FOR STATE PLAN AMENDMENTS
- Provision of Care in Alternative Settings, Hospital Capacity, and General Section 1135 Waiver Flexibilities for Medicare and Medicaid Enrolled Providers in Relation to COVID-19 (April 22, 2020). This guidance clarifies the new Section 1135 waivers and replaces the April 10, 2020 and March 27, 2020 guidance. It allows:
- Inpatient facilities, including nursing facilities, intermediate care facilities for persons with intellectual and developmental disabilities, psychiatric residential treatment facilities, and inpatient care facilities, must be fully reimbursed for services rendered in an unlicensed facility, provided that CDPH has assessed that the facility meets minimum standards;
- Coverage of care in a qualified care establishment for beneficiaries who have not met the three-day prior hospitalization condition;
- Critical access hospitals must have more than 25 beds;
- Acute care hospitals will house acute care inpatients in excluded partial separate units, where beds in the separate unit are appropriate for acute care inpatients;
- Acute care hospitals excluded from separate part inpatient psychiatric units, in order to relocate inpatients to an acute care bed and unit; And
- Medical ambulance providers must transport to alternate locations and charge the standard ambulance transportation rate.
ORDER FROM THE CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS
- Order waiving nurse practitioner supervision requirements (April 14, 2020). This order waives Business and Professions Code § 2836.1(e), which prohibits surgeons and physicians from supervising more than four nurse practitioners at a time when furnishing or ordering drugs or devices. This order took effect immediately and will remain in effect for 60 days from issuance.
DHCS MEDICAL GUIDANCE
- Waiver of patient signature requirement on file for mailed or delivered prescriptions (April 24, 2020). This waiver allows any form of delivery service tracking or electronically documented proof of delivery to suffice as proof of receipt of a drug or device by a beneficiary or authorized representative of Medi-Cal and Family PACT. It also states that carriers can drop off the package discreetly at the door if the recipient does not respond at the time of delivery.
- New presumptive eligibility for COVID-19: Help Code – V2 (Updated April 23, 2020). This guidance introduces the new Presumptive Eligibility Assistance Code, V2, which allows all medically necessary services related to COVID-19 to be provided free of charge to individuals, regardless of insurance coverage, disability status immigration or income. These services will be paid up to the maximum reimbursement rate of the paid service delivery system.
- Novel coronavirus (COVID-19) information for medical transportation providers (April 22, 2020). This letter announces that, during the public health emergency, DHCS is waiving the prescription requirement for eligible beneficiaries to use non-emergency medical transportation. However, a treatment authorization request is still required and the provider must include the statement “Patient affected by COVID-19” in the Miscellaneous Information field when requesting reimbursement. Additionally, ambulances can transport a patient to any destination capable of providing treatment in a manner consistent with state and local EMS protocols.
- New CPT Codes for COVID-19 Antibody Tests (April 17, 2020). This guide announces the three AMA CPT codes for reporting and tracking COVID-19 antibody tests. These codes are covered by Medi-Cal benefits.
- Guidelines for the subacute medical care unit during the COVID-19 pandemic (April 10, 2020). This policy and procedure letter informs providers participating in the Subacute Medical Care Program of the following flexibilities, which may be sought by providers by submitting a Subacute Medical Flexibility Request, which must be approved before taking effect:
- Suspension of continuing education requirements;
- Coverage of certified nursing assistant (“CNA”) hour shortages with excess authorized staffing hours, provided that the CNA staffing hour shortages and excess authorized staffing hours occur on same day and authorized excess staffing hours are used to provide CNA care; And
- Reduced number of required service coordinator/social worker hours in subacute pediatric units, provided beneficiaries are not negatively affected.
COUNTY UPDATES
- On April 27, 2020, six Bay Area counties and one city issued a Press release announcing an extension of the stay-at-home order until May 31. Public health plans to issue official orders later this week. The areas concerned are:
- Alameda County
- The city of Berkeley
- Contra Costa County
- Marin County
- San Mateo County
- San Francisco County
- Santa Clara County
The California government’s response to the COVID-19 pandemic is evolving rapidly. Please revisit this page for periodic updates.
