Medi-Cal
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Medi-Cal managed care coverage of inpatient psychiatric facilities
DHCS issued this letter to clarify managed care plan requirements to cover inpatient psychiatric services. Plans are supposed to cover medically necessary covered services when contacted by specialty mental health providers post-admission to psychiatric inpatient hospitals. The letter…
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Edits to Fluctuating income section of Pre-populated MC 216 form
DHCS updated the MC 216 Pre-Populated Renewal form to replace a question about fluctuating income. The forms are available in all threshold languages. DHCS MEDIL I 15-14 (5/19/15).
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More guidance about Medi-Cal application batches for Rivera, Covered CA transition
DHCS provided an update on the batching process for dealing with processing Medi-Cal applications in a more timely manner in the wake of the Rivera decision. DHCS was to issue a Notice of Inaction mailer for individuals who…
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Coverage of anesthesia services for Medi-Cal dental services
DHCS issued instructions on the coverage of IV sedation and general anesthesia services in connection with dental services. Medi-Cal beneficiaries are entitled to dental services under IV sedation and general anesthesia when medically necessary in an appropriate setting. …
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Updated County instructions about verification of Social Security numbers and income
In July 2014, the Social Security Administration (SSA) announced the availability of SSA benefit verification letters and other SSA verification processes, via its My Social Security site. CDSS has now issued updated instructions (along with a few pointed…
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Counties must accept updated Medi-Cal beneficiary address information from health plans
DHCS has instructed counties that they must accept updated beneficiary contact information from managed care plans. If the beneficiary approves of the plan doing this, the county must update within 2 days. If the beneficiary has not approved,…
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Counties must send back ALJ decisions retroactively terminating Medi-Cal eligibility
The Chief ALJ has determined that hearing decisions that order retroactive termination of Medi-Cal eligibility were issued in error and should be returned to CDSS for correction. Should beneficiaries disagree with the corrected order, due process rights still…
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New Medi-Cal noticing requirements under Rivera
DHCS issued guidance about notice requirements for Medi-Cal applicants whose applications have not been processed within 45 days per the Rivera decision. These beneficiaries have a right to file an appeal and request a hearing when the Medi-Cal…
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2015 Statewide nursing facility Average Private Pay Rate
DHCS has updated the statewide average private pay rate (APPR) for 2015 to $8092. This is used to determine periods of ineligibility due to transfers of nonexempt personal property for less than FMV. DHCS ACWDL 15-17 (3/26/15).
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Resource materials for remote identity proofing proces
DHCS has issued guidance and resources materials on the remote identity proofing process for CalHEERS. The letter contains a guide compiling a number of job aids about the RIDP process, as well as two reference sheets to address…