Blue Shield of California announces fee schedule changes for some services

March 17, 2020
Area(s) of Interest: Public Health 

Gov. Gavin Newsom appeared with state health care leaders Tuesday afternoon to update Californians on the latest developments involving the state's COVID-19 outbreak. 

Newsom announced the state has applied for a new federal waiver to make it easier for patients to use telehealth services, to keep them out of the hospitals and make it easier to receive remote medical services. The California Medical Association (CMA) has been among the groups advocating for expanding telehealth as the state prepares to wrestle with a dramatic spike in COVID cases which can strain our hospital system. 

Earlier in the day, President Donald Trump streamlined federal privacy rules for telehealth. But state laws, which are more stringent than federal privacy laws, require additional waivers. Newsom thanked President Trump for his leadership on streamlining telehealth regulations, and expressed confidence that the state waiver would be approved quickly. 

“To get Californians the care they need during this crisis, we need to change how that care is delivered and communicated,” said Newsom. “By expanding our telehealth options we’re minimizing disruption to our health care system to prioritize care for those who need it most, while providing easier, more accessible options for other Californians seeking care.”

CMA CEO Dustin Corcoran was among those who met with Gov. Newsom for more than three hours Tuesday, and joined Newsom at the Office of Emergency Services for the Tuesday media briefing. 

The new waiver request includes the following:

  • Streamlined enrollment for health care providers, making it easier to meet the increased need for services and ensure they can be paid. 
  • Flexibility allowing providers to be paid for services at a quarantine site or other location where Medi-Cal care isn’t usually offered. 
  • Flexibility for telehealth and virtual communications to make it easier for providers to care for people in their homes. Specifically, flexibility to allow telehealth and virtual/telephonic communications for covered State plan benefits, including but not limited to, behavioral health treatment services, waiver of face-to-face encounter requirements for Federally Qualified Health Centers, Rural Health Clinics, and Tribal 638 Clinics relative to covered services via telehealth, allowance for reimbursement of virtual communication and e-consults for FQHCs, RHCs and Tribal 638 clinics and waiver of limitations around virtual/telephonic communications prior to or after an in office visit. 
  • Easing rules requiring prior authorization for certain services linked to COVID-19, as well as waiving various utilization controls on covered benefits. 
  • Permission to reimburse for “off-label” use of safe and effective medications that have shown promise in treating COVID-19, even if the normally required documentation of that use has not yet been published. 
  • Waiving the requirement for a three-day prior hospitalization for coverage of a skilled nursing facility stay to maximize hospital capacity. 
  • Changes to allow telephonic or live video interactions for individual with development disabilities. 
  • Recognition that COVID-19 testing and any medically necessary follow-up care should be considered as “emergency services” even if they do not occur in a hospital emergency room. These services would be free of cost to all Medi-Cal beneficiaries, even the small percentage whose income places them in a group that normally must pay a share of cost. 
  • Expenditure authority related to temporary housing for homeless, as necessary for quarantining, isolating, or treating individuals who test positive for COVID-19 or who have had a high-risk exposure and are thought to be in the incubation period. 
  • Expanding presumptive eligibility to people who are over 65 or disabled, allowing hospitals to quickly enroll them into Medi-Cal coverage.

Newsom also said the state was on the verge on securing sites for two "large hospitals" by Friday. one would be located in Northern California, the other in the Southern half of the state, though no specific locations were discussed. Newsom said state officials are preparing for various contingencies. On the low end is a scenario where about 5 % of those who eventually contract COVID-19 need to be hospitalized. The "worst case" scenario involves a 20 % patient hospitalization rate. Under those scenarios, the state would need an additional 4,000 -20,000 hospital beds. 

Newsom offered sobering reminders for parents as the overwhelming majority of California schools remain closed. "Don't anticiapte schools are going to open in a week. Don't anticipate in a few weeks," Newsom said.

CMA will continue to keep you updated on the COVID-19 outbreak and how providers can best deal with the unprecedented events surrounding this outbreak. For a full list of COVID-19 resources, please check cmadocs.org/covid-19, which will be updated daily.


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