March 27, 2020
Area(s) of Interest: Payor Issues and Reimbursement Public Health
The California Department of Health Care Services (DHCS) is suspending certain provider enrollment requirements to increase access to health care services for Medi-Cal enrollees. This will allow more physicians to see Medi-Cal patients and be paid for those services. The notice was released March 24, 2020, in accordance with California’s Section 1135 waiver that was recently approved by the Centers for Medicare and Medicaid Services (CMS).
Providers who successfully enroll using the expedited procedures will be granted enrollment for only 60 day, retroactive to March 1, 2020. Should the waiver be extended for approved providers, no additional action is required. Providers may treat Medi-Cal beneficiaries and be reimbursed for covered services even if they are located in another state or licensed to only practice in another state.
If physicians admitted through this 1135 waiver program wish to continue after the emergency enrollment period, they will be required to submit a complete application and meet all program requirements to continue Medi-Cal participation.
How to Apply
Providers that seek to enroll must meet the following modified enrollment requirements and procedures:
- Provider must have treated a Medi-Cal beneficiary who has been affected by the current national COVID-19 public health emergency
- Provider would submit a CROSSOVER ONLY application using the Provider Application and Validation for Enrollment (PAVE) system.
- The provider must email DHCS’ Provider Enrollment Division at: PEDEmergencyEnrollments@dhcs.ca.gov with their PAVE application ID. The email should include the provider’s attestation (see below).
- The provider must include a copy of their driver’s license or state-issued identification in their PAVE crossover only application.
Note: If the provider does not submit a signed attestation (see below) or email PEDEmergencyEnrollments@dhcs.ca.gov with their PAVE application ID then this application will be treated as a true “crossover only” application.
Although providers using this crossover only application, approved providers will be able to bill for all services appropriate to their provider type. DHCS is using the crossover application for emergency enrollment.
Applicants will be asked in PAVE to confirm that they are enrolled Medicare providers and they should answer “yes.” The crossover only application requires proof of enrollment as a medical provider. An applicant who is not a Medicare provider can upload their attestation instead.
After you have completed a crossover only application in PAVE please email this attestation to PEDEmergencyEnrollments@dhcs.ca.gov with your PAVE Application ID. Please note, the following attestation can be typed out in the email or sent as an attachment.
I Name of Provider , understand that approval of my application dependent upon the treatment that I provided to a Medi-Cal beneficiary who has been affected by the COVID-19 national public health emergency. By submitting this application I acknowledge that this attestation is incorporated into my application by reference. Attested to on Day , of Month , of Year .
(Printed name and title of person authorized to legally bind the applicant or provider)