• Golden State Advocates Eligibility

Golden State Advocates Eligibility: Response to COVID-19

Updated: Apr 10



The COVID-19 national emergency affects patients, organizations, and communities in significant ways. Not only is our physical health threatened, but there are risks to emotional and financial health as well.


It is important to address the fact that in addition to health concerns, many people are now unemployed and uninsured because of this crisis. These patients still need access to care and health benefits.


Fortunately, our patient advocates can continue helping patients obtain benefits (including COBRA) during this challenging time. They have been categorized as essential staff and are working on-site with patients to assist them in acquiring coverage and alternative funding sources for their medical bills.

All of us at Golden State Advocates Eligibility would like to express our appreciation for everyone in the healthcare industry on the front lines of this crisis, including each one of our patient advocates. You are making a critical difference in the lives of patients, whether it be in the form of physical care, financial assistance, or countless other types of support.


Thank you for all of the sacrifices you make in order to keep patients and communities throughout California safe and healthy!


Important Updates From CMS

The Centers for Medicaid and Medicare Services (CMS) issued emergency blanket waivers in response to COVID-19. These blanket waivers have a retroactive effective date of March 1, 2020 until the end of the emergency declaration.


We’d like to point out a few changes in particular, which we’ve pulled from the CMS document, COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers:


3-Day Prior Hospitalization Waiver for SNF placement

  • “CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19.”

  • “For certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).”


CAH Length of Stay Waiver

  • “CMS is waiving the requirements that CAHs limit the number of beds to 25, and that the length of stay be limited to 96 hours under the Medicare conditions of participation for number of beds and length of stay at 42 CFR §485.620.”


California’s Approved Waivers

CMS has approved certain Medicaid 1135 Waiver Requests made by the State of California. Here are some highlights from the approval statement:

  • Waives or modifies “the state plan prior authorization requirements and processes for benefits administered through the fee-for-service delivery system.”

  • Extends “pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.”

  • Allows flexibility for “scheduling of Medicaid fair hearings and issuing fair hearings decisions during the emergency period.”

  • “California may reimburse otherwise payable claims from out-of-state providers not enrolled in California Medicaid program” if certain criteria are met.

  • “If a certified provider is enrolled in Medicare or with a state Medicaid program other than California, California may provisionally, temporarily enroll the out-of-state provider for the duration of the public health emergency in order to accommodate participants who were displaced by the emergency.”

  • Allows “California to enroll providers who are not currently enrolled with another SMA or Medicare” if the state meets certain minimum requirements.

  • Approves “California’s request to temporarily cease revalidation of providers who are located in California or are otherwise directly impacted by the emergency.”

  • “These provider enrollment emergency relief efforts also apply to the Children’s Health Insurance Program (CHIP) to the extent applicable.”

You can find the full text of approvals for California waiver requests here.

Please contact us with questions and concerns or for more information. We are here to support you during this difficult time and to help you navigate these new regulatory flexibilities. Together we will make it through this crisis while minimizing its financial impact on your patients, their families, your organization, and your community.

402 W Broadway

Suite 400

San Diego, CA 92101

(619) 595-3154

info@goldenstateadvocates.com

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