CHA News Article

DHCS Updates Recent Policy Changes to HPE Program
Changes relate to requirements for hospital-owned and county-owned clinics conducting presumptive eligibility

The California Department of Health Care Services (DHCS) has announced updates to recent policy changes to the Hospital Presumptive Eligibility (HPE) program, following approval by the Centers for Medicare & Medicaid Services of the HPE State Plan Amendment (SPA). According to DHCS, its prior guidance contained incomplete information, and the new updates will be effective June 22.

Hospital-Owned Clinics
Approved HPE providers who own clinics listed on their hospital license will be able to expressly indicate whether their hospital-owned clinic(s) may also make HPE determinations.

Hospitals that wish to conduct HPE in their hospital-owned clinics must submit a completed new HPE Program Provider Election Form and Agreement (DHCS 7012) with the marked choice to permit the hospital-owned clinic(s) to make HPE determinations, even if the hospital is already conducting HPE in their hospital-owned clinic under an existing DHCS Form 7012.

Hospitals that wish to update information on their existing DHCS Form 7012 must submit an updated DHCS Form 7012 by Sept. 1. Until the form is submitted, those hospital-owned clinics will continue to be permitted to participate as an approved HPE provider.

HPE providers must take full responsibility for permitting their hospital-owned clinic(s) to participate in the program and must adhere to the rules below and in DHCS Form 7012:

  • The applying hospital is responsible for HPE determinations made at the participating clinics.
  • All HPE determinations must be made by HPE-approved hospitals or hospital-owned clinic employees who are HPE trained and adhere to all program rules and guidelines.
  • The applying hospital must maintain a current list of all HPE-trained hospital employees conducting determinations at the hospital and clinic locations.
  • If the applying hospital’s clinic has a different National Provider Identifier (NPI) than the applying hospital, the following additional information must be provided for the hospital-owned clinic(s):
    • Clinic(s) business name;
    • Clinic(s) NPI;
    • Either the clinic(s) federal employer ID number, taxpayer identification number or Social Security number; and
    • Clinic(s) business address

County-Owned/Operated Clinics
Approved HPE county providers may permit their county-owned/operated clinic(s) to assist with gathering HPE application information according to the rules. The applying county hospital agrees to take full responsibility for permitting county-owned/operated clinic(s) to assist with gathering HPE Medi-Cal application (DHCS Form 7022) information and must adhere to the rules below and in DHCS Form 7012:

  • All HPE determinations must be made by approved HPE county-owned hospital employees.
  • All county-owned/operated clinic employees who assist with gathering HPE information must adhere to confidentiality rules.
  • The applying county hospital must maintain a current list of all county-owned/operated clinics permitted to assist in HPE.
  • The applying county hospital must maintain a current list of HPE-trained county hospital employees conducting HPE determinations in county-owned/operated clinics.

In mid-June, DHCS will announce the release of new and updated HPE forms via its ACA Hospital PE Program website. The approved HPE SPA is attached.

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