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Requirements and Procedures for Emergency Medi-Cal Provider Enrollment
The Department of Health Care Services (DHCS) is establishing Medi-Cal provider enrollment
requirements and procedures for providers seeking enrollment in order to assist Medi-Cal
beneficiaries with the national COVID-19 public health emergency. Effective for dates of service on or
after March 1, 2020, providers may apply for enrollment in the fee-for-service Medi-Cal program using
the streamlined enrollment procedures outlined below.
In accordance with Welfare & Institutions (W&I) Code Section 14043.75(b) and as authorized by the
Section 1135 waiver granted by the Centers for Medicare and Medicaid Services (CMS), the Director
is establishing requirements and procedures to suspend certain provider enrollment requirements to
facilitate greater beneficiary access to care and enable reimbursement for medical services provided
during the national COVID-19 public health emergency.
During the approved Section 1135 waiver period, DHCS will streamline the enrollment of these
providers and will apply the flexibilities granted by CMS statewide.
DHCS will deny enrollment if a provider is found on any exclusionary database. Providers who enroll
using this method will not be subject to the following requirements: submission of an application fee,
designation of screening levels and submission of a completed Medi-Cal Provider e-Form Application,
which includes a completed Medi-Cal Disclosure Information Section and Medi-Cal Provider
Agreement. Additionally, 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 as the
waiver permits providers located outside of California to provide care to Medi-Cal beneficiaries and be
reimbursed for those covered services. Moreover, DHCS will waive requirements such as the
following for both in-state and out-of-state providers: application fees required by Title 42 of the Code
of Federal Regulations (CFR) Section 455.460, screening levels pursuant to 42 CFR 424.518,
provider agreements required by 42 CFR 431.107, disclosure statement required by 42 CFR 455.104,
and in-state licensure requirements pursuant to 42 CFR 455.412.
Providers who successfully enroll using the procedures listed will be granted enrollment for only 60
days, retroactive to March 1, 2020.
Please note the 60-day emergency enrollment period may be extended in 60-day increments, in
accordance with the Section 1135 waiver. Should the waiver period be extended, no further action will
be required on behalf of the approved provider.
Providers who wish to enroll following the completion of the 60-day emergency enrollment period and
conclusion of the Section 1135 waiver will be required to submit a complete application package for
their provider type and meet all program requirements.
