FAQs: Vulnerable Populations

What are clinical considerations for giving long-acting injectables (LAIs) during the COVID-19 public health emergency?

Since these antipsychotics need to be administered in person, planning can help assure continuity of treatment if a patient is uncomfortable coming to clinic. Here are some considerations from SMI Adviser:

  • Create a spreadsheet to make sure nobody falls through the cracks.
  • For patients who usually travel to a clinic, arrange for more local injections.
  • Check with pharmacies to see if they may be able to administer injections.
  • Set up and coordinate outreach with services such as visiting nurses, if possible.
  • Consider medication changes during the pandemic.
  • If appropriate, give a higher dose than the usual maintenance dose to provide a buffer in case the next injection is delayed.
  • As a last resort, family members with some medical background could be trained to give an injection.
  • If giving a LAI is not possible, temporarily prescribe oral medications again. (4/21)

My emergency department (ED) is overwhelmed. How is California’s homeless care law being enforced during this crisis? 

Due to the COVID-19 pandemic, the California Department of Public Health (CDPH) has taken the unprecedented step of suspending most hospital licensing requirements. The homeless patient discharge planning law is one of the requirements that is suspended until March 1, 2021. (9/25)

How can we best communicate with EMS and others about prioritization of patients and alternate destinations?  

The California Emergency Services Authority (EMSA) has issued guidance  allowing EMTs and paramedics to transport patients to alternate destinations. The Local Emergency Services Agency (LEMSA) has to submit a written request to EMSA. You can alert your LEMSA about this option. (4/9)

What information about the Medi-Cal program is available for providers and program partners?

The Department of Health Care Services (DHCS) has posted a comprehensive web page of links, resources, and waiver information. (4/9)

For hospitals near California’s state prisons: when and how will prisons transfer sick inmates to hospitals? Will there be communication ahead of time?

According to California Correctional Health Care Services, only patients who require a higher level of care to prevent or reduce the risk of morbidity and mortality should be sent to hospitals. Those who can safely receive clinically appropriate care at the prison should not be sent out. Symptomatic but stable patients should not be sent to emergency departments or community hospitals. (9/25)

How can I help people experiencing homelessness find shelter during this time?

A regional or local Continuum of Care (CoC) — a planning body that coordinates housing and services funding for people experiencing homelessness — can help during this time to support the placement of unsheltered individuals and families. A list of local CoCs and contact information is available here, and more resources for providers and those experiencing homelessness are available here. (7/22)

May telehealth be used to place and release involuntary holds on individuals as per Welfare and Institutions Code (WIC) 5150, and are these services are billable to Medi-Cal?

According to DHCS, WIC 5150 evaluations may be performed by authorized providers face-to-face via telehealth as per WIC 5008(a). This may include releases from involuntary evaluation and treatment, as appropriate. These services are billable to Medi-Cal regardless of whether they are provided in person or through telehealth as long as the individual has Medi-Cal coverage for the service and all Medi-Cal requirements are met. That said, assessments required by WIC 5151 are to be completed “in person” and, as such, shall not be provided using telehealth. (4/27)

How can we help our patients with behavioral health needs during this time, including through telemedicine? Are there any new waivers or other rules we should know about?

DHCS has updated its website with new information related to behavioral health and COVID-19, including:

  • Flexibility for residential mental health facilities and for alcohol and other drug facilities
  • FAQs for mental health and psychiatric health facilities, narcotic treatment programs, and medication-assisted treatment via telehealth
  • Behavioral health services for formerly homeless persons under Project Roomkey (4/27)