Emergency Drug Benefit Claim Submission To End June 29, 2007

The California Legislature enacted and Governor Arnold Schwarzenegger signed Assembly Bill (AB) 813, which established an Emergency Drug Benefit (EDB) program for individuals dually eligible for Medicare and Medi-Cal. The EDB program allowed Department of Health Care Services (DHCS) to continue covering the cost of medications for dual eligibles who were unable to obtain their medications from the Medicare Part D program for dates of service from May 17, 2006 through January 31, 2007.

Though not required to do so, DHCS is allowing the submission of retroactive claims through June 29, 2007. DHCS has determined that this five-month period (January 31, 2007 through June 29, 2007) is sufficient for providers to submit claims for drugs dispensed prior to February 1, 2007. Therefore, effective June 30, 2007, DHCS will begin denying all EDB claims for dates of service prior to February 1, 2007.

For detailed instructions on the appropriate uses of the EDB program and how to submit claims, view the DHCS Emergency Drug Benefit for Dual Eligible Updated Information bulletin.