The California Department of Managed Health Care (DMHC) today directed health plans regulated by the Department to remove administrative burdens on hospitals during the COVID-19 surge. This includes directing plans to take immediate steps to reduce or remove unnecessary barriers to the efficient admission, transfer, and/or discharge of health plan enrollees.
“Hospitals and providers are on the frontlines of California’s battle in fighting the COVID-19 pandemic,” said DMHC Director Mary Watanabe. “As California experiences a historic surge in the number of COVID-19 cases, the number of people being treated in hospital intensive care units is increasing and expected to continue to increase over the coming weeks. Health plans must remove unnecessary administrative barriers to help hospitals quickly respond to the unfolding crisis and enable hospital staff to provide the most efficient care possible to seriously ill patients.”
Health plans must report to the DMHC the steps they are taking to support hospitals in removing barriers to providing efficient care during this unprecedented time, which could include the following, among other actions:
Waiving prior authorization requirements or providing blanket pre-authorizations in certain circumstances. Increasing the number of health plan staff available to respond to hospitals’ requests to admit, transfer or discharge plan enrollees. Working with durable medical equipment suppliers, pharmacies, and other suppliers to ensure they are available to quickly provide needed equipment, medications and services to plan enrollees who are being discharged from a hospital.
The DMHC has also enacted new reporting requirements for health plans to ensure plans are sufficiently supporting providers to acquire COVID-19 supplies, such as Personal Protective Equipment (PPE), to safely deliver services to plan enrollees.
Providers experiencing issues with receiving these supports from their contracted health plan, can reach out to the DMHC for assistance at 1-877-525-1295 or by email at providercomplaintunit@dmhc.ca.gov.
Health plan enrollees having trouble accessing needed health care services or treatment, should first contact their health plan at the member services phone number on their health plan member card. Their health plan will review the grievance and should ensure the enrollee is able to timely access medically necessary care. If the enrollee does not agree with their health plan’s response, they should contact the DMHC Help Center at www.HealthHelp.ca.gov or by calling 1-888-466-2219. The enrollee should contact the DMHC immediately if they are facing an urgent issue.