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What's New

Financial Solvency Standards Board Meeting

The Department of Managed Health Care (DMHC) invites you to the Financial Solvency Standards Board (FSSB) Meeting to be held on August 19, 2020, beginning at 10 am. The meeting will be conducted exclusively through videoconference and teleconference.

Members of the public may participate in the meeting by Zoom Video or Conference Call Number: (877) 853-5757, Meeting ID: 918 7047 5448, Password: 850835

For more information about this public meeting, please read the agenda or visit the Financial Solvency Standards Board webpage.

DMHC COVID-19 Testing Emergency Regulation

The DMHC filed emergency regulations with the Office of Administrative Law (OAL) earlier this month, which took effect on July 17. The regulation classifies COVID-19 testing as medically necessary urgent care for essential workers. The regulation specifies, during the relevant state of emergency, COVID-19 diagnostic testing is a medically necessary basic health care services for all essential workers, as defined, and prevents delays in testing and claims payment related to such individuals.

The regulation will have the benefit of enabling the testing of more Californians who have broad contact with the public or with vulnerable populations, or whose work environment does not allow social distancing. Increased testing of such individuals, including asymptomatic individuals with no proven exposure to COVID-19, will result in prompt identification of new COVID-19 cases. This will allow the affected individuals to take appropriate action to limit exposure of others to the virus, and stop the spread of COVID-19.

DMHC COVID-19 Testing Emergency Regulation

DMHC APL 20-028 - Emergency Regulation Regarding COVID-19 Diagnostic Testing

DMHC FAQ on COVID-19 Testing

DHCS COVID-19 Virus and Antibody Testing Guidance

DMHC 2019 Annual Report & Infographic

The Department of Managed Health Care 2019 annual report and infographic are now available online. Both of these documents highlight the DMHC’s activities during 2019 and include key statistics about the Department. 

2019 DMHC Annual Report2019 DMHC Infographic

DMHC Reminds Health Plans to Comply with California Nondiscrimination Requirements

The DMHC remains committed to protecting the health care rights of all Californians, regardless of their gender identity, sexual orientation, or English proficiency. The Department issued an All Plan Letter (APL) reminding health plans licensed in California that they must continue to comply with California law, which protects all Californians from discrimination based on, among other things, gender identity and sexual orientation. Likewise, California-licensed health plans must continue to comply with California’s requirements to provide enrollees with notice of the availability of free language assistance services in English and the top 15 languages spoken by Limited English Proficiency individuals in California.

DMHC APL 20-022 - Compliance with California nondiscrimination requirements

Chief Medical Officer Job Announcement

The Department of Managed Health Care (DMHC) is seeking a dynamic, creative, collaborative and consumer-oriented contracted Clinical Consultant to serve as the DMHC’s Chief Medical Officer (CMO). CMO will assist with ensuring health plan medical, behavioral health and administrative compliance with statutory and regulatory requirements in order to drive improvement in clinical outcomes for health plan enrollees and to improve the DMHC’s effectiveness.

For more information, please read this CMO Job Announcement. Interested candidates must submit required documents by December 31, 2020.

Financial Solvency Standards Board Meeting

Due to the COVID-19 Pandemic, the Department of Managed Health Care (DMHC) has cancelled the Financial Solvency Standards Board (FSSB) Meeting scheduled for May 13, 2020.

In lieu of the May 2020 FSSB Meeting, the DMHC will post important information the week of May 11, 2020 on the Financial Solvency Standards Board Webpage.

DMHC Directs Health Plans to Ensure Californians Can Access Necessary Medical Care Through Telehealth

The DMHC issued an All Plan Letter (APL) in March directing health plans to ensure Californians can access necessary medical care through telehealth when medically appropriate. This includes directing health plans to reimburse providers for care provided through telehealth at the same rate as in-person care and ensuring enrollee cost-sharing is not changed for telehealth services. Following several questions from plans and providers, the DMHC issued All Plan Letter (APL)  20-013 - Billing for Telehealth Services; Telehealth for the Delivery of Services with a Frequently Asked Questions (FAQ) document. This includes information on provider billing during the COVID-19 State of Emergency to decrease administrative burdens on providers and plans.

DMHC APL 20-013 - Billing for Telehealth Services; Telehealth for the Delivery of Services

DMHC FAQ - Telehealth During the COVID-19 State of Emergency

DMHC APL 20-009 - Reimbursement for Telehealth Services

DMHC Directs Health Plans to Waive Cost-Sharing for COVID-19 Testing

Under the direction of Governor Gavin Newsom, the Department of Managed Health Care (DMHC) issued an All Plan Letter directing all full-service commercial and Medi-Cal plans regulated by the Department to immediately reduce cost-sharing to zero for all medically necessary screening and testing for the novel coronavirus (COVID-19). This includes waiving cost-sharing for emergency room, urgent care or provider office visits when the purpose of the visit is to be screened and tested for COVID-19. The need for COVID-19 testing is based on medical necessity, a clinical determination made on a case by case basis by medical professionals.

DMHC All Plan Letter

CDPH Press Release

Assistance for Patients Impacted by the AKF Leaving California

The American Kidney Fund (AKF) has announced it is ending financial assistance funds for Californians in need. The following fact sheet includes information on alternative options patients can explore and how to get help with these other health coverage options.

English Fact Sheet

Spanish Fact Sheet

2018 Annual Report and Infographic

The Department of Managed Health Care 2018 annual report and infographic are now available online. Both of these documents highlight the DMHC’s activities during 2018 and include key statistics about the Department.

2018 DMHC Annual Report2018 DMHC  Infographic

CDPH COVID-19 Updates

DMHC COVID-19 Updates

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