DMHC COVID-19 Response

safety tips: stay home, wash your hands, practice social distancing, cover your cough, call your doctor

COVID-19 is a new illness that can affect your lungs and airways. It's caused by a virus called coronavirus.

The DMHC is taking action to protect consumers’ health care rights and ensure a stable health care delivery system during this pandemic. The Department is working closely with state and local leaders, health plans, providers and other stakeholders in supporting actions to mitigate the spread and severity of COVID-19.

If you are a health plan enrollee experiencing a problem with your health plan, please visit the DMHC Help Center online or by calling 1-888-466-2219.

State Resources & Actions:

California COVID-19 Response

CDPH COVID-19 Updates

DHCS COVID‑19 Response​​​​

Health Care Coverage Options

If you do not have a source of health care coverage or have recently lost your employer-sponsored health care coverage, this fact sheet provides and an explanation of some options to gain health care coverage. Contact the specific programs for more information.

Coverage Options Fact Sheet in English

Coverage Options Fact Sheet in Spanish

Governor Newsom Issues Executive Order to Expand Telehealth Services

Governor Gavin Newsom signed an executive order to expand protections to medical providers as they amplify the use of video chats and similar applications to provide routine and non-emergency medical appointments in an effort to minimize patient exposure to COVID-19. The executive order allows health care providers to use video chats and applications to provide health services without risk of penalty, and aligns with federal Health and Human Services guidelines and waivers issued in response to COVID-19.

DMHC Actions:

DMHC COVID-19 Testing Emergency Regulation, APLs, FAQs and Fact Sheet

The DMHC emergency regulation regarding COVID-19 diagnostic testing took effect on July 17, 2020. 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.

Additionally, the DMHC has issued All Plan Letters on the implementation of the emergency regulation, a Frequently Asked Questions (FAQs) document, and a Fact Sheet to help clarify what individuals should do if they need a COVID-19 test.

DMHC COVID-19 Testing Emergency Regulation

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

DMHC APL 20-033 - Implementation of Emergency Regulation Regarding COVID-19 Diagnostic Testing

DMHC COVID-19 Testing Fact Sheet

DMHC FAQ on COVID-19 Testing

DHCS COVID-19 Virus and Antibody Testing Guidance

DMHC Extends Special Enrollment Period in Response to COVID-19

As the state of California is taking action to respond to the COVID-19 pandemic, the Department of Managed Health Care (DMHC) joined with Covered California and the Department of Health Care Services to make sure Californians have a ready path to health care coverage.

The DMHC provided guidance on March 21, 2020 to health plans on opening a special enrollment period  to offer individual health insurance coverage to all Californians as the state faces a surge in cases of COVID-19, the disease brought on by the new coronavirus. This will ensure consumers enrolling in the entire individual market in California will have access to coverage during the pandemic emergency. On July 31, 2020, the DMHC issued updated guidance extending the special enrollment period through August 31, 2020.

APL 20-029 Extension of Special Enrollment Period to August 31, 2020

APL 20-023 Extension of Special Enrollment Period in APL 20-010

APL 20-010 Special Enrollment Period; Coverage Effective Dates

DMHC Directs Plans to Ensure Continued Network Adequacy, Encourages Removing Burdens on Providers

The DMHC directed health plans with commercial lines of business to submit an informational filing explaining the steps the plan has taken, and/or will take, to ensure continued network adequacy. Health plans have an on-going duty to ensure they have adequate networks to provide enrollees with all medically necessary services in a timely and geographically appropriate manner. Providers, including medical and dental clinics and hospitals, report experiencing significant financial difficulties due to COVID-19, as patients have delayed receiving all but emergency and urgent medical services.

APL 20-020 – Ensuring Continued Network Adequacy and Removing Unnecessary Burdens on Providers

DMHC Extends Phase-Out Period Related to Association Health Plans

Due to the COVID-19 state of emergency the DMHC is extending the end of the phase-out period through October 31, 2020. Beginning November 1, 2020, health plans may not renew large group coverage for small employers or individuals, regardless of the arrangement by which the small employer or individual purchased the coverage.

APL 20-019 – Association Health Plans: Extension of “Phase-Out” Period

DMHC Modifies 2020 Timely Access PAAS Start Date Due to COVID-19

The DMHC has modified the start date for the Timely Access Provider Appointment Availability Surveys (PAAS) for Measurement Year (MY) 2020 due to the COVID-19 pandemic. Health plans shall begin administration of the MY 2020 PAAS no earlier than August 1, 2020.

APL 20-018 – COVID-19 (OPM) Modification of Timely Access Provider Appointment Availability Surveys (PAAS) Timeframes

DMHC Extends Phase-In Period for General Licensure Regulation

The DMHC has extended the phase-in period under the General Licensure Regulation, adopted in 2019. The All Plan Letter extends the phase-in period through December 31, 2020 due to the uncertainty caused by the COVID-19 pandemic. The DMHC has also updated the guidance document to reflect the extended phase-in period.

DMHC APL 20-017 – General Licensure Regulation: Extension of Phase-In Period For Expedited Exemption Requests

Revised General Licensure Guidance (updated April 16, 2020)

DMHC, CDA Provide Guidance on Supporting Older and At-Risk Enrollees During COVID-19

The DMHC and California Department of Aging (CDA) issued an All Plan Letter (APL) to offer reminders and resources to help health plans serve enrollees who are aged 60 and older, or have high-risk health conditions during the COVID-19 emergency response. During California’s stay-at-home order, older Californians and other at-risk adults will likely need the help of their health plans, as well as family, friends, neighbors and community, to help them maintain basic needs like groceries and prescriptions, and much-needed social interaction and connection.

DMHC APL 20–016 — Preventing Isolation and Supporting Older and other At-Risk Individuals to Stay Home and Stay Healthy During COVID-19 Efforts

DMHC Provides Temporary Extension for Health Plan Filing Deadlines

In light of the COVID-19 State of Emergency, the DMHC has determined that select deadlines and requirements may be temporarily extended to give health plans additional time to comply. The extensions enumerated in the DMHC All Plan Letter (APL) shall be in effect until the California Governor declares the COVID-19 State of Emergency no longer exists or the DMHC notifies health care service plans that the extensions permitted in this APL are no longer in effect.

DMHC APL 20-015 – COVID-19 Temporary Extension of Plan Deadlines

DMHC and OSG Offer Reminders & Resources to Help Mitigate Negative Health Outcomes

DMHC and the Office of the Surgeon General (OSG) offer reminders and resources to help health care service plans serve enrollees and mitigate negative health outcomes to members due to the COVID-19 emergency. To mitigate negative secondary health outcomes, it is crucial that health care service plans and their providers continue to provide high-quality care to enrollees.

DMHC APL 20-014 – Mitigating Negative Outcomes

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 APL 20-032 – Continuation of Telehealth All Plan Letters

Guidance Relating to Non-Discrimination in Medical Treatment for Novel Coronavirus 2019 (COVID-19)

The Departments of Health Care Services (DHCS), Public Health (CDPH), and Managed Health Care (DMHC) continue to closely monitor and assess appropriate next steps as well as release guidance to ensure the safety of Medi-Cal beneficiaries, health plan enrollees, medical providers, and California communities in general.

The State of California understands that people with disabilities are concerned that medical providers might consider an individual’s disability status when determining which patients to treat if hospitals or other health care facilities experience a surge of patients needing life-saving care. This joint bulletin reminds health care providers and payers that rationing care based on a person’s disability status is impermissible and unlawful under both federal and state law.

DMHC Encourages Health Plans Practice “Social Distancing” Measures in Response to COVID-19

The Department of Managed Health Care (DMHC) issued an All Plan Letter encouraging health plans take actions to facilitate the delivery of health care services in a manner that decreases the need for in-person visits and practices “social distancing” measures to help slow the spread of COVID-19. This includes expanding health care delivery via telehealth and decreasing the need for in-person pharmacy visits.

DMHC All Plan Letter