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What's New

DMHC Guidance to Health Plans on Continued Coverage of COVID-19 Testing

Health plans must continue to cover certain COVID-19 testing for their enrollees pursuant to federal law. The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security Act (CARES Act) continue to require plans to cover COVID-19 diagnostic testing, regardless of whether enrollees access such tests through in- or out-of-network providers. Health plans may not require any type of prior authorization for testing and may not impose medical management/utilization management criteria on testing.

DMHC APL 21-016 – Continued coverage of COVID-19 diagnostic testing

DMHC Guidance to Health Plans on COVID-19 Vaccine Prioritization

Following guidance issued by the California Department of Public Health (CDPH), the DMHC issued an All Plan Letter (APL) to ensure health plans take all appropriate steps to help enrollees at the very highest risk receive COVID-19 vaccinations in a timely and efficient manner. Health plans should coordinate with their contracted health care providers to engage in outreach to enrollees at the very highest risk to ensure those enrollees are aware they are eligible to receive COVID-19 vaccinations and how the enrollees can obtain vaccinations.

On February 12, 2021, CDPH issued a Provider Bulletin (“Provider Bulletin”) regarding vaccine prioritization for individuals deemed to be at the very highest risk to get very sick from COVID-19 either because the individual has one or more enumerated severe health conditions and/or a developmental or other significant, high-risk disability. On March 11, 2021, the CDPH issued guidance to the public regarding how people at the very highest risk, as described in the Provider Bulletin, can gain access to COVID-19 vaccinations beginning March 15, 2021.

DMHC APL 21-012 - COVID-19 Vaccine Prioritization for Individuals with High-Risk Health Conditions and/or Disabilities

DMHC Finds Acquisition of HAI-CA and MHSC’s indirect parent, Magellan Health, Inc. (Magellan) by Centene, Inc. (Centene) to be a “Major Transaction or Agreement”

The DMHC finds the acquisition of Human Affairs International of California (HAI-CA) and Magellan Health Services of California, Inc. – Employer Services (MHSC) and MHSC’s indirect parent, Magellan Health, Inc. (Magellan) by Centene, Inc. (Centene) to be a “major transaction or agreement” under Health and Safety Code section 1399.65. Upon due consideration, the Department determined that the specific facts of this change of control meet criteria set out in Section 1399.65, subdivision (g)(1). Accordingly, the change of control proposed through the Notices is a major transaction or agreement, and a public meeting and independent analysis is required as set forth in Section 1399.65, subdivisions (a)(4) and (c).

DMHC Guidance to Health Plans on COVID-19 Testing

On February 26, 2021, the federal Centers for Medicare & Medicaid Services (CMS), in conjunction with the Department of Labor and the Department of the Treasury, issued new guidance making it easier for enrollees to obtain diagnostic COVID-19 testing and clarifying when health plans must cover such testing for their enrollees.

The new federal guidance clarifies that health plans must cover COVID-19 diagnostic testing for all health plan enrollees by any provider with no cost-sharing. The DMHC issued an All Plan Letter (APL) to health plans providing an overview of the new federal guidance, and explaining how the federal guidance and the DMHC’s emergency regulation regarding COVID-19 testing work together to ensure enrollees have ready access to COVID-19 testing at no cost to the enrollee.

Additionally, the DMHC issued a Consumer Fact Sheet on COVID-19 Testing to help clarify the requirements under the new federal guidance.

Consumer Fact Sheet on COVID-19 Testing (March 10, 2021)

DMHC APL 21-011 – New Federal Guidance Regarding COVID-19 Testing (March 10, 2021)

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 Emergency Regulation on COVID-19 Testing

DHCS COVID-19 Virus and Antibody Testing Guidance

DMHC Takes Action to Ensure Health Plans Comply with California's Mental Health and Substance Use Parity Law

The California Department of Managed Health Care (DMHC) today issued guidance to ensure health plans comply with amendments made to California's mental health parity law enacted under Senate Bill (SB) 855, authored by Senator Scott Wiener and signed by Governor Gavin Newsom last year.

"The DMHC is committed to ensuring Californians can access quality mental health and substance use disorder services. This is especially critical right now as people are dealing with the COVID-19 pandemic that has no doubt had an impact on the mental health of many," said DMHC Director Mary Watanabe. "This new law strengthens California's mental health parity statute and will help improve access to quality mental health and substance use disorder services."

Press Release

DMHC APL 21-002 - SB 855, Mental Health and Substance Use Disorder Coverage

DMHC Directs Health Plans to Cover COVID-19 Vaccines with No Cost-Sharing to Enrollees

The California Department of Managed Health Care (DMHC) issued guidance reminding health plans that all qualified, approved COVID-19 vaccines must be provided with no cost-sharing for health plan enrollees, regardless of whether the enrollee receives the vaccine from an in-network or out-of-network provider.

"As we begin to enter this new phase of the pandemic with vaccines becoming available, the DMHC is reminding health plans they must cover the cost of COVID-19 vaccines," said DMHC Director Mary Watanabe. "It is critical that all Californians have access to a safe COVID-19 vaccine to help protect their health. Financial challenges should not and will not get in the way of getting protection from COVID-19."

Press Release

Fact Sheet

DMHC APL 20-039 – Health Plan Coverage of COVID-19 Vaccines

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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