DMHC Announces Health Equity and Quality Committee Meeting
The Department of Managed Health Care (DMHC) invites you to the Health Equity and Quality Committee Meeting to be held on July 13, 2022, beginning at 12 p.m. The meeting will be conducted exclusively through videoconference and teleconference.
Members of the public may participate in the meeting by Zoom Video or find your local number: https://us02web.zoom.us/u/kqf3XJG6J, Meeting ID: 856 1286 3882, Password: 310818
Persons who need assistance in order to participate in this meeting should, at least five business days prior to the meeting, contact DO.Admin.Support@dmhc.ca.gov. TTY/TDD and Speech-to-Speech users may dial 711 for the California Relay Service to submit comments on an agenda item or to request special accommodations for persons with disabilities.
For more information about this public meeting, please read the agenda or visit the Health Equity and Quality Committee Webpage.
Joint Statement from CalHHS Agency Leaders on Continued Access to Reproductive Health Services
California Health and Human Services (CalHHS) Secretary Dr. Mark Ghaly, Department of Health Care Services Director Michelle Baass and Department of Managed Health Care Director Mary Watanabe issued a joint statement following the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization.
"Today we link arms with all Californians as we commit to ensuring that reproductive health care is a right and not a privilege.
"The Supreme Court’s decision counters our vision of a Healthy California for All, where health care is affordable, accessible, equitable and high-quality so it drives toward improved health outcomes; where equity is not just a word or concept, but the core value; and where we constantly pursue social and racial justice by not only lifting all boats but especially those boats that need to be lifted more…” Read the full statement.
DMHC Releases 2021 Annual Report & Infographic
The DMHC released the 2021 Annual Report and Infographic, highlighting the Department’s achievements and activities during the year. The DMHC regulates the majority of health care coverage in California including 96% of commercial and public enrollment in state-regulated health plans. In 2021, 94 full service health plans licensed by the DMHC provided health care services to 28.4 million Californians. This included approximately 13.9 million commercial enrollees and approximately 14.5 million government enrollees. In addition to full-service health plans, the DMHC oversees 46 specialized health plans including chiropractic, dental, vision, behavioral health (psychological), and pharmacy. As of the end of 2021, the DMHC has assisted 2.6 million consumers through the Department’s Help Center.
Select an image below to read the 2021 Annual Report or Infographic:
RFP 22MC-SA003 – Social Media Outreach Campaign (Updated with Q&A)
The Department of Managed Health Care (DMHC) Office of Communications and Planning is soliciting proposals from qualified entities to develop a social media outreach campaign aimed at targeted audiences representing California's culturally diverse demographics. The Proposal Submittal Deadline is July 7, 2022 at 4 p.m. PDT. RFP 22MC-SA003 now including the Questions and Answers may be viewed and downloaded from Cal eProcure.
DMHC Fines Molina $1 Million in Enforcement Actions for Delaying Provider Payments
The DMHC announced enforcement actions against Molina Healthcare of California (Molina) including a $1 million fine for the plan’s failure to timely acknowledge and resolve 29,124 provider disputes between September 2017 and September 2018. The plan has paid the fine and implemented corrective actions, including the remediation of $80.3 million in payments to providers, with an additional $1.8 million in interest.
Health plans are required to have a Provider Dispute Resolution (PDR) program when a dispute arises over payments to providers. California law requires a health plan to identify and acknowledge each provider dispute within two working days of the date of receipt of an electronic provider dispute, and 15 working days of the date of receipt of a paper provider dispute. Additionally, health plans must resolve each provider dispute or amended provider dispute and issue a written determination stating the pertinent facts and explaining the reasons for the plan’s determination within 45 working days after the date of receipt.
DMHC Issues Guidance on Coverage of COVID-19 Therapeutics
The DMHC issued an All Plan Letter (APL) regarding commercial health plan coverage of COVID-19 therapeutics, steps plans can take to encourage providers to use therapeutics, when appropriate, and directs plans to submit a description of how the plan is ensuring enrollees who need and are eligible for therapeutics have ready access to such treatment. Health plans must ensure enrollees for whom a COVID-19 therapeutic is medically necessary have access to these treatments within 48 hours if the plan does not require prior authorization or 96 hours if the plan requires prior authorization. Given treatment should be started as soon as possible after symptoms start, the DMHC strongly urges plans to waive any prior authorization requirements with respect to therapeutics and to ensure enrollees can receive needed treatment as quickly as possible.
DMHC APL 22-017 – Coverage of COVID-19 Therapeutics
DMHC Fines Anthem Blue Cross $1.1 Million, Requires Corrective Actions to Protect Consumers
The DMHC has taken enforcement actions totaling $1,110,000 in fines against Blue Cross of California (Anthem Blue Cross) to protect consumers. The Department’s enforcement actions include a fine of $750,000 for incorrectly applying office visit costs to enrollee deductibles impacting 6,561 enrollees from 2015 through 2020, and a fine of $360,000 for failing to mail Explanation of Benefits (EOB) to 363,257 enrollees in 2019. Anthem Blue Cross reported both issues to the Department, and has agreed to pay the fines and complete corrective actions including identifying and reimbursing enrollees impacted by the incorrect office visit costs.
The plan was in violation of the law when it failed to properly exclude certain office visits from enrollee deductibles. These office visits included primary care, and behavioral health office visits. The plan agreed to corrective actions including identifying and reimbursing impacted enrollees, which includes reimbursing nearly $9.2 million to 6,561 enrollees.
DMHC Consumer Fact Sheets on COVID-19 Tests & Vaccines
The DMHC is taking action to protect consumers’ health care rights and ensure a stable health care delivery system during the COVID-19 pandemic. The Department is working closely with state and local leaders, health plans, providers and others in supporting actions to mitigate the spread and severity of COVID-19. This includes creating fact sheets to inform consumers about their rights to access free COVID-19 tests and vaccines:
Consumer Fact Sheet on COVID-19 Testing
Consumer Fact Sheet on COVID-19 Vaccines
More information about the DMHC’s actions related to COVID-19 is available on the DMHC COVID-19 Response webpage.