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
The Department of Managed Health Care (DMHC) Timely Access Report for Measurement Year (MY) 2019 is now available. This report summarizes provider appointment availability data submitted by health plans to the DMHC.
MY 2019 Timely Access Report
The California Department of Managed Health Care (DMHC) released the Prescription Drug Cost Transparency Report for Measurement Year 2019. The report looks at the impact of the cost of prescription drugs on health plan premiums and compares this data over three reporting years: 2017, 2018, and 2019. Among other findings, the report reveals that health plans paid an increase of $1 billion on prescription drugs since 2017, including an increase of $600 million in 2019.
“The amount health plans paid for prescription drugs has increased by $1 billion since 2017,” said DMHC Director Mary Watanabe. “The cost of prescription drugs is continuing to grow rapidly every year, which is having a real impact on the cost of premiums and the affordability of health care. This report provides greater transparency into prescription drug costs and the impact on health plan premiums.”
Press Release
Prescription Drug Cost Transparency Report (Measurement Year 2019)
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. 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.
Press Release
DMHC APL 20-042 - Removal of Administrative Burdens on Hospitals
DMHC APL 20-043 - Health Plan Reporting Regarding PPE and Related Support to Providers
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
Given the ongoing state of emergency due to the COVID-19 pandemic, the DMHC is concerned with the potential effects of the upcoming flu season on California’s population and health care system as well as a surge in other vaccine preventable illnesses, particularly in children. Now more than ever, it is imperative that all Californians receive timely and appropriate vaccinations and that barriers to coverage of and provider reimbursement for the vaccinations are lessened. The DMHC issued an All Plan Letter to remind health plans of existing requirements and to encourage health plans and their delegated entities to exercise maximum flexibility in covering and reimbursing for vaccines for enrollees.
DMHC APL 20-037 - Vaccinations; Coverage and Flexibility
The California Department of Managed Health Care (DMHC) requires California health plans to help victims of Natural Disasters, including wildfires, who are experiencing problems obtaining health care services. This could include speeding up approvals for care, replacing lost prescriptions and ID cards, or quickly arranging health care at other facilities if a hospital or doctor’s office is not available due to the disaster. You should first contact your health plan for assistance. If you have problems obtaining services or assistance from your health plan, you can contact DMHC’s Help Center at 1-888-466-2219 or visit www.HealthHelp.ca.gov.
DMHC APL 20-030 - State of Emergency due to Extreme Weather and Wildfires
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, 2021.