Amicus Curiae Brief: Centinela Freeman Emergency Medical Associates vs. Health Net of California, Inc.

Notice of Errata for Amicus Curiae Brief

2015 SLAA Report

Public Meeting on the Acquisition of Humana by Aetna

Testing Thursday, December 17, 2015 

The Department of Managed Health Care (DMHC) invites you to a public meeting on the acquisition of Humana by Aetna.  Representatives from both plans will be present.  The meeting will be held in Sacramento on January 4, 2016 from 1:30 p.m. to 3:30 p.m.  The purpose of the meeting is to discuss DMHC’s jurisdiction and authority to oversee the transaction and to solicit public comment for DMHC’s consideration as it reviews the transaction.  Public comments will be limited to 3 minutes.  Comments may also be submitted in writing to publiccomments@dmhc.ca.gov until 5 p.m. on Friday, January 8, 2016.  More.....

Public Meeting on the Acquisition of Health Net of California by Centene

The Department of Managed Health Care (DMHC) invites you to a public meeting on the acquisition of Health Net of California by Centene.  Representatives from both plans will be present.  The meeting will be held in Sacramento on December 7, 2015 from 9:30 a.m. to 11:30 a.m.  The purpose of the meeting is to discuss DMHC’s jurisdiction and authority to oversee the transaction and to solicit public comment for DMHC’s consideration as it reviews the transaction.  Public comment will be limited to 3 minutes.  Comments may also be submitted to publiccomments@dmhc.ca.gov until 5:00 p.m. on December 12, 2015. More . . .

Timely Access Archive

• Measurement Year 2016
• Measurement Year 2015
• Measurement Year 2014

 MEASUREMENT YEAR 2016

Survey Tools

• MY 2016 Timely Access Compliance Report Instructions (Rev. 05/22/17)
• MY 2016 Frequently Asked Questions (Rev. 05/19/17)
• MY 2016 Checklist for Timely Access Compliance Report Vendor (Issued 03/10/17)
• MY 2016 Timely Access Web Portal Technical Assistance Grid (Rev. 05/26/17)
• All Plan Letter - April 7, 2017 (Supersedes APL Issued on February 13, 2017)
• All Plan Letter - February 13, 2017
• MY 2016 Provider Appointment Availability Survey Methodology.
• MY 2016 Methodology Clarifications (Rev. 03/01/17)



Survey Templates

• Provider Contact List - Ancillary (Issued 02/14/17)
• Provider Contact List - Non-Physician Mental Health (Issued 02/14/17)
• Provider Contact List - PCP (Issued 02/14/17)
• Provider Contact List - Specialist (Issued 02/14/17)
• Survey Tool - Ancillary (Issued 02/14/17)
• Survey Tool - PCP (Issued 02/14/17)
• Survey Tool - Specialty Care and Non-Physician Mental Health Providers
• Raw Data - Ancillary (Issued 02/14/17)
• Raw Data - Non-Physician Mental Health (Issued 02/14/17)
• Raw Data - PCP (Issued 02/14/17)
• Raw Data - Specialist (Issued 02/14/17)
• Survey Results - Ancillary (Issued 02/14/17)
• Survey Results - Non-Physician Mental Health (Issued 02/14/17)
• Survey Results - PCP (Issued 02/14/17)
• Survey Results - Specialist (Issued 02/14/17)

Audit Templates

• DMHC MY2016 Provider Appointment Audit Methodology
• DMHC Manual Audit Worksheet
• DMHC MY2016 Electronic Audit Worksheet

 

 MEASUREMENT YEAR 2015

Survey Tools

• Finalized MY2015 Provider Appointment Availability Survey Methodology
• Finalized MY2015 Provider Appointment Availability Survey Tool for PCPs, SCPs, and Non-Physician Mental Health Providers
• Finalized MY2015 Provider Appointment Availability Survey Tool for Ancillary Providers

Audit Templates

• DMHC Manual Audit Worksheet
• DMHC MY2015 Provider Appointment Audit Methodology

Steps for submitting Timely Access Compliance Report (A-F data):

     1.  Read the MY 2015 Timely Access Compliance Report Instructions. 

     2.  Please use the MY 2015 templates by relevant provider type when reporting results for section B.3 Data Source: Appointment Availability Audit/Survey in the DMHC's web portal.

• Provider Appointment Availability Survey Results Template for PCP
• Provider Appointment Availability Survey Results Template for Specialist
• Provider Appointment Availability Survey Results Template for Ancillary
• Provider Appointment Availability Survey Results Template for Mental Health           

3.      Submit documents per instructions via the DMHC's web portal (You may download the D. Advanced Access Form (optional) to report provider groups).

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Provider Appointment Manual Audit Dates

Rule 1300.67.2.2, subd (g)(2)(B) requires health plans to report a rate of compliance with several appointment wait time standards. Pursuant to SB 964 and Section 1367.03, subd (f)(3), DMHC has adopted two standardized methodologies that plans may use to report compliance with the required appointment wait time standards for Measurement Year 2015 (“MY2015”).

Plans conducting a manual audit using the DMHC MY2015 Provider Appointment Audit Methodology will perform appointment availability audits on four days during MY2015, one day in each calendar quarter of the year. After the close of each calendar quarter, DMHC will post on its website a notification of one date from the quarter for which data shall be collected. Data should be collected for each date soon after it is posted on DMHC’s website to allow plans to use the data for ongoing monitoring and to ensure that data systems are not purged before collection is accomplished.

For MY2015, the first two audit dates are:

First quarter: Wednesday, February 11, 2015

Second quarter: Tuesday, May 5, 2015

SPECIAL REMINDER: In the DMHC's web portal, please complete Steps 1 and 2 under the Submit tab and make sure you receive a confirmation email to identify your report has been successfully submitted to the DMHC. The Timely Access Compliance Report will not be submitted if Step 2 (Affirmation to Complete) is not completed. 

 

Measurement Year 2015 Templates

Timely Access Data Element Changes – At-A-Glance

Timely Access Web Portal Profile Tab Instructions - Profile Tab Instructions

Timely Access Provider Network Report Form Instructions - Network Report Form Instructions

To clearly illustrate the changes in data elements required and requested for Measurement Year 2015 (MY2015), the DMHC has summarized them in an “at a glance” table format for each Timely Access Report Form. The tables display the following:

• The name of the Timely Access Report Form (template), e.g. PCP or Enrollment
• The affected data element (columns) from each Report Form;
• The action taken, e.g. whether a previously required or requested data element was removed or a new data element added, and;
• A brief description of the new data element or a description of the previously requested/required data element that is no longer required.

2015 Contracted Provider Network information per California Code of Regulations, title 28, section1300.67.2.2(g)(2)(G)1 & 2

In order to ensure compliance with Health and Safety Code section 1367.035 (added under Senate Bill 964), the DMHC has modified its Timely Access Provider Network report forms for the 2015 reporting year. Below please find the 2015 Timely Access report forms in a “locked” Excel format. Plans must utilize these templates to compile network data as of December 31, 2015. As a reminder, network templates are due to the Department no later than March 31, 2016.

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2015 Timely Access Provider Network Report forms:

• Timely Access Report Form – PCPs
• Timely Access Report Form – Specialists
• Timely Access Report Form – Mental Health
• Timely Access Report Form – Other Contracted Providers
• Timely Access Report Form – Hospitals and Clinics
• Timely Access Report Form – Enrollment

Please note that, in addition to submitting the network templates provided above, each Plan is also required to complete a “Plan Profile” in the DMHC's web portal. For assistance, see sample data for PCPs, Specialists, Mental Health, Other Contracted Providers, Hospitals and Clinics, Enrollment.

Timely access report forms from previous measurement years are now available at the archive portion of our website. Plan data for Measurement Year 2015 must be submitted on the Excel templates provided above. The Department will not accept health plan network reports submitted on templates from prior years.

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2015 Timely Access and Network Adequacy Grievance Reporting Documents:

For Measurement Year 2015, the Department has created a standardized template for which the health plans must submit data regarding network adequacy and timely access grievances as required by Health and Safety Code section 1367.035 (a)(6).


• Timely Access and Network Adequacy Grievance Template Instructions (includes description of required and requested data elements).
  
  
• Timely Access and Network Grievance Template
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2014 Model Provider Appointment Available Survey Methodology & Survey Tool

• MY 2014 DMHC Model Provider Appointment Availability Survey Methodology
• MY 2014 DMHC Model Provider Appointment Availability Survey Tool

2014 Timely Access Reports

• MY 2014 Timely Access Report
• MY 2014 Timely Access Data    
• MY 2014 Timely Access Data (Excel)
• MY 2014 Timely Access Fact Sheet

2014 Timely Access Request Forms

• Timely Access Report Form – PCPs
• Timely Access Report Form – Specialists
• Timely Access Report Form – Mental Health
• Timely Access Report Form – Other Contracted Providers
• Timely Access Report Form – Hospitals and Clinics
• Timely Access Report Form – Enrollment

MY 2014 Timely Access Network Report Instructions

Frequently Asked Questions - FAQ

• Ten Year Report on Health Care Consumer Protections - The year 2010 marks a major milestone for consumers and the managed care industry in California -- the ten-year anniversary of the establishment of the DMHC. This report details the significant consumer protection laws and policies established by the DMHC over the past ten years.
• Implementation of Department Review of Prescription Drug Benefits
• DMHC/CDI Consistency in Consumer Protection (SB 1913)
• DMHC issues amended Order of Approval for the Notice of Material Modification to Blue Cross of CA Knox-Keene License.  
  This amended order supersedes the Order of Approval issued on July 23, 2004, concerning the same transaction.
  • Statement by Director Ehnes
  • Fact Sheet
  • Correspondence to Blue Cross of California
  • Amended Order of Approval
  • Blue Cross of California Undertakings
  • Exhibit A to Undertakings
• Report to Senate Insurance Committee and Assembly Health Committee Pursuant to Health and Safety Code section 1367.03(j)
• Filing Suggestions: Exhibits F, L, and M
• Compliance with Section 1366.35(i): Disclosure of the Availability of HIPAA Coverage; Model Language for Use in Evidences of Coverage
• Implementation of the Claim Settlement Practices and Dispute Mechanisms Regulations
• Plan Disclosure of Personal Health Information to the Department of Managed Health Care
• Cancellation of Enrollment
• Revised Financial Reporting Forms
• Signature Requirements for Reports
• Unilateral Amendments to Contracts
• Updated Information On The Financial Reporting Forms And Web Portal
• Advisory Regarding Exempt Employee Assistance Program
  Memo
  Notice (MS Word)
• Exclusion of Coverage for Certain Pharmaceuticals
• Required Disclosures and Conditions of Binding Arbitration
• Confidentiality of Enrollee Social Security Numbers
• Restrictions on out of area maternity services

 

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Right Care Initiative

The DMHC co-sponsored the Right Care Initiative from 2007 through December 31, 2016. The Right Care Initiative is now solely supported by the UC Berkeley School of Public Health. For more information visit: https://rightcare.berkeley.edu/

These pages will remain on the DMHC website for archival purposes.

 

• Right Care Initiative Homepage
• Awards
  • 2014 Awards Photos
• Summits
• University of Best Practices
• Health Plan and Medical Group Performance Data
• Eight Key Strategies
• Promising Best Practices
• Key Research Articles
• In the News
• Archive
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