By Taylor C. Brewer
On March 12, 2020, acting general counsel, Sarah Ream, of the Department of Managed Health Care (Department) issued a letter to all health care service plans in response to the COVID-19 pandemic. The letter addresses the declaration of a pandemic by the World Health Organization (WHO) and the state of emergency issued by California Governor Gavin Newsom on March 4, 2020. The Department encourages health plans to assist with medically appropriate “social distancing” in the delivery of health care services pursuant to WHO, the Centers for Disease Control and Prevention (CDC), and the California Department Public Health recommendations. In addition to this, the All Plan Letter also outlines further actions health care service plans should take to further prevent the spread of the virus.
The first action outlined is the expansion of telehealth healthcare delivery. The Department encourages the health plans to expedite or relax the preauthorization requirements that allow contracted providers to have covered telehealthcare, as defined in Business and Professions Code section 2290.5. In addition, the Department asks that the plans waive applicable cost-sharing for care delivered via telehealth in spite of a cost-share being applicable if the provider had delivered the care in-person. This recommendation was further discussed in a prior letter issued on March 5, 2020, which directs all plans to immediately reduce cost-sharing (including, but not limited to, co-pays, deductibles, or coinsurance) to zero for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.
The March 12 All Plan Letter also recommends that plans decrease the need for in-person pharmacy visits by providing coverage for outpatient prescription drug benefits. To do this the Department encourages plans to allow enrollees to receive 90-day supply maintenance of drugs, as indicated by section 1300.67.24(d)(3)(D), Title 28 of the California Code of Regulations. The letter also advises plans to suspend prescription drug refill limitations and waive delivery charges for home delivery of prescriptions.
Since the issuance of the March 12letter, the Department has furthered these recommendations by issuing a March 18, 2020, All Plan Letter 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.