November 08, 2019
Governor Gavin Newsom has declared state of emergencies in response to the wildfires across California that have destroyed structures, threatened homes and forced the evacuation of tens of thousands of residents.
As part of a new law enacted in 2018, health plans and insurers are required to act quickly to ensure patients in areas affected by wildfires and other disasters have continued access to care.
Under the new law, plans and insurers operating in counties affected by an official state of emergency must within 48 hours of the emergency declaration notify the California Department of Health Care Services about the actions the plan has taken or is in the process of taking to ensure that the health care needs of its enrollees are met. This may require payors to take actions, including but not limited to, the following:
- Relaxing time limits for prior authorization, precertification, or referrals.
- Extending filing deadlines for claims.
- Suspending prescription refill limitations and allow an impacted enrollee to refill his or her prescriptions at an out-of-network pharmacy.
- Authorizing the replacement of medical equipment or supplies.
- Allowing access to appropriate out-of-network provider if in-network providers are unavailable due to the state of emergency or if enrollees have been displaced by the emergency.
- Having a toll-free telephone number that affected enrollees can call for assistance.
The California Medical Association has also published a guide to help patients navigate these services. This guide includes phone numbers to call if patients are experiencing difficulty refilling prescriptions, replacing medical supplies or obtaining access to care, as well as links with more information about other services each payor is offering.
Download the guide here.