September 18, 2020
On August 16, 2020, Governor Gavin Newsom declared a state of emergency related to the extreme heat and wildfires across California that have destroyed structures, threatened homes and forced the evacuation of thousands of residents. As a result, health plans and insurers are taking action to ensure patients in the affected areas have continued access to care.
Under law enacted in 2018, 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 (CMA) has 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 plan or insurer is offering.
Download the guide here.