COVID-19 screening and testing for health plans

The California Department of Managed Care (DMHC) has issued a directive to all commercial health plans and full service Medi-Cal plans regarding steps to ensure that cost does not interfere with availability of COVID-19 testing.

DMHC directs all commercial health plans and full service Medi-Cal plans to: 1) reduce cost-sharing to zero for all medically necessary screening and testing for COVID-19, 2) notify the plan’s contracted providers that the plan is waiving cost-sharing, 3) ensure that the plan’s advice line and customer service representatives are so informed, and 4) display on their websites that cost-sharing for medically COVID-19 screening and testing is waived.

DMHC reminds plans that they must: 1) cover all medically necessary emergency care without prior authorization, comply with utilization review timeframes for approving requests for urgent and non-urgent services, 2) ensure their provider networks are adequate to handle an increase in need for services, 3) ensure enrollees are not liable for balance billing, and 4) ensure 24-hour access to a person with authority to authorize services.

DMHC encourages plans to work with contracted providers to use telehealth services when medically appropriate, and to waive prior authorization and/or step therapy requirements if the provider recommends the enrollee take a different drug and there is a shortage of any particular prescription drug.  (APL 20-006, March 5, 2020.)