Author: Stephen Goldberg

Health plan social distancing measures — telehealth and pharmacy

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The California Department of Managed Health Care Social Services (DMHC) encourages health plans to take measures regarding telehealth and pharmacy visits in response to COVID-19.

Health plans should expedite any pre-authorization or pre-certification requirements for contracted providers to cover care delivered by telehealth.  The plan should either expedite review or relax requirements to allow the plan to more quickly approve offering services via telehealth.  Plans should also waive applicable cost-sharing for telehealth, notwithstanding that cost-sharing might apply if the provider delivered the care in person.

Plans should allow at least a 90 day maintenance supply of drugs unless the enrollee’s provider indicates a shorter supply of the drug is appropriate for the enrollee.  Plans should suspend prescription drug refill limitations where the enrollee’s provider indicates a refill is appropriate.  Plans should waive delivery charges for home delivery of prescription medications.  (APL 20-007, March 12, 2020.)

Reimbursement for telehealth services

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The California Department of Managed Health Care Social Services (DMHC) has ordered that health plans reimburse providers at the same rate regardless of the modality of delivery.  For services provided by telehealth, a health plan may not impose cost-sharing greater than if the services were provided in person.  Health plans must provide the same amount of reimbursement for a service provided by telephone as they would if the service is provided by video, as long as the modality by which the service is provided is medically appropriate for the enrollee.  (APL 20-009, March 18, 2020.)

Health services during self-isolation orders

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The California Department of Managed Health Care Social Services (DMHC) has issued guidance regarding health plan services during self-isolation orders.  Health plans must continue to provide health care services and perform health plan functions.  Plans may delay some services such as elective surgeries or other non-urgent procedures if the referring or treating provider, or the health professional providing triage or screening services, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the enrollee.

Plans can communicate with enrollees electronically and/or telephonically if the plan does not have personnel available to mail hard copy information.  Plans must maintain a record or log of such communications.  (APL 20-008, March 18, 2020.)

FHA mortgage and eviction moratorium

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The United States Department of Housing and Urban Development (HUD) has issued a directive that properties secured by FHA- insured Single Family mortgages are subject to a 60 day moratorium on foreclosure. The moratorium applies to initiation of and completion of the foreclosure process.

Evictions of persons from properties secured by FHA- insured Single Family mortgages are suspended for 60 days.

Deadlines for the first legal action and reasonable diligence timelines are extended by 60 days.  (Mortgagee Letter 2020-04, March 18, 2020.)

90 day suspension of redeterminations, CalWORKs clock stop, and public meeting requirements

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Governor Gavin Newsom has issued an executive order regarding public benefits programs in California.  The executive order suspends otherwise required redeterminations for Medi-Cal, CalWORKs, CalFresh , Cash Assistance Program for Immigrants, California Food Assistance Program, and In Home Supportive Services for 90 days.

The executive order also stops the CalWORKs 48 month time clock through June 17, 2020.  Any month or partial month of CalWORKs received will not be counted toward California’s 48 month time on aid limit.

The Executive Order also suspends any requirement of physical presence in the Brown Act or the Bagley-Keene Act for meetings or local or state bodies.  Meetings of state or local bodies held via teleconference and allowing members of the public to observe and address the meeting shall satisfy any requirement that the body allow members of the public to attend the meeting and offer public comment.

The body must have a procedure for reasonable accommodations for persons with disabilities and advertise that procedure in each public meeting notice.  Requirements for notice of the time and agenda for meetings are unchanged, except that the notice of the time of the meeting must also give notice of how the public may observe and comment.  These public meeting provision apply as long as state or local public officials have imposed or recommended social distancing. (Executive Order N-29-20, March 17, 2020.)

CPUC moratorium on utility shutoffs

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The California Public Utilities Commission (CPUC) has issued an order that energy, water, sewer, and communications companies under CPUC jurisdiction should stop disconnections for non-payment because of Governor Newsom’s COVID-19 emergency declaration.  These customer protections are retroactive to March 4, 2020.

Pursuant to Governor Newsom’s March 16, 2020 executive order Paragraph 6, CPUC will monitor the customer service protections undertaken by public and private utility providers and to report on the customer protection measures they have implemented.  (California Public Utilities Commission Press Release, March 17, 2020.)