Archive | Network Adequacy

New Timely Access to Care Standards Adopted by CA Department of Insurance

On March 9, consumer advocates cheered the new standards announced by the California Department of Insurance for health insurers to create and maintain accurate provider directories. The new standards also require insurers to have adequate numbers and types of providers in their networks so consumers can get the care they need when they need it. […]

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Anthem Blue Cross-Cigna’s Troubling Track Records Spotlighted at DMHC Public Meeting

On March, 4, 2016, the Department of Managed Health Care (DMHC) held a public meeting on the proposed takeover of Cigna by Anthem Blue Cross. The public meeting was requested by consumer groups including Health Access, Consumers Union, and others to raise questions about the structure of the deal, its potential impact on California’s patients […]

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DHCS Stakeholder Advisory Committee Digs Deeper into Medi-Cal 2020 Waiver, SB 75 Implementation (Health4Kids), and Other Care Transformation Initiatives

This blog was written by Tam M. Ma (Policy Counsel) and Judi Hilman (Director of Special Projects) DHCS held its quarterly Stakeholder Advisory Committee today, the first time since California’s Medi-Cal 2020 waiver was approved at the end of December, covering a range of topics, including the waiver renewal, SB 75 implementation of Health for […]

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Covered CA Board Takes Big Steps on Standardized Benefit Design and Quality/Equity Measures; Considers New Barriers to Special Enrollment

Thursday’s Covered California Board meeting, the first since the last day of open enrollment 2013, offered a deep dive on the standardized benefit designs and the quality/equity framework that will guide contracting with insurers for the next 3-year cycle (2017-2019), and a heated discussion about the new documentation requirements that insurers are calling for to qualify […]

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DHCS & CMS Agree to Medi-Cal 2020 Waiver Framework!

This past Saturday (Halloween), the California Department of Health Care Services announced it had reached a new “conceptual agreement” with the federal Centers for Medicaid and Medicare Services (CMS) on the general framework of “Medi-Cal 2020,” the renewal of the 2010-2015 Medi-Cal waiver. Toplines With details to be specified in the coming months, the framework is […]

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Covered California Open Enrollment Started Sunday!

Yesterday marked the official start of Covered CA open enrollment, which will run through January 31, 2016. For coverage effective January 1, people must enroll by December 31, 2015. As always, Medi-Cal enrollment is open year-round and individuals experiencing any life transitions (losing a job or moving, among many qualifying events for Special Enrollment) may […]

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DHCS Stakeholder Advisory Committee October 14, 2015: Highlights for Consumer Advocates

Update on MCO (Managed Care Organization) Tax DHCS Director Jennifer Kent opened with an update on the MCO tax and the need to revise it to meet new federal guidelines to broaden the base to all health plans (learn more here).  Last Spring, the Governor called a special session to resolve this and related Medicaid financing […]

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Key Patient Protections Pass Legislature, Now On Governor’s Desk

With the California Legislature adjourning after midnight last Saturday, most of the action on priority bills for health consumers moves to the Governor’s desk. Most of the Heath Access-sponsored bills protecting consumers from unfair out-of-pocket costs are now one Governor’s signature away from enactment. There were disappointments in the final days of this year’s legislative […]

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Senate Appropriations Committee Hears Key Health Access Bill and Special Session Tobacco Control Legislation

Yesterday, the Senate Appropriations Committee heard Health Access sponsored bill, AB 533 (Bonta) on “surprise billing” and select special session tobacco control bills. AB 533 (Bonta), which would protect consumers from surprise bills from out-of-network doctors when a consumer does the right thing by going to an in-network hospital, lab or imaging center was not voted […]

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Special Session on Healthcare – Informational Hearings

This week, the Legislature held two informational hearings as part of the 2015-16 Second Extraordinary Session on healthcare. These hearings were convened to help lawmakers, and the public, understand approaches to structuring a Managed Care Organization (MCO) tax and the state of Medi-Cal funding more broadly. The current MCO tax only applies to health plans […]

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