On Thursday, March 12, 2020, the California Department of Managed Health Care (the “Department”) released a guidance letter (the “Letter”) to all health care service plans regarding the coronavirus (COVID-19) pandemic. The Letter encourages plans to take certain steps to promote social distancing to decrease in-person visits during the delivery of health care services.  The Letter encourages plans to continue following these social distancing measures for the duration of the state of emergency proclaimed by Governor Newsom on March 4th.

Coronavirus; social distancing

First, the Department encourages plans to expand the use of telehealth by (i) expediting or relaxing any pre-authorization/pre-certification requirements for contracted providers, so that providers are able to more quickly offer services via telehealth; and (ii) waiving any telehealth cost-sharing above that which would be applicable if the provider had delivered in-person care.

Second, the Department encourages plans to decrease the need for in-person pharmacy visits, if appropriate for the enrollee, by (i) allowing enrollees to receive at least a 90-day supply of maintenance drugs; (ii) suspending prescription drug refill limitations; and (iii) waiving delivery charges for home delivery of prescription medications. Maintenance drugs are defined as those outpatient prescription drugs that are prescribed for the enrollee on a continual basis to treat a chronic condition.

We will continue to provide updates regarding the Department’s position and guidance.

For more legal insights regarding the coronavirus, please visit our Coronavirus (COVID-19) page.