Blue Cross of California Partnership Plan Fined $1.2M for Not Authorizing Medically Necessary Services
The California Department of Managed Health Care (DMHC) announced it’s taken enforcement action against Blue Cross of California Partnership Plan, Inc. for failure to timely authorize coverage for medically necessary services. Blue Cross was fined $1,205,000. Blue Cross confirmed receiving DMHC’s notifications of two Independent Medical Review (IMR) decisions, but failed to timely authorize the enrollees’ services. California law requires health plans to authorize the services within five working days of receiving an IMR determination accepted by DMHC. Health plans are subject to a fine of no less than $5,000 for each day that an IMR decision is not implemented. According to a DMHC written statement:
“The DMHC Help Center’s appeals process, called an Independent Medical Review, is a critical protection for health care enrollees. The Independent Medical Review is a backstop to ensure health plans cover medically necessary health care services enrollees are entitled to receive,” said Acting DMHC Director Mary Watanabe. “It is a serious violation when a health plan fails to follow the Independent Medical Review decision and cover the required medical services. This mandated fine is needed to prevent similar violations from happening in the future.”
Rapid Results COVID Test Coming to a CVS Near You
CVS Health announced plans to expand COVID-19 testing services at select CVS Pharmacy locations to include rapid-result testing at nearly 1,000 sites by the end of the year. The sites will include California locations.
Rapid-result COVID-19 diagnostic tests are available at no cost to patients who meet Centers for Disease Control and Prevention criteria. In addition, rapid-result tests may also be available as a testing option for eligible employees or students affiliated with an organization that has adopted CVS Health’s Return Ready™ return-to-work COVID-19 testing program.
Patients must register in advance at CVS.com to schedule an appointment. Children can be tested, but must be accompanied by a legal guardian if they are 15 or younger. Procedures will vary by location, but CVS says most locations will ask patients to proceed to a designated structure in the parking lot for a test kit and instructions. A CVS Health team member will observe a self-swab process and patients will wait in their cars for results. The process, from the collection of the swab to the delivery of the results, is expected to take approximately 30 minutes.
MEDICARE
SCAN Health Plan Earns 4.5-Star Medicare Rating for Fourth Straight Year, Named to U.S. News Best List for Third Straight Year
SCAN Health Plan® announced it received a 4.5-star rating* from the Centers for Medicare and Medicaid Services (CMS) for the fourth consecutive year, making it the only Medicare Advantage plan in California to do so. SCAN was also named to U.S. News & World Report’s 2021 list of Best Insurance Companies for Medicare Advantage in California for the third year in a row. Also for the third year running, 90% of SCAN members gave the plan high marks in the annual CMS Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey, which gauges member satisfaction. Way to go, SCAN.
MENTAL HEALTH
UnitedHealth Announces Mental Health Collabs with UCSD and UCSF
Numerous reports paint a bleak picture for California’s mental health workforce. The state has a mental health professional workforce shortage that is projected to worsen. By 2028, California will have only about half of the psychiatrists it will need to serve those in need of treatment, and 28% fewer psychologists, social workers and counselors than necessary to meet the projected demand, according to the UC San Francisco’s Philip R. Lee Institute for Health Policy Studies. But things won’t be so bleak if UnitedHealth Group can help it. The health care provider recently announced a new four-year, $4 million grant collaboration with the University of California San Diego to expand the mental health workforce in California. Led by UC San Diego School of Medicine’s Department of Psychiatry and funded by UnitedHealth Group, the collaboration aims to diversify the pipeline of child and adolescent psychiatrists and encourage medical students to pursue careers in this field through the introduction of novel learning opportunities, individualized mentorship, scholarships and financial education support for participating residents. Together, the initiatives should help create an inclusive, skilled workforce representing the changing social, racial and economic demography of California’s families. In addition, UnitedHealth Group has also awarded a four-year, $4 million grant to the University of California, San Francisco, to grow the pipeline of diverse child and adolescent mental health clinicians. That grant will create new clinical learning opportunities and mentoring supports for child and adolescent psychiatry fellows and psychiatric-mental health nurse practitioners, as well as provide scholarships and other support to underrepresented medical and nursing students pursuing child and adolescent mental health careers.
FINANCIAL PLANNING
Midland and RetireOne Team Up for New Annuity Products
Midland National® Life Insurance Company and RetireOne® have collaborated on the development of a new protected accumulation solution offering growth potential in two different forms. The IndexMax ADVSM fixed indexed annuity (FIA) layers in potential annual performance credits with additional 5- or 7-year term participation credits. IndexMax ADV offers two indices for its layered crediting strategy: the Fidelity Multifactor Yield Index 5% ERSM and the S&P 500® Low Volatility Daily Risk Control 5% Index ERSM. Exclusively available through RetireOne’s fiduciary marketplace, the products connect easily to preferred advisor technologies. Click here for more info on how the layered crediting strategy works.
EMPLOYEE BENEFITS
2020 Tools & Tactics Webinar: FMLA Certifications – A Step-by-Step Guide
The Family Medical Leave Act (FMLA) has been around for 25 years, but employers still struggle with several administrative aspects of the law. Employers regularly report confusion around managing the certification process, which is the cornerstone of successful FMLA administration. That’s why the Disability Management Employer Coalition is offering a Family Medical Leave Act webinar on Thursday, November 12, 9 a.m. Pacific. Join DMEC for a deep dive into FMLA certifications. Info and registration here.
PEOPLE
Vanderyacht Joins SF’s Newfront Insurance
Newfront Insurance, a tech-enabled, full-service brokerage based in San Francisco, has brought Jason Vanderyacht on board as a principal and logistics practice leader. Vanderyacht joins Newfront after being VP of Aliant, where he was the leading expert on logistics companies within their Energy & Marine team.
EVENTS
- LAAHU’s Zoom Happy Hour is the first Wednesday of the month from 4-5p.m. Members and nonmembers welcome. Register here.
- NAHU Power Hour, 4th Wednesday of the month from 4-5p.m. Pacific. Members and nonmembers welcome. Register here.
- IICF Foundation Women in Insurance Regional Forums Rescheduled
Insurance Industry Charitable Foundation has rescheduled the Women in Insurance Regional Forums:
Los Angeles: October 30
Dallas: November 17 More info at IICF’s website.
- NAIC Fall National Meeting, Virtual, Dec 3-9
The agenda for the 2020 NAIC Fall National Meeting is now available. The schedule includes interactive sessions, as well as a special session that will be held by The Center for Insurance Policy and Research (CIPR). Meeting registration opened September 25, and the registration fee is $495. As a reminder, unused registration fee credits received from the cancelled 2020 Spring National Meeting may be applied to the registration fees for the 2020 Fall National Meeting. Register here.
- CAHU Women’s Leadership Summit will now be April 7-9, 2021!
The latest news from CAHU’s WLS committee is that the CAHU Women’s Leadership Summit will now take place April 7 –9, 2021, at Green Valley Ranch in Las Vegas. Questions should be emailed to info@cahu.org.
