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What Health Plans Need to Know: California DMHC All Plan Letter on Implementing Senate Bill 855 | Manatt, Phelps & Phillips, LLP


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On January 5, 2021, the California Department of Managed Health Care (DMHC) issued an All Plan Letter regarding the newly passed California Senate Bill 855 (Wiener, Stats. 2020, ch. 151 § 2) (SB 855).
1 SB 855 became effective on January 1, 2021. It amends the California Health and Safety Code and Insurance Code to expand state coverage requirements for mental health and substance use disorder services, and it requires health plans and insurers to adopt a standardized definition of “medical necessity” for those treatments.
2
The All Plan Letter provides an overview of SB 855, identifies clinical criteria and guidelines that health plans ....

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DMHC reminds Californians approved COVID-19 vaccines will be provided at no cost


The California Department of Managed Health Care (DMHC) issued guidance reminding health plans that all qualified, approved COVID-19 vaccines must be provided with no cost-sharing for health plan enrollees, regardless of whether the enrollee receives the vaccine from an in-network or out-of-network provider.
“As we begin to enter this new phase of the pandemic with vaccines becoming available, the DMHC is reminding health plans they must cover the cost of COVID-19 vaccines,” said DMHC Director Mary Watanabe. “It is critical that all Californians have access to a safe COVID-19 vaccine to help protect their health. Financial challenges should not and will not get in the way of getting protection from COVID-19.” ....

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