23-066 Statewide State of Emergency Due to Winter Storms

Date: 01/06/23

Support for CalViva Health members impacted by winter storms

On January 4, 2023, Governor Gavin Newsom declared a state of emergency statewide due to the winter storms that began on Dec. 27, 2022. CalViva Health is providing assistance to members affected by these winter storms.

We want to help ensure that members who have been impacted, because they or their usual health care physicians or other providers have been temporarily displaced, have continued access to health care services and prescriptions during the state of emergency.

Here is what you need to know.

Prior authorization, precertification and referrals

CalViva Health is taking steps to ensure that participating physicians and other providers in areas affected by the winter storms are able to continue providing care for members’ medical needs.

Participating physicians and other providers may call the Provider Services Center by 888-893-1569 for guidance on:

• Shortening time limits for health care service plans to approve prior authorization, precertification, or referrals, and extending the time that prior authorizations, precertification, and referrals for treatment remain valid.
• Approving out-of-network services in the event a contracting physician, other provider or facility becomes unavailable.
• Authorization for the replacement of medical equipment or supplies.

Filing claims

The deadline to file claims for physicians and other providers impacted by the winter storms will be extended. Physicians and other providers may contact the Provider Services Center by 888-893-1569 for additional guidance on claims extension time frames.

Prescription information

CalViva Health will approve physician administered medications for any member whose medication treatment was interrupted by the evacuation. CalViva Health will also suspend refill limitations and allow an impacted enrollee to refill their prescriptions at an out-of-network pharmacy. If the pharmacy is not open due to the state of emergency, affected members can contact CalViva Health Member Services at 888-893-1569 for questions or assistance.

Coping assistance

CalViva Health members who lost their homes or have been evacuated due to the winter storms may contact CalViva Health Member Services at 888-893-1569 for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss or other trauma resulting from the winter storms.

Additional information

Depending on how these winter storms progress, CalViva Health may make additional changes to its policies as needed to ensure members have access to necessary health care services.

If you have questions regarding the information contained in this update, contact the applicable CalViva Health Provider Services Center within 60 days, by phone 888-893-1569 or through the CalViva Health provider website.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.