23-253 State of Emergency: Severe Winter Storms Impacting Multiple Counties

Date: 03/03/23

Support for impacted CalViva Health members

On March 1, 2023, Governor Gavin Newsom declared a state of emergency in Amador, Kern, Los Angeles, Madera, Mariposa, Mono, Nevada, San Bernardino, San Luis Obispo, Santa Barbara, Sierra, Sonoma, and Tulare counties due to severe winter storms. These storms that began in late February brought damaging winds and significant rain, including snowfall in areas not accustomed to snow. They continue to cause damage and closures to highways and roads, power outages, and forced evacuations stranding residents and motorists.

The Plan is providing assistance to members affected by the severe winter storms. We want to help ensure that members who have been impacted, because they or their usual health care 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

The Plan is taking steps to ensure that participating providers in areas affected by the severe winter storms are able to continue providing care for members’ medical needs.

Participating providers may call the Provider Services Center at 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 provider or facility becomes unavailable.
• Authorization for the replacement of medical equipment or supplies.

Filing claims

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

Prescription information

The Plan will approve physician-administered medications for any member whose medication treatment was interrupted by the severe winter storms. The Plan 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.

Member insurance cards and health care information

Members whose insurance cards have been lost or left behind due to the state of emergency and members who have health care questions during the state of emergency can contact CalViva Health Member Services at 888-893-1569 for questions or assistance.

Coping assistance

Members who lost their homes or have been evacuated due to the severe winter storms may call 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 severe winter storms.

Additional information

Depending on how the severe winter storms and their impacts progress, the Plan 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 Provider Services Center by phone at 888-893-1569 or through the 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.