23-986 State of Emergency: Impacts from Tropical Storm for Multiple Counties

Date: 08/23/23

Support for CalViva Health members impacted

On August 19, 2023, Governor Gavin Newsom declared a state of emergency in the following counties due to the projected impacts from Tropical Storm Hilary: Alpine, Fresno, Imperial, Inyo, Kern, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Tulare, and Ventura. Health Net, on behalf of CalViva Health, is providing assistance to members affected by the storm’s impacts.

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 storm are able to continue providing care for members’ medical needs.

Participating providers may call the Provider Services Center by phone 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 storm will be extended. Providers may contact the Provider Services Center 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 storm. 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

CalViva Health members who have lost their homes or have been evacuated due to the storm 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 storm.

Additional information

Depending on how impacts from Tropical Storm Hilary 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 or through the provider protal.

 

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.