On November 9, 2011 NovaRest Consulting was invited to the California Department of Managed Health Care (DMHC) Financial Solvency Standards board (FSSB) meeting. The meeting covered updates on Timely Access Regulation (TAR), Senate Bill 260 and Division of Financial Oversight (DFO).
Maureen McKennan, Acting Deputy Director of Plan and Provider Relations at the California Department of Managed Health covered the Timely Access Regulation. This regulation will ensure that consumers have timely access to health care services. Health care plans in California will be required to survey consumers on provider access, nurse advice and appointment availability. Grievances must be reviewed at least quarterly and plan providers must promptly investigate and implement corrective action plan for deviations.
The first report on TAR is due March 31, 2012. DMHC will review the report and determine compliance or non-complaince with TAR. In addtion, going forward, DMHC will be building a web portal where consumers can compare the performance of plans and providers.
Michelle Yamanaka, Supervising Examiner at Department of Managed Health Care, provided a brief update on Senate Bill 260. Since 2005, SB260 regulations require risk based organizations (RBOs) to provide financial survey reports and organizational information to DMHC. If, based on five grading criteria, DMHC determines that an organization is on verge of insolvency, they will be put on a corrective action plan (CAP). Of the 185 risk based organizations that reported, DMHC has placed a CAP on eleven (down from fourteen in 2010). Of the eleven, eight are carryovers from last year.
Finally, in his report on the Division of Financial Oversight (DFO), Stephen Babich explained that the DFO has begun claim initiative and medical loss ratio examinations (MLR). DFO will be routinely conducting these examinations every eighteen months. As of the meeting, there were eleven examinations complete and eight exams started. The next meeting of the FSSB will be held on February 9, 2012.