California

State behavioral health guidelines and updates due to COVID-19

State-specific guidelines

Effective 3/18/2020

An order has been in place requiring CA Health Care Service Plans to reimburse providers at the same rate, whether a service is provided in-person or through telehealth.

Effective 3/14/2020

The Department of Health Care Services is issuing guidance to Behavioral Healthcare Providers to assist them in providing medically necessary health care services, including telehealth. DHCS is exploring additional options to temporarily waive and/or modify certain federal and state requirements.

Understanding new Commercial Payer guidelines

Many commercial payers have also issued important updates explaining their expansion of telehealth services. While expanded coverage includes more services, looser restrictions put the responsibility on the provider to determine appropriate services. This shift can significantly increase the risk of payer denials later on. An informed interpretation of these new guidelines is essential to avoid issues with your revenue cycle in the coming weeks. We are available to further discuss our findings and analysis with you. To learn more about recent updates regarding commercial payer guidelines, please contact us directly.