What’s happening: On Oct. 8, California Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) officials announced they have reached settlement agreements with the largest Medi-Cal plan in the state.
What else to know: The two agreements with the Local Initiative Health Authority for Los Angeles County (L.A. Care Health Plan) — a $35 million settlement with the DMHC and a $20 million settlement with the DHCS — require that L.A. Care Health Plan improve its operations to ensure timely access to medically necessary health care services for all plan members, among other actions.
The $55 million total includes a $27 million financial penalty, and the remaining $28 million will consist of contributions over a three-year period that will benefit communities throughout Los Angeles County in one the following areas (or a combination thereof):
- DHCS’s Comprehensive Quality Strategy goals and guiding principles
- CalAIM implementation
- Behavioral health
These settlement agreements, which will significantly affect L.A. Care Health Plan’s 2.5 million members, were reached more than 18 months after the agencies fined L.A. Care Health Plan $55 million for “systemic failures across several core functions the plan is responsible for to make sure members receive appropriate care.”
Over the past year, CHA has engaged with state regulators regarding harmful insurance company practices that jeopardize patients’ ability to receive care in a timely manner and in the most appropriate care setting. These recent actions underscore CHA’s messages to the agencies and reinforce the need for ongoing education and awareness about threats to patients. CHA member hospitals that continue to encounter problems with health care plans are encouraged to file a complaint on the DMHC provider complaint web page.
