CHA News

DMHC Provides Additional Guidance Regarding Post-Stabilization Care Requests

What’s happening: The Department of Managed Health Care (DMHC) has issued All Plan Letter (APL) 24-012, which reminds plans that they may not require a hospital to make more than one telephone call to request authorization to provide post-stabilization care to plan members.   

What else to know: The APL reiterates the requirements of Health & Safety Code 1371.4, which states that plans must provide hospitals with one telephone number to serve as the point of contact for 24-hour access for post-stabilization authorization requests. Plans may not require a hospital to contact the plan in any way other than the plan’s designated phone number.   

While the plan may delegate responsibility for staffing the number, the plan is still responsible for ensuring that there is a uniform point of contact for the hospital. The plan or delegate must respond to a hospital’s requests for authorization within 30 minutes.