Notes from the Department of Managed Health Care’s
Consumer Provider Plan Agency (CPPA) Meeting
February 27, 2017
Every few months, a CAMFT Staff Attorney participates in meetings of the Consumer
Provider Plan Agency (CPPA) Mental Health Work Group which is hosted by the
Department of Managed Health Care (DMHC). The Department of Managed Health
Care (“DMHC”) oversees most health care service plans (including
Kaiser Permanente), health maintenance organizations (“HMOs”) incorporated
in California, as well as California Blue Cross and Blue Shield participating
provider organizations (“PPOs”).
The purpose of the quarterly CPPA meetings, held in Sacramento, is to bring
mental health consumer and provider advocates together with representatives
of the managed care plans that are regulated by the DMHC to discuss issues
related to the delivery of mental health care in California.
Mental Health Parity Compliance Update
Elizabeth Spring, Senior Attorney with the Office of Plan Licensing, provided
the group with an update on the Department’s parity enforcement project.
The Department is in the process of completing the on-site MHPAEA compliance
surveys of 25 commercial plans. As the Department completes the on-site reviews,
it will draft preliminary reports related to those reviews. The preliminary
drafts of the reviews are confidential and go only to the plans. The plans
then have 45 days to review the Department’s findings and come up with
a Corrective Action Plan. The Department will then use the plans’ responses
to finalize its reports which must be made available to the public within
180 days of the Department’s completion of the on-site surveys. The
Department anticipates completing the last of the 25 on-site reviews by the
end of June.
In anticipation of the CPPA meeting, CAMFT sent the Department two questions
I wanted Ms. Spring to address as part of her update. CAMFT asked whether the
Department had many any determinations about how it is going to tackle the
parity reimbursement issue.
Ms. Spring reported that SAMHSA, a unit of CMS, selected 20 states to participate
in a federal mental health parity project. Ms. Spring and an attorney from
the Department of Insurance will be participating in the group and will be
receiving input from other States and the Department of Labor about how best
to assess parity in regard to provider reimbursement. This project is just
getting underway, but Ms. Spring will provide the group with an update at the
next CPPA meeting.
CAMFT also asked Ms. Spring to address whether health plans requiring pre-authorization
for mental health treatment, but not for medical/surgical treatments raises
concerns about parity compliance. Ms. Spring stated this is one of the issues
being reviewed as part of the Department’s parity enforcement project.
She indicated they investigated any pre-authorization discrepancies during
the first phase of the project and that the Department did find occasional
discrepancies. In those cases, the Department issued pointed questions to the
plans and is requesting further information during the on-site survey process
so it can review the plans’ relevant policies and procedures even more
Department of Managed Care Update
The Department recently hired five new Deputy Directors, including Chief Medical
Officer, Kaiser Kim. Mr. Kim will be in charge of assisting the Department’s
Help Center with clinical issues.
County Mental Health Plan and Medi-Cal Managed Care Plan Coordination
Linnea Koopmans, a Senior Policy Analyst, at the County Behavioral Health Director’s
Association, gave a brief presentation on some of the issues the counties are
experiencing from a care coordination standpoint. The counties and the Medi-Cal
Managed Care Plans are having difficulty deciding which entity is responsible
for treating particular clients when there is disagreement about the level
of care that a patient requires. The Department of Health Care Services requires
counties and plans to have MOUs which outline their responsibilities. In recognition
of this problem and to better ensure continuity of care for consumers, the
Department is offering further instructions through All Plan Letters and Information
Notices about what the MOUs must address.
Help Center Update
The Department’s Help Center received a total of 330 mental health case
complaints between September and December of 2016. Of those 330 complaints,
225 of them resulted in Independent Medical Reviews. Only 84 of the plan’s
original determinations were overturned.
Discussion about Health Plan Care Guidelines
Randall Hagar, Director of Government Relations for the California Psychiatric
Association, presented the memo he and CAMFT’s Deputy Executive Director,
Cathy Atkins, drafted outlining concerns regarding the complex guidelines
providers are expected to follow and to encourage discussion about whether
there are ways to make guidelines across the plans uniform.
Representatives from Anthem Blue Shield (Rob Friedman) and Optum (Mimi Maguire)
indicated that plans initially adopted their guidelines from Interqual and
Milmen’s Clinical Guidelines. However, over the years, the cost of using
these standard guidelines caused plans to revert developing their own. Both
Anthem and Optum have national assessment committees that are responsible for
developing national guidelines. Therefore, both Rob and Mimi suggested any
changes to the guidelines would have to be made at a national level.
CAMFT and CPA asked that the DMHC and the CPPA work group work together to
create a single repository for the plans’ guidelines.
The CPPA work group’s next meeting is Friday, May 12, 2017.