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DMHC – Constant Change, Continual Improvement October 17, 2007. Licensing Improvements. Reorganized Licensing Division Recruiting and hiring attorneys and staff with experience in health care a priority. Instituted intensive training for health plan compliance staff.

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Dmhc constant change continual improvement october 17 2007

DMHC – Constant Change, Continual Improvement

October 17, 2007

Licensing improvements

  • Reorganized Licensing Division

    • Recruiting and hiring attorneys and staff with experience in health care a priority.

    • Instituted intensive training for health plan compliance staff.

    • Developed filing guidelines and checklists to promote consistency.

      • 13 completed, 3 in development.

Licensing improvements con t
Licensing Improvements (con’t.)

  • Improved filing processes.

    • Prefiling conferences.

    • Training sessions for health plan staff of grievance resolutions and utilization.

    • Implemented Post-Examination Survey for plans to rate DMHC performance.

    • Launched a bimonthly health plan Ad Hoc Workgroup to seek input.

Licensing improvements con t1
Licensing Improvements (con’t.)

  • Reduced the review time for Evidence of Coverage filing from a median of 147 days in 2003 to 27 days in 2005.

  • Cut new product review time in half, from 1 year to 6 months.

  • In 2006, 17 new product benefit designs approved.

  • Streamlined filing process and number of filings to include only those essential.

  • Created new financial statement format and e-filing system.

Licensing improvements con t2
Licensing Improvements (con’t.)

  • Created a web portal and document management system for electronic filing.

    • Goal is to go paperless.

    • Eliminates rejected filings by catching errors and resolving them.

    • By developing system in-house, saved over $1 million.

Licensing improvements con t3
Licensing Improvements (con’t.)

  • On-line Technical Assistance Guides help plans prepare for medical and financial exams.

  • Consolidated or eliminated some of the periodic required reports and surveys.

Complaint management and administrative improvements
Complaint management and administrative improvements

  • HMO Help Center “Quick Resolution” process saves money and workload before complaints reach the formal process.

  • Electronic Funds Transfer portal allows plans to complete financial transactions with DMHC more quickly.

Reduced rbo financial insolvency
Reduced RBO financial insolvency

  • SB 260 provides early warning signal about RBO financial issues.

  • More than 96% of RBOs have filed their annual reports.

  • Identifies financial trouble and allows Corrective Action Plan.

  • 53 RBOs have filed CAPs, 26 have achieved compliance.

Government plan collaboration
Government Plan Collaboration

  • Established a forum for DMHC, DHCS, and MRMIB to coordinate filing reviews.

  • Share information regarding review times and deadlines for product filing approvals.

  • Resolve any discrepancies at the departmental level to ensure consistency.

  • Coordinate efficient approval of service area changes.

Implementing key legislation
Implementing Key Legislation

  • Banning balance billing of enrollees.

  • Providing access to care for non-English speaking Californians.

  • Getting timely access to health care.

Encouraging health information technology investment
Encouraging Health Information Technology Investment

  • Advancing the HIT cause within State Government to build broad support.

  • Focusing on aiding the “business case” for sustainable HIT adoption through financing options, P4P, and reimbursement.

  • Advancing literate & transparent consumer information.

  • Addressing privacy & security considerations.

Discount plans
Discount Plans

  • Cracked down on fraudulent plans with cease and desist orders.

  • Licensing makes it practical and legal for plans to offer legitimate products.

  • First Dental Health licensed in 2006.

Specialty plans improvements
Specialty Plans Improvements

  • Different template than traditional for some dental plan designs.

  • Conditional approval for 2 years for individual products.

  • Dental, vision technical assistance guides help specialty plans through licensing processes.

What s ahead
What’s Ahead

  • Discount plans, post-claims underwriting, balance billing implementation.

  • Review of Timely Access regulation, input from CAHP.

  • Work with CAHP on key implementation concerns.

  • New block transfer web portal.

  • New E-filing enhancements.

  • HIT implementation.

  • New product innovation.