Notice Date: March 14, 2023
This notice is posted in order to be compliant with AB 2941 State of Emergency Mandate, which is required due to the Severe Winter Storms in California that brought damaging winds, historic precipitation, and snowfall and is effective immediately.
If a member has an authorization in place and has had to change the location or provider due to circumstances stemming from the State of Emergency due to the Severe Winter Storms in California, Heritage Victor Valley Medical Group will honor that authorization for a different location or provider.
Heritage Victor Valley Medical Group will monitor the affected area for urgent requests and, if needed, can provide access to care support or authorize as in-network, out of network physicians if in-network services are not available or otherwise affected by the Severe Winter Storms in California. A list of zip codes for the affected county/counties can be obtained by using this URL: https://www.getzips.com/county.htm
In addition, the State of Emergency Proclamation attached can be found within this URL: https://www.gov.ca.gov/wp-content/uploads/2023/03/3.1.23-Storms-State-of-Emergency-signed.pdf?emrc=ac8179
The following procedures have been put in place:
Relax time limits for prior authorization, precertification, or referrals any current prior authorization approval for an additional 4 months if the requester states a need to reschedule due to the State of Emergency.
Extend filing deadlines for claims by 180 days before denying for non-timely filing.
Authorize an enrollee to replace medical equipment or supplies due to the State of Emergency evacuation and covered under the member’s benefits. DMEs are a one-time PA approval. The PA request and the subsequent EOA approval is a response to a provider requesting an immediate DME for a member.
Allow enrollee to access out-of-network provider if an in-network provider is unavailable due to the state of emergency or if the enrollee is out of the area due to displacement. Once the State of Emergency has been lifted, members may seek out-of-network providers through the Continuity of Care/Access to Care process.
The above requirements must remain in place through close of business day on August 21, 2023.