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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.

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DMHC – Constant Change, Continual Improvement October 17, 2007

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  1. DMHC – Constant Change, Continual Improvement October 17, 2007

  2. LicensingImprovements • 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Implementing Key Legislation • Banning balance billing of enrollees. • Providing access to care for non-English speaking Californians. • Getting timely access to health care.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

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