Member Emergency Preparedness Plan
The Member Emergency Preparedness Plan has been established to address members’ needs during an emergency and ensure member access to health care services in the event of a natural disaster or man-made emergency, including members:
- In long-term care facilities, skilled nursing facilities or other institutional settings
- With disabilities, limitations in activities of daily living, and/or cognitive impairments.
Member communication
An active cloud-based phone system, which is also the Member Services Call Center, will allow HPSM to communicate with members before, during and after an emergency. Emergency protocols have been established for the Member Services Call Center that will allow for escalations, ensuring access to covered services, varying call scripts that account for different members’ needs, staff training for crisis response and warm hand-off connections to nurses or doctors for members requiring immediate assistance during an emergency. A sample call center script can be found in Appendix A of the Communications Plan for Incidents.
- Members reaching out to the Member Services Call Center will be provided instruction on how to reach the plan’s Nurse Advice Line, Care Coordinators, Medi-Cal Rx pharmacy services, telehealth services, behavioral and mental health services, and other services and resources as deemed appropriate. This information will also be available within the member newsletter, the HPSM website, Facebook, LinkedIn and Instagram.
- Members can find alternative care (primary pharmacy, dialysis center, chemotherapy or other infusion therapy locations and other treatment sites) by accessing the online provider directory via the HPSM website.
- Proactive discussions with members during the care planning process prompt them to develop their own personalized emergency plans.
- HPSM will inform members about how benefits may be modified by removing barriers of care and adjusting protocols as needed to ensure access to medically necessary services in the event of an emergency. Some benefit modifications and adjusted protocols include easing of authorization protocols, out-of-network restrictions, pharmacy refill limitations, obtaining DME replacements and retrieving medical records.
Continuity of care
HPSM will ensure that members impacted by a federal, state or county declared state of emergency, where there is also a disruption of access to healthcare, continue to have access to covered services by taking actions, including but not limited to the following:
Relaxing time limits for prior authorizations, pre-certification and referrals
Extending filing deadlines for grievance and requests for appeals
Coordinating, transferring and referring members to alternate sources of care, including out-of-network providers, when providers are closed, unable to meet the demands of a medical surge, affected by an emergency or if the member is outside of the service area due to displacement during or after an emergency
Authorizing out-of-network care, at in-network cost sharing, for DME and medical supply replacement
Members have been provided a toll-free telephone number to call with questions, including questions about the loss of a Beneficiary Identification Card (BIC),access to prescription refills, assistance with displacement and how to access healthcare in the event of an emergency