California Healthline: CMS, State Officials Halt Participation of CalOptima in Dual-Eligible Plan

by David Gorn

Federal officials on Friday declared Orange County’s CalOptima insurance company had “multiple, serious violations” in its program for seniors and the disabled.

The insurer denied legally-required prescription coverage, failed to process provider payments in a timely manner and failed to pay for covered emergency services, among other charges, according to a letter released Friday by CMS officials.

The 10-day audit found these problems to be “widespread and systemic.”

“CMS has determined that CalOptima failed to provide its enrollees with services and benefits in accordance to CMS requirements,” the letter said.

In a written statement, CalOptima CEO Michael Schrader said he hopes to address all CMS concerns quickly. “While there is a significant amount of work ahead for CalOptima and our health network partners, rest assured that there is no higher priority than ensuring access and quality of care for our members,” he said.

Continue reading here: http://www.californiahealthline.org/capitol-desk/2014/1/cms-state-officials-halt-participation-of-caloptima-in-dualeligible-plan

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  • LAAAC is managed by St. Barnabas Senior Services; Funded, in part, by Archstone Foundation.
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