California's Independent Medical Review: History, Impact, and Prospects for Change

For more than 10 years, California consumers in most private health plans have had the right to obtain an independent external review of any health plan coverage denials, known as Independent Medical Review (IMR). The California IMR process is available to the more than 24 million Californians covered through health plans regulated by the California Department of Managed Health Care (DMHC) or health insurers regulated by the California Department of Insurance (CDI). This Sacramento briefing focused on a new Kelch Associates analysis of the California IMR program's history and impact, and prospects for change. The federal Affordable Care Act (ACA) mandates independent external review for all health coverage, including products for self-insured group plans. As coverage expands under health reform, the number of health plan enrollees with access to IMR appeal rights will increase. The federal Department of Health and Human Services determined that California need not make any statutory changes to its IMR process to comply with the ACA. Changes to California's IMR process, or the way California administers and evaluates it, will be state driven. The briefing highlighted several potential administrative improvements that position the state to more effectively deliver on the promise of a credible, transparent, and effective IMR program. Participants included: Beth Capell, lobbyist/policy advocate, Health Access California Tony Cignarale, deputy commissioner, CDI Lyn Gage, health program manager II, DMHC Andrew George, assistant deputy director, DMHC Help Center Patrick Johnston, president and CEO, California Association of Health Plans Deborah Kelch, president and CEO, Kelch Associates Carol Lee, president and CEO, California Medical Association Foundation Marian Mulkey, director, Health Reform and Public Programs Initiative, CHCF Sandra Shewry, director, State Health Policy, CHCF Jill Yegian, managing director, American Institutes for Research Read more: http://www.chcf.org/events/2012/briefing-medical-review#ixzz1lMpgyhVP