CHA News Article

Certain Rural Counties Exempt From Anthem Advanced Imaging Policy

The Department of Managed Health Care has required Anthem to amend its “Access Standards” on file with the department to reflect that the advanced imaging policy, which requires a medical necessity review before a procedure may be performed in a hospital, will only be effective if there are at least five alternate freestanding imaging sites available within 15 miles of the prescribing provider. Based on this criteria, Anthem is not implementing the policy in the following counties: Amador, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Imperial, Inyo, Lake, Lassen, Madera, Mariposa, Mendocino, Modoc, Mono, Napa, Nevada, Placer, Plumas, San Benito, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yolo and Yuba.

Providers in these exempt counties were issued a notice that the policy is not applicable to them due to the lack of availability of alternate sites. As reported in CHA News, Anthem significantly narrowed the policy earlier this month. The revised policy and the exemption for certain rural areas addresses some of the concerns raised by hospitals; CHA continues to address remaining concerns with the department. The revised policy is still scheduled to take effect Jan. 1.