MedicaidAdministrativeMedium impact
Available Resources and Reminders
L.A. Care Health Plan·CA·Provider Communication
Effective date
Aug 3, 2026
We identified it
Aug 4, 2026
Summary
L.A. Care Health Plan issued a reminder policy emphasizing Enhanced Care Management (ECM) eligibility screening and prior authorization best practices for L.A. Care members. The policy clarifies that DME prior authorization requests should originate from contracted DME suppliers (not ordering providers) to ensure accurate codes and quantities, and introduces in-home assessments via Periscope for complex DME requests exceeding $5,000 or with access concerns.
Action Required
Immediately effective (August 3, 2026): (1) Billing and clinical staff must update DME prior authorization workflow to direct all requests through contracted DME suppliers (e.g., Western Drug at https://www.westerndrug.com/) rather than submitting from the ordering provider. (2) Providers must include complete clinical documentation (written orders, prescriptions, history, physical exam findings, treatment plan, progress notes) with all prior authorization submissions to prevent delays and secondary authorization requests. (3) When ordering DME items with anticipated costs >$5,000 or where member access/usability is unclear, providers should anticipate L.A. Care will coordinate in-home assessments through Periscope and plan accordingly for extended review timelines. (4) Front-desk and billing staff should refer eligible members (experiencing homelessness, frequent ED/hospital admissions, serious mental health/substance use disorder, high-risk pregnancy, recent incarceration, long-term care risk, or recent SNF discharge) to ECM team at (844) 200-0104 or ECMMembership@lacare.org. Failure to route DME requests through contracted suppliers will result in incomplete authorizations requiring resubmission and delayed member equipment delivery.