California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the California Medical...more
5/9/2024
/ Affordable Care Act ,
Algorithms ,
Analytics ,
Artificial Intelligence ,
Bias ,
California ,
Centers for Medicare & Medicaid Services (CMS) ,
Discrimination ,
Health Care Providers ,
Healthcare ,
Insurance Industry ,
Machine Learning ,
Managed Care Contracts ,
Popular ,
Section 1557
On Monday, August 8th, the Deputy Director of Legislative Affairs of the Department of Managed Health Care (the “Department”) released a letter of opposition (the “Letter”) to Assembly Bill 1249 (“AB 1249”). The Letter was...more
After a protracted comment period, the California Department of Managed Health Care (the “Department”) formally adopted its much anticipated “global risk” regulation (the “Regulation”), which will go into effect on July 1,...more
Dual Special Needs Plans -
This part 6 of our 7 part series focuses on the provisions regarding dual special needs plans (“D-SNPs”) released by the Centers for Medicare and Medicaid Services (“CMS”) in the proposed rule...more
11/15/2018
/ Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Dual Eligibility ,
Enrollment ,
Fee-for-Service ,
Filing Grievances ,
Health Care Providers ,
Hospitals ,
Managed Care Contracts ,
MCOs ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Beneficiaries ,
Pharmaceutical Industry ,
Pharmacies ,
Physicians ,
Prescription Drug Coverage ,
Prescription Drugs ,
Proposed Rules