News & Analysis as of

California Centers for Medicare & Medicaid Services (CMS)

ArentFox Schiff

Investigations Newsletter: Medical Group and Related Parties to Pay Over $62 Million to Resolve FCA Claims for False Diagnoses

ArentFox Schiff on

Medical Group and Related Parties to Pay Over $62 Million to Resolve FCA Claims for False Diagnoses - On March 26, the US Department of Justice (DOJ) announced that a California-based medical group and related parties...more

Goodwin

Health Headlines: February 2025

Goodwin on

Welcome to the third issue of Health Headlines, a newsletter created by lawyers in our Healthcare practice....more

Davis Wright Tremaine LLP

Effective Care: California Left Behind as Other States Expand Hospital at Home Programs

Hospital at Home (“HaH”) programs received renewed interest during the COVID-19 pandemic as a way to relieve hospital capacity issues and allow patients to receive effective care outside of the traditional hospital setting....more

Proskauer - Health Care Law Brief

This New Year, California Imposes Guardrails on the Use of AI by Payors for Utilization Management Determinations

SB 1120 (the “Bill”), which takes effect on January 1, 2025, amends existing California law to adopt guardrails around the use of artificial intelligence tools for the purpose of utilization management. As discussed in a...more

Sheppard Mullin Richter & Hampton LLP

The Intersection of Artificial Intelligence and Utilization Review

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

McDermott Will & Schulte

New York State Budget Institutes Revenue-Neutral Health Plan Tax

The New York State fiscal year 2024 – 2025 budget was signed on April 20, 2024, instituting, among many other provisions, a new tax on health plans, including insurers and managed care organizations. This tax has been...more

Foley & Lardner LLP

FCA Managed Care Case Update: A Court’s View of ICD Guidelines in Risk Adjustment Cases

Foley & Lardner LLP on

Addressing a recent motion to dismiss, the Northern District of California predominantly denied Kaiser Permanente’s (“Kaiser”) motion to dismiss the government’s complaint in United States ex rel. Osinek v. Permanente Medical...more

Wilson Sonsini Goodrich & Rosati

New California Law Turns Up the Heat on the Sunshine Act: California Physicians and Surgeons Must Provide Notice to Patients About...

Effective January 1, 2023, California Assembly Bill 1278 requires California-licensed physicians and surgeons, including physicians and surgeons licensed under the Medical Practice Act or the Osteopathic Act (but excluding...more

McDermott Will & Schulte

New California Law Requires Open Payments Notice to Patients

McDermott Will & Schulte on

On September 29, 2022, California Governor Gavin Newsom signed Assembly Bill 1278, which requires physicians and their employers to provide patients with notices about the Open Payments database starting January 1, 2023. ...more

Sheppard Mullin Richter & Hampton LLP

California Passes First State Law Requiring Physicians to Disclose Open Payments Database to Patients

Effective January 1, 2023, the recently enacted California Assembly Bill 1278,requires a physician and surgeon (defined as a physician and surgeon licensed pursuant to the Medical Practice Act or an osteopathic physician and...more

Mintz - Health Care Viewpoints

California Passes New Law Requiring Physicians and their Employers to Notify Patients about the Open Payments Database

A new California law (AB 1278) will require physicians and their employers to provide patients with several forms of notices about the Open Payments database, starting January 1, 2023. The law is intended to increase...more

ArentFox Schiff

HHS COVID-19 Public Health Emergency Persists as California COVID-19 Policies Are Set To Expire

ArentFox Schiff on

The US Department of Health and Human Services’ (HHS) declaration that COVID-19 remains a public health emergency (PHE) will continue through July 15, 2022, and is expected to be renewed again through October 13, 2022....more

Sheppard Mullin Richter & Hampton LLP

Medicaid and Health Equity: CalAIM’s Bold Experiment

More than 13 million people were enrolled in Medi-Cal in California in September 2021, making it the largest Medicaid program in the nation. In December 2021, the Centers for Medicare & Medicaid Services (CMS) approved the...more

Sheppard Mullin Richter & Hampton LLP

DMHC Guidance Confirms that California Law, Not the Federal No Surprises Act, Governs Payment and Dispute Resolution Processes for...

Executive Summary - The California Department of Managed Health Care (“DMHC”) issued a recent guidance interpreting the application of the No Surprises Act (“NSA”)—a new federal law prohibiting out-of-network healthcare...more

King & Spalding

California DMHC Takes Position that Additional California Law Constitutes “Specified State Law” Under the No Surprises Act

King & Spalding on

Last week, the California Department of Managed Health Care (DMHC) issued an All-Plan Letter (APL) stating that California case law and the Knox-Keene Health Care Service Plan Act of 1975 (the Knox-Keene Act) constitute...more

King & Spalding

CMS Approves CalAIM proposal to transform California’s Medi-Cal

King & Spalding on

On December 29, 2021, the California Department of Health Care Services (DHCS) announced CMS’s approval of its California Advancing and Innovating Medi-Cal (CalAIM) proposal. CalAIM’s launch on January 1, 2022 is part of a...more

Constangy, Brooks, Smith & Prophete, LLP

FAQs About California’s Vaccine Mandate For Health Care Workers

Compliance is required by September 30. As a result of COVID-19 outbreaks related to unvaccinated health care workers, the California Department of Public Health has issued two significant orders. The first order,...more

Bass, Berry & Sims PLC

New California Rules Limit Prescription Auto-Refill Programs

Bass, Berry & Sims PLC on

Starting next summer, California licensed pharmacies offering automatic prescription refill programs will be subject to new constraints and limitations. California recently approved new Board of Pharmacy regulations, which go...more

Sheppard Mullin Richter & Hampton LLP

Private Equity and Healthcare – MedPAC’s Desire for More Transparency in Provider Ownership

In 2019, the Chair of the U.S. House Committee on Ways and Means (the “Committee”) asked the Medicare Payment Advisory Commission (“MedPAC”), an independent congressional agency established in 1997 to advise Congress on...more

King & Spalding

California Medicaid Set to Lose $200 Million in Funding Next Quarter for its Universal Abortion Coverage Mandate

King & Spalding on

On December 16, 2020, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), announced that the Centers for Medicare & Medicaid (CMS) will disallow $200 million in federal Medi-Cal funding next...more

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