News & Analysis as of

California Health Insurance

Woodruff Sawyer

California’s New Fertility Coverage Mandate: What Employers Need to Know

Woodruff Sawyer on

California passed SB 729, a fertility coverage mandate that addresses accessibility to fertility treatments for certain employees. This compliance alert provides a brief overview of who the law applies to, what benefits are...more

Davis Wright Tremaine LLP

Two California Appellate Decisions Highlight Liability Risks Arising From Hospital "Conditions of Admission" Forms and Billing...

In the ever-evolving world of healthcare billing, two recent reported California appellate court decisions, Naranjo v. Doctors Medical Center of Modesto and Dameron Hospital Association v. Progressive Casualty Insurance...more

Troutman Pepper Locke

California AG Takes Action Against $1.3 Million Insurance Fraud Scheme

Troutman Pepper Locke on

In May, California’s attorney general (AG) charged a local dermatologist with more than 20 counts of fraud after uncovering a scheme that allegedly resulted in the state’s Medicaid program paying out over $1.3 million for...more

Fennemore

California’s Bold Experiment with Whole-Person Centered Care: Has it Worked?

Fennemore on

CalAIM is an initiative of the California Department of Health Care Services (the Department) to improve the quality of life and health outcomes of Medi-Cal members by implementing delivery system, program, and payment...more

ArentFox Schiff

Mental Health Parity: In a Pair of Decisions, California Federal Court Rejects United’s Efforts to Kick Behavioral Health Class...

ArentFox Schiff on

Within the last month, the US District Court for the Northern District of California rejected efforts by United Behavioral Health (UBH) to dismiss and decertify two class actions seeking relief related to UBH’s processing of...more

Mintz

[Podcast] Health Law Diagnosed – Health Care Transaction Review Laws and the New Normal

Mintz on

In the latest episode of Health Law Diagnosed, host Bridgette Keller discusses the evolving legislative and regulatory landscape impacting health care transactions, particularly for private equities and hedge funds. She is...more

Hanson Bridgett

Peer Review by Licentiates Only: Beware Health Care Service Plans!

Hanson Bridgett on

On February 19, 2025, the California Court of Appeal published a decision, Lin v. Board of Directors of PrimeCare Medical Network, Inc., 108 Cal.App.5th 1163, emphasizing California Business and Professions Code’s requirement...more

Weintraub Tobin

President Signs Executive Order To Study IVF Policy Protections Forecasting Possible Future Federal Safeguards for California IVF...

Weintraub Tobin on

On February 18, 2025, President Donald Trump signed an executive order to study policy recommendations to protect access to in vitro fertilization (IVF) and to reduce their associated costs. While headlines about the order...more

Maynard Nexsen

The Legal Landscape for AI-Enabled Decisions for Health Care Claims and Coverage Continues to Evolve:  From Litigation to Emerging...

Maynard Nexsen on

With all the hype around AI, business partners and legal professionals are scrambling to understand, adapt, and possibly implement the rapidly changing technology. From a business perspective, the excitement around AI with...more

ArentFox Schiff

California Claps Back on Insurer Use of AI to Deny Needed Medical Care Decisions

ArentFox Schiff on

California is leading the way in ensuring that determinations of medically necessary health care services are made by licensed physicians and not artificial intelligence (AI) algorithms....more

Mintz - Health Care Viewpoints

California Attorney General Issues Warning on Artificial Intelligence in Health Care

On January 13, 2025, California Attorney General Rob Bonta (the California AG) issued two Legal Advisories regarding the utilization of artificial intelligence (AI). The first Legal Advisory provides guidance to consumers and...more

McDermott Will & Schulte

California SB 923: New Trans-Inclusive Healthcare Requirements for Health Plans

Beginning in the first quarter of 2025, California healthcare service plans, health insurers, Medi-Cal managed care plans, and PACE organizations must ensure that staff who have direct enrollee contact receive evidence-based...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

Fennemore

California Department of Public Health (CDPH) ‘All Facilities Letter’ and Survey Activities Impacting Nurse Anesthesiology Scope...

Fennemore on

The California Department of Public Health’s (CDPH) September 6, 2024, All Facilities Letter (AFL) reaffirms the independent practice authority of Certified Registered Nurse Anesthetists (CRNAs). Despite this reaffirmation,...more

DLA Piper

California Implements New AI and Software Regulations for Insurers

DLA Piper on

On September 28, 2024, California enacted SB 1120, which regulates the use of artificial intelligence (AI), an algorithm, or “other software tool” in utilization review and utilization management (UR/UM) functions by...more

Troutman Pepper Locke

California Governor Signs Legislation Impacting Health Care Claim Reimbursement and DMHC Requests for Records

Troutman Pepper Locke on

On September 27, California Governor Gavin Newsom signed into law two bills that will impact health care service plans and insurers in the state....more

Bass, Berry & Sims PLC

The California Insurance Frauds Prevention Act: Recent Developments Regarding California’s Powerful Commercial Health Insurance...

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We have previously discussed the California Insurance Frauds Prevention Act (IFPA)–a state antifraud statute that, while modeled on the False Claims Act (FCA), is unique in targeting fraud in the commercial health insurance...more

BakerHostetler

OHCA Proposes Material Updates to CMIR Regulations

BakerHostetler on

California’s Office of Health Care Affordability (OHCA) released a set of proposed revisions to its sweeping Cost & Market Impact Review (CMIR) regulations yesterday afternoon. ...more

Sheppard Mullin Richter & Hampton LLP

California is Capping Health Care Cost Increases – Starting at 3.5% in 2025

As we previewed last year regarding SB 184 and the establishment of the California Office of Health Care Affordability (OHCA), California now has taken a significant regulatory step aimed at restraining growth in health care...more

King & Spalding

California Hospitals Sue Insurance Company Over Delayed Patient Discharges

King & Spalding on

Last week, the California Hospital Association (CHA), which represents more than 400 hospitals, filed a lawsuit against Anthem Blue Cross (Anthem) alleging that Anthem’s untimely arrangement for, and authorization of,...more

Jones Day

California Health Care Providers to Face Greater Headwinds as State Implements Health Care Cost Targets

Jones Day on

Pursuant to California's Health Care Quality and Affordability Act (the "HCQA"), the newly created Office of Health Care Affordability ("OHCA") recently proposed statewide health care cost targets and standards and goals for...more

Mintz - Health Care Viewpoints

California’s Health Care Transactions Review Law: Preparing for What Comes Next

California’s health omnibus trailer bill SB-184 and the final cost and market impact review (CMIR) regulations (CMIR Regulations), which went into effect on December 18, 2023, have ushered in a significant change in...more

Epstein Becker & Green

California Finalizes SB 184 Pre-Transaction Notice Requirements for “Material Change” Health Care Transactions

Epstein Becker & Green on

On December 18, 2023, the California Office of Administrative Law approved the emergency regulations promulgated by the Office of Health Care Affordability (OHCA) that set forth the procedural framework for (i) the...more

Epstein Becker & Green

California Enacts Statute That Furthers Efforts to Move Toward a Unified Health Care Financing System

Epstein Becker & Green on

On October 7, 2023, California Governor Gavin Newsom signed SB 770 into law, providing for the further development of a framework to establish a unified health care financing system in California....more

Nossaman LLP

CA DHCS Announces New MLR Requirements on Subcontractors, Including IPAs, RBOs and RKKs

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California’s Department of Health Care Services (DHCS) is in the final stages of establishing new Medical Loss Ratio (MLR) requirements in Medi-Cal Managed Care. Most significantly, the guidelines specify that the MLR...more

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