News & Analysis as of

California Health Insurance Health Care Providers

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

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

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

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

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

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

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

Mintz - Health Care Viewpoints

California Publishes Proposed Regulations for the Pre-Closing Review of Health Care Transactions: What You Need To Know Before...

January 1, 2024 is rapidly approaching, which is when California’s new Office of Health Care Affordability (OHCA) is set to begin advance regulatory review of certain health care mergers, acquisitions, affiliations, and other...more

Robinson+Cole Health Law Diagnosis

California Governor Signs Trailer Bill to State Budget Increasing Oversight of Health Care Entities Statewide

On June 30, 2022, Governor Gavin Newsom signed the 2022-2023 California state budget, which included a trailer bill, Senate Bill 184 (the Bill) which makes numerous statutory revisions impacting health programs and consumers....more

Nossaman LLP

CMIA Amendments Increase Health Care Providers’ Responsibility for Protecting Enrollees’ Privacy

Nossaman LLP on

Newly enacted Assembly Bill 1184 (“AB 1184”) will effectuate revisions to the Confidentiality of Medical Information Act that will require significant changes to the operational practices and risk management assessments of...more

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