News & Analysis as of

Health Insurance Medi-Cal

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

Nossaman LLP

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

Nossaman LLP on

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

Foley & Lardner LLP

California Moves to Transform the Behavioral Health Delivery System – are Payers and Providers Ready?

Foley & Lardner LLP on

This is the first article in a series addressing key changes to the California health care marketplace, focused on changes to California’s behavioral health delivery systems. Forthcoming articles in the series will address...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

McDermott Will & Schulte

New Laws Expand Telehealth in California

California Governor Gavin Newsom recently signed into law two bills that expand the delivery of telehealth services in the state. In particular, the legislation: • Permits providers to prescribe medications without a...more

King & Spalding

How Payers Are Improperly Underpaying Inpatient Services As Observation Services

King & Spalding on

Health plans and their delegated IPAs are using a number of different tactics to deny payment for inpatient services by improperly classifying inpatient claims as observation or other types of outpatient status. Payers are...more

Brownstein Hyatt Farber Schreck

Expansion of Medicaid Eligibility for Undocumented Young Adults

In recent weeks, the states of California and Washington, and New York City have proposed expanding Medicaid eligibility for undocumented young adults. Given Medicaid’s combination of state and federal funding, House and...more

Mintz - Health Care Viewpoints

A Rundown of Recent State Action Relating to Medicaid Expansion

To date, 34 states (including D.C.) have adopted Medicaid expansion. Of the remaining 17 states, some are considering expanding Medicaid. States with recent activity relating to Medicaid expansion include Florida, Idaho,...more

Buchalter

California Clamps Down On Surprise Out-Of-Network Bills

Buchalter on

On September 23, 2016, Governor Brown signed AB 72, California’s surprise out-of-network law. The bill protects patients who seek care at an in-network facility from balance billing by individual health care providers who are...more

Foley & Lardner LLP

California Targets Surprise Medical Bills, Follows on the Heels of New York and Florida

Foley & Lardner LLP on

Governor Brown approved a new law last Friday that limits patient exposure to so-called surprise medical bills. AB 72 caps the cost-sharing obligations of patients who unexpectedly receive care from non-contracted providers...more

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