The California Department of Health Care Services (DHCS) funds healthcare services for more than 15.4 million Medi-Cal beneficiaries. About one-third of Californians receive health care services financed or organized by DHCS,...more
Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more
In our practices, we are seeing an increasing number of denials or de facto denials of Medi-Cal provider enrollments. The consequences of a Medi-Cal enrollment denial can be quite serious. First, a provider may not receive...more
California AG Rob Bonta, in partnership with the DOJ, settled with four health care providers to resolve allegations that they violated state and federal False Claims Acts through the submission of fraudulent claims to...more
In February 2023, the California Department of Health Care Services (DHCS) published the Medi-Cal for Kids & Teens Outreach and Education Toolkit. The Toolkit was developed to promote and improve understanding among families,...more
California’s Advancing and Innovating Medi-Cal (CalAIM) seeks to transform the Medi-Cal (California Medicaid) delivery system for more than 14 million Californians, embracing a population health approach that prioritizes...more
The recently unveiled California Health and Human Services Data Exchange Framework (the Framework) creates a new regulatory and governance structure to promote the exchange of health information between health care providers...more
Many California health care providers, including hospitals and physician groups, will soon be required to sign on to California’s first-ever statewide data sharing agreement governing the exchange of health and social...more
Family Health Centers of San Diego (Health Center) operates a federally qualified health center (FQHC) that has 49 locations throughout San Diego County, California, and provides a comprehensive range of primary and...more
Editor’s Note: In a new report commissioned by the David and Lucile Packard Foundation, the J.B. and M.K. Pritzker Family Foundation, and Genentech Charitable Giving, Manatt Health—in partnership with DCR Initiatives and the...more
Editor’s Note: In a new report for the California Health Care Foundation, summarized below, Manatt Health discusses the impact of key legal changes that supported the delivery of community behavioral health services in...more
California has joined the growing ranks of states, as well as the federal government, in efforts to facilitate the efficient provision of healthcare services during the pandemic....more
On March 5th, the Department of Managed Health Care (DMHC) issued its first COVID-19 related All-Plan Letter (APL 20-006) regarding screening and testing. The DMHC directed all full service commercial and Medi-Cal health care...more
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
The California Department of Health Care Services (“DHCS”) recently revised its Medi-Cal telehealth policy to allow providers increased flexibility in their use of telehealth as a modality for delivering medically necessary...more
Assembly Bill 3087 seeks to establish a nine-person commission tasked with imposing set prices for specific services and procedures provided by hospitals and other healthcare providers in California. Medi-Cal, Medicare, and...more
California’s First District Court of Appeal (“Court of Appeal”) has recognized that percentage-based billing arrangements do not violate California’s Medi-Cal laws and that the California Department of Health Care Services...more
A new report prepared for the California Health Care Foundation reviews California’s Medicaid rate-setting process and offers recommendations for adjustments to that process to encourage health plan investments in...more
California’s Medicaid agency has posted draft language of a new state plan amendment (SPA) that would make major changes to federally qualified health center (FQHC) and Rural Health Clinic (RHC) reimbursement. Public comments...more
Medi-Cal and other California health care providers will soon be required to change their document retention policies and practices for services rendered under programs administered by California’s Department of Health Care...more
The Bankruptcy Court for the Central District of California examined the scope of the doctrine of recoupment for Medicaid and related payments, allowing the deduction by the state. The court held that the California...more
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
Montana receives approval to expand Medicaid beginning 2016; California’s $6.2 billion Medicaid waiver receives pre-approval; and HHS proposes broadening circumstances under which states receive enhanced federal matching...more
On March 31, 2015, a 5-4 plurality of the Supreme Court of the United States ruled that Medicaid providers do not have a private right of action under the Medicaid statute to challenge reimbursement rates. The Supreme Court’s...more