State's high court rules health plans cannot negligently delegate payment responsibility The California Supreme Court today ruled that health plans cannot absolve themselves of the responsibility to pay claims for emergency care by noncontracted providers by negligently delegating that responsibility to a risk-bearing organization that it knows—or should have known—to be financially insolvent. "Today's ruling is a huge victory for physicians," said Francisco Silva, Senior Vice President and General Counsel for the California Medical Association (CMA). "California's high court is unequivocally telling health plans they cannot get away with this morally blameworthy behavior. They cannot irresponsibly delegate risk and leave physicians ... November 21, 2016 Managed Care Amicus Briefs, California Supreme Court, Health Net, Legal Advocacy 0 0 Comment Read More »
CMA tells California Supreme Court it must protect patient data in CURES The California Medical Association (CMA) has filed an amicus brief with the California Supreme Court asking that it give meaningful privacy protection to patient data contained in the Controlled Substance Utilization Review and Evaluation System (CURES) database. CMA was joined on the brief by the American Medical Association, California Psychiatric Association, California Dental Association and the American Dental Association. This case, Lewis v. Superior Court (Medical Board), examines the constitutionality of the Medical Board of California's practice of routinely data mining the confidential prescription records of California patients. In response ... November 9, 2015 General CMA Legal Case List, CURES, Amicus Briefs, California Supreme Court 0 0 Comment Read More »
Supreme Court limits avenues providers can use to sue states over Medicaid funding In March, a divided U.S. Supreme Court ruled in a 5-4 vote, stating that individual health care providers cannot sue states under the Medicaid Act to challenge how states set reimbursement rates in their Medicaid programs. The California Medical Association (CMA) had filed an amicus brief in Armstrong v. Exceptional Child Center, which went to the Supreme Court last month to determine whether Medicaid providers have a cause of action under the Supremacy Clause of the U.S. Constitution to challenge a state’s compliance with Medicaid laws in setting reimbursement ... April 8, 2015 Medi-Cal Medicaid, Medi-Cal, California Supreme Court 0 0 Comment Read More »
