The Weekly Articles

The Department of Managed Health Care (DMHC) recently amended its regulation for the reimbursement methodology for certain health care services provided by non-contracting providers at in-network facilities under California’s out-of-network billing and payment law (AB 72 (Bonta, 2016)). Beginning January 1, 2024, health plans will be required to add an annual inflation adjustment to their average contracted rates when calculating out-of-network provider reimbursements for services subject to AB 72. Prior to this amendment, the reimbursement rate was based on average contracted rates from two years prior to the date of service. This amendment aligns DMHC’s AB 72 methodology with that of the Department of Insurance, which has required an inflation adjustment since 2019.

Kiel Yager with CommonSpirit Health was promoted to Senior Corporate Counsel where he serves as operational counsel for the Sacramento market.

Kiel Yager with CommonSpirit Health was promoted to Senior Corporate Counsel where he serves as operational counsel for the Sacramento market.

Effective January 1, 2024, certain health care practitioners will be allowed to provide care to California residents without a California license. AB 1369 (Bauer-Kahan) authorizes out-of-state physician specialists in good standing to provide care using telehealth to California patients who have an immediately life-threatening disease or condition who meets specified requirements. The goal of this legislation was to allow patients with life-threatening conditions to access highly specialized physicians in other states without having to travel out-of-state for care. Additionally, AB 232 (Aguiar-Curry) permits marriage and family therapists, professional clinical counselors, and clinical social workers licensed in other states to provide services to California clients for up to 30 days without a California license. These individuals must meet specific requirements and must have an established, on-going client-provider relationship at the time the client becomes located in California. The allowance of the temporary practice is to address continuity of care issues for clients who may be temporarily in, or relocating to, California.

Lastly, California continues its efforts to streamline expanded telehealth coverage following the flexibilities in pace during the COVID-19 pandemic. AB 1241 (Weber) clarifies that Medi-Cal providers who offer services via telehealth are not required to schedule and appointment with a different provider on behalf of a patient in order to meet the requirement that they either must provide the option of in-person care for any services they offer using telehealth or facilitate in-person care with a different provider.

In addition to her “regular” job with the University of California, Margia Corner was recently asked to step up and become one of two Interim Deputy General Counsels for Health Affairs, Privacy and Data Protection – along with her colleague and friend Hoyt Sze - while a national search is conducted for someone to fill the role on a fulltime basis.

For Margia the Interim role has a special significance going back to the beginning of her career as a lawyer – when she was a law clerk for Rachel Nosowsky at the University of Michigan.  She credits that early opportunity for her later interest in inhouse roles where she has been able to not just give legal advice but also serve as part of a team achieving an organization’s priorities.  She discovered that she thrives in multi-stakeholder, consensus based environments like the UC where she spends much of her days talking with brilliant, diverse non-lawyers.

Asked what advice she would give to those starting a health law career, Margia said that new health lawyers should (1) look for an intellectual community that they find challenges them and (2) learn to trust themselves even in situations that don’t have lots or rules or precedent to rely on.  (She also notes that the UC summer clerkship and full-time two year clerkship in privacy and data protection – both accepting applications now – might be a good way to check out the realities of inhouse work.)

Part of Margia’s “intellectual community” is CSHA – she makes many accidental discoveries when talking with other members and learning their perspectives. She also doesn’t remember a CSHA conference where she hasn’t come way with at least one “Uh oh” topic that wasn’t even on her radar until listening to someone’s presentation and that represents an opportunity for improvement for UC!

The Department of Health Care Access and Information (HCAI) finalized new regulations about hospital charity and discount care policies and practices. These regulations establish new requirements for:

• Notices and correspondence directed to patients about charity care and discount payment
• Hospital signage, website language
• Submitting hospital policies to HCAI
• Responding to patient complaints and HCAI correspondence, including timelines
• Penalties for violating the Hospital Fair Pricing Policies (HFPP) statutes and regulations

The regulations were required by AB 1020 (2021), which also transferred enforcement authority for the HFPP law from the California Department of Public Health to HCAI. Hospitals are advised to carefully review the new regulations now and take the steps needed to become compliant by Jan. 1, 2024.

The California Society for Health Attorneys (CSHA) invites potential sponsors to be part of the 2024 Annual Meeting & Spring Seminar, taking place from May 3-5 at the stunning Everline Resort & Spa in Lake Tahoe!

Patient notice requirements related to the Open Payments database, a CMS database listing payments or transfers of value made to physicians by certain drug and medical device manufacturers, will expand to physician websites on January 1, 2024

Individuals and employers alike are faced with an increase in premiums as California’s open enrollment began on November 1.  Inflation and abortion coverage in response to the Dobbs decision may be to blame. 

Last week the California Department of Justice released a report on healthcare facility compliance with the California Dignity in Pregnancy and Childbirth Act (Sen. Bill No. 464 (Mitchell) (2019-2020 Reg. Sess.)), Health & Safety Code, section 123630 et seq. (the “Act”).