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On Friday, January 25, 2019, the Department of Managed Health Care (DMHC) published its latest draft of a proposed regulation that will dramatically expand the scope of arrangements subject to licensure under the Knox-Keene Act. The regulation breaks with the DMHC’s longstanding policies and threatens to disrupt common provider payment arrangements in California, including hospital risk pools, bundled payment arrangements, and accountable care organizations (ACOs), and to stifle innovation in the area of value-based payments.

Under the proposed regulation, a Knox-Keene license would be required for an entity to accept “global risk,” which is defined as the acceptance of a “prepaid or periodic charge” in exchange for assuming “both professional and institutional risk.” (28 C.C.R., proposed § 1300.49, subds. (a) & (b)(1).) The statute has long defined health care service plans in reference to providing or arranging for health care services in exchange for a “prepaid or periodic charge.” However, the regulation provides a new definition of that term that encompasses payments made “at the start or end of a predetermined period… that may be fixed either in amount or percentage of savings or losses in which the entity shares.” (28 C.C.R., proposed § 1300.49, subd. (a)(4).) Providers that engage in shared risk arrangements, which involve fee-for-service payments with shared savings payable after a set period of time, even those involving upside risk only, may be subject to licensure under the new rule. Read More ›

Beginning October 2, 2018, California health care professionals authorized to prescribe, order, administer or furnish controlled substances must consult the state’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) prior to prescribing, ordering, administering or furnishing Schedule II-IV controlled substances, unless an exemption applies.[1]  The duty to consult takes effect almost two years after the law was initially enacted, and six months after the California Department of Justice (DOJ) certified CURES as ready for statewide use. Read More ›

The Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services (HHS), issued a final rule on January 3, 2018 to the federal regulations governing the confidentiality of health information in federally-assisted substance use disorder (SUD) programs, found in 42 CFR Part 2 and known as “Part 2.” Read More ›

On July 19, 2016, the HHS Office for Civil Rights (OCR) published materials, including training materials for health care providers and Notices of Nondiscrimination and Taglines that alert limited English proficient (LEP) individuals of available language assistance services.  Read More ›

In response to a growing lifestyle disease epidemic over the last several decades, and the resulting adverse impact on employee health and well-being, there is increased interest in employer-based wellness programs, as well as employer-based health clinics. According to RAND Health’s Workplace Wellness Programs Study Final Report (2013), recognizing that these chronic conditions lead to lowered productivity due to absence from illness (absenteeism)and reduced performance even while at work (presenteeism), as well as the associated increase in health care coverage costs and reduced competitiveness in the marketplace, about half of all U.S. employers with 50 or more employees offer workplace wellness programs. Read More ›

For media assistance, please contact Maura Fisher at 202-580-7714.