Regulatory Advocacy

Among the many advocacy efforts that CAL/ACEP engages in on behalf of its members is regulatory advocacy. The myriad state departments, agencies, bureaus and boards that engage in the regulation of health care providers, insurers and services demand a watchful advocate to safeguard physician and patient interests. Over the years, CAL/ACEP has successfully fought back regulations that would have seriously harmed the ability of emergency physicians to care for their patients effectively. If you have any questions regarding current regulatory advocacy efforts, please check here for information or contact us at advocacy@calacep.org.

CAPG CHALLENGE TO THE GOULD CRITERIA

CAL/ACEP Continues to Fight for Fair Payment

UPDATE: On Monday, April 20, 2009, the Department of Managed Health Care denied CAPG's request to amend the Gould criteria, concluding that the legal developments cited by CAPG did not require amendment of existing regulations and that the out-of-state cases cited by CAPG had no bearing in California. The Department's ruling affirmed that the Gould criteria, as it stands, are consistent with California case law.

DMHC Decision Denying CAPG Request

CAL/ACEP continues to defend fair payment by HMOs and their delegated payers. CAPG has once again filed a request with the Department of Managed Health Care to amend the regulations that set forth the Gould criteria as the basis for determining fair and reasonable reimbursement. CAPG seeks to add contract rates as well as payments under Medi-Cal and Medicare to the list of factors to be considered. CAPG filed a similar request in 2006 which the Department denied.

CAPG's Letter to DMHC

CAL/ACEP's Response to CAPG Request

CMA's Response to CAPG Request

BALANCE BILLING/FAIR PAYMENT REGULATIONS

The Department of Managed Health Care has repeatedly proposed regulations that would ban balance billing while ignoring the lack of fair payment for providers of non-contracted emergency care. CAL/ACEP continues to advocate on behalf of emergency physicians and their patients who would suffer if hundreds of millions of dollars were siphoned off from the already crumbling emergency care system into the hands of the billion dollar HMOs.

DMHC Unfair Billing Practices Regulations (Control# 2008-1536)
DMHC Response to Public Comments - Unfair Billing Practices Regulations (Control# 2008-1536)

DMHC Unfair Billing Patterns Regulations (Control# 2007-1253)
CAL/ACEP Comments - DMHC Unfair Billing Patterns Regulations (Control# 2007-1253)

DMHC Unfair Billing Patterns Regulations (Control# 2006-0782)
CAL/ACEP Comments - DMHC Unfair Billing Patterns Regulations (Control# 2006-0782)

DMHC Unfair Billing Patterns Regulations (Control# 2006-0777)
CAL/ACEP Comments - DMHC Unfair Billing Patterns Regulations (Control#2006-0777)