The Department of Managed Health Care last week filed new proposed regulations that would prevent noncontracted physicians from billing patients for emergency services. The regulations will officially be published by the Office of Administrative tomorrow. In August of 2006 DMHC issued similar regulations but did not act on them.

In addition to prohibiting noncontracted and contracted physicians from billing enrollees for emergency services (except for copayments, coinsurance, and deductibles), the new proposal creates a voluntary independent dispute resolution process to resolve payment disputes; requires HMOs in the event of a payment dispute to pay physicians an interim amount of 150 percent of 2007 Medicare rates; and modifies the Gould criteria (the nationally accepted standard for determining fair and reasonable payment for health care services) to include Medicare and contract rates.

CMA still needs to analyze the regulations so that we can more precisely assess the scope of the proposal and develop appropriate strategies to deal with these regulations. Stay tuned to CMA Alert for more information.

Contact: Francisco Silva, 916/444-5532 or fsilva@cmanet.org.