On December 2, the Sacramento Superior Court finalized its order in the CMA-led lawsuit seeking to invalidate the Department of Managed Health Care’s “balance billing” regulation. Consistent with its preliminary ruling, the court determined that the regulation is valid, but only insofar as it seeks to define balance billing as an unfair billing pattern. The court did not address whether DMHC can enforce the regulation against providers, despite DMHC’s public assertions that this regulation “prohibits” balance billing. Despite the lack of clarity from the court on this point, DMHC has indicated that it intends to take enforcement actions against providers that “balance bill.”

CMA is considering its options in response to this ruling and will very likely appeal. Once formal judgment is entered, which will likely happen this week, CMA will have 60 days to file an appeal. CMA may seek to expedite the appeals process, which can take more than a year. CMA’s legal team is also actively exploring separate litigation avenues to challenge DMHC’s authority to take any enforcement action based on this regulation.

As part of our efforts on balance billing and other issues related to out-of-network services, CMA will be conducting a survey of physicians in the coming days. This survey will help provide us with the data to support our legislative and legal advocacy efforts. CMA encourages all physicians to keep an eye out for the survey, and to respond if possible.

Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.