DSR Health Law

DSR represents more than 20 full-service health care plans and specialty plans throughout California, including more than half of the state’s Medi-Cal managed care plans.  Our experience makes us uniquely positioned to represent health plans, health insurers, and other health care payors through the complicated regulatory and legal issues distinct to our clients.  Whether it is heightened government scrutiny, creative industry practices, or litigation, we advise our clients to effectively compete in the complex health care world.

DSR Health Law Blogs

Latest from DSR Health Law

CMS Recently Introduced New Interoperability Mandates for Health Plans That Must be Implemented by July 1, 2021 The CMS Interoperability and Patient Access Rule (“Interoperability Rule”) requires payors to permit third-party applications to retrieve, with the approval and at the direction of a current enrollee certain health care data.  42 C.F.R. §§ 422.119(a), 431.60(a), 457.730(a); 45 C.F.R. § 156.221(a).  The Interoperability Rule does not alter covered entities’ or business associates’ responsibilities to protect PHI under HIPAA, however, once a member selects a third-party application and authorizes access of their data to the application, the covered entity and business associate are…
New U.S. Supreme Court Decision May Expand Health Plans’ Ability to Text Members Under the TCPA The Telephone Consumer Protection Act of 1991 (TCPA) has restricted health plans’ ability to call or send text messages to cell phone numbers.  The U.S. Supreme Court’s recent decision in Facebook, Inc. v. Duguid, 141 S. Ct. 1163 (2021) (“Facebook”) eases those restrictions by clarifying and narrowing the type of dialing equipment which falls within the TCPA’s definition of an automatic telephone dialing system (“autodialer”). The TCPA generally makes it unlawful to make any call (other than a call made for emergency purposes…
Department of Health Care Services Seeks Input From Health Plans The Department of Health Care Services (DHCS) released a Request for Information (RFI) to solicit stakeholder input into the development of a forthcoming Medi-Cal Managed Care Plan Request for Proposal (RFP) and the updated Medi-Cal managed care contract. The RFI contained two parts.  The first is a set of questions to guide stakeholder input to the RFI related to the DHCS’s expressed goals for the Medi-Cal managed care delivery system.  The second is an invitation for input specifically from health plans that may be interested in submitting a proposal in…
Federal Court ruling confirms that the Health Insurance Provider Fee must be factored into Medicaid capitation rates In a recent decision, the Fifth Circuit Court of Appeals reversed a United States District Court judgment that would have resulted in Medicaid managed care organizations (MCOs) paying the Affordable Care Act’s (ACA) Health Insurance Provider Fee (HIPF) without having that enormous expense factored into their capitation rates.  The appellate decision maintains the rule that actuarially sound rates are to provide for all reasonable, appropriate, and attainable costs, and such costs include government-mandated taxes and fees like the HIPF. In Texas v. United…
The FCC’s Declaratory Ruling Exempts COVID-19 Messages The Telephone Consumer Protection Act (TCPA) establishes various restrictions on the use of calls or text messages, particularly without express consent.  The TCPA does, however, include an exemption for “emergency purposes.”  In the event there were any question regarding whether the current COVID-19 pandemic qualifies as an emergency under this exemption, the Federal Communications Commission (FCC) removed all doubt in late March 2020, issuing a Declaratory Ruling (DA 20-318).  The Declaratory Ruling provides immediate emergency exemptions for government officials, health care providers, and state and local health officials, among others, to communicate…
What Triggers a Force Majeure Provision and Excuses Performance? According to Merriam-Webster, “force majeure” translates from French as “superior force.”  In contracting terms, a “force majeure” clause is an often overlooked provision containing boilerplate language that will very rarely ever be triggered.  The clause is intended to allow a party to be relieved of contractual obligations when unforeseen events beyond that party’s control make it impossible or impracticable for the party to perform. Most health plan contracts with providers or vendors contain a force majeure clause.  Whether and/or to what extent a particular force majeure clause will be impacted by…
Court Rules that California Legislature Intended Medi-Cal Managed Care Plans to Pay APR-DRG Rates to Out-Of-Network Hospitals for Post-Stabilization Services A five-year battle against Dignity Health concluded on January 9, 2020 when the Second District Court of Appeal ruled in L.A. Care’s favor.  L.A. Care successfully defended the State’s All Patient Refined Diagnosis Related Groups (APR-DRG) payment methodology as the appropriate payment for out-of-network emergency and post-stabilization services provided to L.A. Care’s Medi-Cal members by Dignity’s subsidiary, Northridge Hospital.  The appellate court’s ruling establishes once and for all that the State’s APR-DRG payment methodology (which provides a single payment amount…