On Dec. 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. The CRS has joined with the CMA in this litigation and is also a plaintiff in this suit.  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 the DMHC can enforce the regulation against providers, despite the DMHC's public assertions that this regulation "prohibits" balance billing. The DMHC, however, has indicated that it intends to use its definition to take an enforcement action against a provider that balance bills.  The Department recognizes that at that point its authority to take an enforcement action can be challenged. While our attorneys believe the DMHC is wrong, they understand that physicians have stopped balance billing because of the ambiguity of the DMHC's authority. 
Accordingly, CMA/CRS  attorneys are reviewing the ruling with appellate specialists to determine the best strategy for an immediate appeal. The legal team cannot file an appeal until a formal judgment is entered (probably a week from now)--thereafter they have 60 days to file an appeal. Additionally, the CMA legal team is actively exploring separate litigation avenues to challenge the DMHC's authority to prohibit balance billing or take any enforcement action based on this regulation. 
While the court's ruling is a setback, there are important questions left open which must be answered in the next round.  We will keep you updated as CMA's litigation efforts move forward.