Topic
Utilization Management
4 published works
Health Care and Life Sciences
This New Year, California Imposes Guardrails on the Use of AI by Payors for Utilization Management Determinations
By Whitney Phelps, Jonian Rafti, Michael Menconi
SB 1120 (the “Bill”), which takes effect on January 1, 2025, amends existing California law to adopt guardrails around the use of artificial intelligence tools for the purpose of utilization…
Healthcare Law Blog
California Limits Health Plan Use of AI in Utilization Management
By Carolyn Metnick, Lynsey Mitchel, Michael Sutton
California Governor Newsom signed Senate Bill 1120 into law, which is known as the Physicians Make Decisions Act. At a high level, the Act aims to safeguard patient access to…
Medicaid & Medicare: A Legal Blog
Auditing Medicare Advantage Organizations – About Time!
The American Hospital Association (“AHA”) is asking the Department of Justice (DOJ) to look into health insurance companies that routinely deny patients access to care and payments to providers. I’d…
Health Care Reform Dashboard
CMS Encourages Flexibility in Utilization Management and Prior Authorization Within Limits
The Centers for Medicare & Medicaid Services (CMS) issued FAQ guidance encouraging health insurers to relax their utilization management and prior authorization requirements in view of the COVID-19 pandemic while at the…