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California Department Of Managed Health Care

CALIFORNIA | LOCAL
January 11, 2002 | From Staff and Wire Reports
The California Department of Managed Health Care dropped several allegations against Kaiser Permanente during a hearing into the validity of a $1.1-million fine against the state's largest HMO. The state dropped its claim that Kaiser lacks adequate ambulance services at its Hayward emergency room. Regulators also deleted claims relating to Kaiser's telephone call center, through which patients make appointments or ask medical questions.
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BUSINESS
November 14, 2000
Safeguard Health Enterprises Inc.'s pending recapitalization and change of control cleared another regulatory hurdle, the Aliso Viejo company said Monday. The California Department of Managed Health Care has approved the move just days after the state Department of Insurance gave it the green light. Safeguard had agreed in March to an $8-million cash infusion from an investor group, which will convert the debt into shares. The company said the transaction is essential to its financial health.
CALIFORNIA | LOCAL
June 28, 2002 | From Times Staff and Wire Reports
An appeals court ruled Thursday that state HMO regulators cannot force Kaiser Permanente to pay for the anti-impotence drug Viagra, upholding a lower court ruling. The California Department of Managed Health Care had argued that the law required health plans to cover all medically necessary prescription drugs for members if the HMO chose to offer any drug coverage at all.
CALIFORNIA | LOCAL
September 29, 2009 | Patrick McGreevy
A former deputy director for the California Department of Managed Health Care has agreed to pay a $3,000 administrative fine after admitting a conflict of interest violation, the state's ethics watchdog agency said Monday. Kevin Donohue, who still works for the agency in another capacity, admitted he held stock in UnitedHealth Group Inc. when he helped review the 2005 merger of the firm with PacifiCare Health Systems Inc., according to a stipulated settlement with the state Fair Political Practices Commission.
BUSINESS
January 7, 2014 | By Chad Terhune
Blue Shield of California said it has agreed to acquire GemCare Health Plan, expanding its presence in Kern County and the Central Coast area. Blue Shield, one of the state's largest health insurers, said Tuesday that GemCare customers should see minimal changes at first. Terms of the deal weren't disclosed. GemCare, based in Bakersfield, is owned by hospital chain Dignity Health and the physicians of GemCare IPA. Blue Shield said the deal would enable it to grow its overall membership and provider networks as well as add Medicare patients in Kern, San Luis Obispo and Santa Barbara counties for the first time.
BUSINESS
May 10, 2013 | By Chad Terhune, Los Angeles Times
A worrisome abdominal pain drove Jalal Afshar to seek treatment last year at healthcare giant Kaiser Permanente. The Pasadena resident and Kaiser member had lived for years with a rare condition known as Castleman's disease, which affects the lymph nodes and the body's immune system. But this was the first time he experienced such severe symptoms. Kaiser granted his request to see a specialist in Arkansas. But it ultimately declined to pay for his treatment there. By June, Afshar said, Kaiser was arranging for hospice care so that he could die at home.
BUSINESS
June 25, 2013 | By Chad Terhune
California officials have fined healthcare giant Kaiser Permanente $4 million for problems related to patient access to mental health services. The fine announced Tuesday stems from deficiencies the California Department of Managed Health Care identified in March that were found during a routine medical survey. This marks the agency's second-largest enforcement action after a $10 million fine against Anthem Blue Cross in 2008 related to improper policyholder cancellations. "The Department's actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them," said Brent Barnhart, director of the Department of Managed Health Care.
BUSINESS
October 11, 2009 | Times Staff and Wire Reports
Several large health maintenance organizations and insurers in California have agreed to refrain from charging co-payments or deductibles for vaccinating patients against the H1N1 flu. State regulators said they obtained agreements from the companies to waive all charges for administering the vaccine, which is provided free by the federal government. "The likelihood that some health insurers would charge some administrative fee for the vaccine was very, very high," state Insurance Commissioner Steve Poizner said in a conference call.
BUSINESS
October 26, 2008
The Schwarzenegger administration has chosen to jeopardize Californians' access to necessary emergency care in order to protect the bottom line of for-profit health maintenance organizations. ("Hospitals protest new rules on billing," Oct. 15.) For-profit HMOs have been refusing to pay the bill for emergency services provided to their policyholders by out-of-network doctors and hospitals. This refusal left many Californians facing a bill they rightly thought their insurance company was going to pay. Other states require HMOs to pay the bill for these services.
BUSINESS
January 19, 2010
New rules The California Department of Managed Health Care has issued regulations for HMOs requiring timely access to medical care. Plans have one year to comply. Consumers can complain to the department at (888) 466-2219 or www.healthhelp.ca.gov. Among the rules for HMOs: Patients with urgent matters that require "prompt attention" must be seen by a physician or other healthcare professional within 48 hours of requesting an appointment. Urgent care with specialists must be provided within 96 hours.
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