What is the legal framework for health care dispute resolution?

The legal framework for health care dispute resolution in California is provided for by several different statutes. The foremost among these is the California Health and Safety Code (CHSC). This code provides provisions for resolving conflicts between health care providers and patients, and it outlines the procedures for initiating and conducting mediations, arbitrations, and other types of dispute resolution processes. The California Department of Managed Health Care (DMHC) also has authority to resolve health care disputes. Under the DMHC’s jurisdiction are HMOs, health plans, and other health care service plans operating in the State. The DMHC has a process for resolving disputes through its review and appeal system. The appeal process typically starts with the filing of a written complaint by the patient and may include an administrative hearing. In the absence of the DMHC ruling, California also has a Health Care Choices Law in place, allowing patients to initiate a “Patient-Initiated Arbitration” process to mediate disputes between themselves and their health care providers. This option is only available to patients who have already attempted to resolve the dispute through the DMHC system but have been unable to reach an agreement. Finally, the California courts are another legal avenue available to resolve health care disputes. While this is often a more expensive and drawn out approach, it can be necessary in cases where the parties involved do not reach a resolution through the other dispute resolution processes. A health care dispute that is brought before the court is subject to the same rules and procedures as any other civil dispute.

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What is the legal framework for health care dispute resolution?

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