California approved a progressive enforcement framework for organizations that exceed health-care spending targets, with financial penalties possible only after several corrective steps.

What changed: On August 26, the Office of Health Care Affordability board adopted a penalty range of 0% to 125% of the amount by which an entity's spending exceeded its target, after permitted adjustments. It also approved procedural penalties of up to $10,000 per day for repeated failures involving performance-improvement plans or required information, and one-time penalties up to $500,000 for repeated failure to implement a plan or knowing falsification.

Who it affects: Physician organizations with fewer than 25 physicians are generally exempt unless identified as high-cost outliers. The statewide spending-growth target is 3.5% for 2026, falling to 3% by 2029.

What to watch: Enforcement is staged through technical assistance, possible public testimony and a performance-improvement plan of up to three years. OHCA says the earliest spending-target penalty…

Practices may have only five months before denials begin for orders, referrals and prescriptions from non-enrolled clinicians.

What changed: Yesterday’s brief noted that DHCS had not announced an enforcement date. CMA reported later September 2 that phased enforcement could begin as early as February 2027.

Who it affects: Physicians and other clinicians who order, refer or prescribe for Medi-Cal patients must be enrolled individually under a Type 1 NPI. Managed care, Medicare or Medi-Cal Rx enrollment alone does not satisfy the requirement.

Your move: Check every prescriber now. Applications can take up to 90 days, and submission alone does not prevent denials.

Review CMA’s enrollment guidance

The Cooperative of American Physicians (CAP) invites you to join us for an evening mixer to recognize and celebrate the contributions of California’s independent physician community. Enjoy complimentary refreshments, appetizers, and engaging conversation with your fellow physician colleagues.

RSVP NOW

Space is limited.

As fall approaches, physicians and care teams will need to navigate updated immunization guidance, changes affecting Medi-Cal coverage, and emerging public health concerns.

On September 23, the Los Angeles County Department of Public Health will host a live CME session covering several issues that could directly affect patient care and practice operations this season.

Topics include:

• Updated COVID-19, influenza, and RSV immunization recommendations for the coming respiratory viral season

• Changes to Medi-Cal and efforts to help preserve patient coverage across Los Angeles County

• A clinical review of Cyclospora and current food and water safety considerations