The State - News from Dec. 14, 1986

The state is entitled to limit Medi-Cal benefits based on its own rather than individual physicians’ interpretations of what is medically necessary, a state appeals court ruled. The 2-1 opinion reversed a 1984 decision by a Sacramento Superior Court judge that said any physician could decide which services the patient should get, and which the taxpayers should pay for. Justice Frances Newell Carr, who wrote the majority opinion for the state 3rd District Court of Appeal, said the physician could not be “the sole arbiter of medical necessity. Not only would such a rule result in inconsistent and unfair applications based on the variation between physicians . . . but the state’s requirement of reimbursement would be limited only by the imagination of physicians.” The dissenting opinion by Justice Coleman Blease warned that the ruling will adversely affect “tens, perhaps hundreds of thousands of persons.”