Right to a Hearing Before Prior Authorization Requirement
In Margulis v. Myers (1981) the issue was whether a physician participating in the Medi-Cal program had a right to a hearing before being subjected to a prior authorization requirement.
The court noted there was no state or federal statute or regulation that required the state agency to allow providers of services an administrative hearing before implementing a prior authorization policy.
Moreover, the court explained a prior authorization requirement was not a sanction or a penalty, but a means to ensure only necessary services are provided. ( Id. at pp. 341-342.)
The court concluded the physician was "neither legally nor constitutionally entitled to a hearing before implementation of the prior authorization requirement." ( Id. at p. 343.)