Zingale

The California Department of Managed Health Care (Department) ordered Kaiser Foundation Health Plan, Inc. (Kaiser) to continue providing coverage for prescription drugs, such as Viagra, to treat sexual dysfunction. Kaiser petitioned for a writ of administrative mandamus, and the trial court determined that such compulsion is beyond the Department’s statutory authority. The Department appeals, We also conclude the Department does not have authority to compel Kaiser to continue covering prescription drugs to treat sexual dysfunction.

The Knox-Keene Health Service Plan Act

The Knox-Keene Health Service Plan Act of 1975 (Act) was enacted, and amended through the years, “to promote the delivery of health and medical care to the people of the State of California who enroll in, or subscribe for the services rendered by, a health care service plan . . . .” (Health & Saf. Code, § 1342; hereafter, unspecified statutory references are to the Health and Safety Code.) Among the stated goals of the Act are (1) “[e]nsuring the continued role of the professional as the determiner of the patient’s health needs which fosters the traditional relationship of trust and confidence between…