DHCS requires enrollment for all Medi-Cal managed care providers In January 2018, the California Department of Health Care Services (DHCS) began requiring that all Medi-Cal managed care providers be enrolled through the Medi-Cal program. Medi-Cal managed care plans have the option to develop and implement a managed care physician screening and enrollment process that meets federal requirements, or they may direct their network physicians to enroll through the DHCS fee-for-service (FFS) enrollment portal. (Enrolling through DHCS does not obligate managed care network providers to also see FFS patients.) Some physicians have already reported receiving notices from Medi-Cal managed care ... July 11, 2018 Managed Care, Medi-Cal DHCS, Medi-Cal, Medi-Cal Provider Enrollment, Department of Health Care Services 0 0 Comment Read More »
Health plans terminate relationship with Vantage Medical Group The California Medical Association (CMA) has learned that two health plans, the Inland Empire Health Plan (IEHP) and Molina Healthcare, are terminating their contracts with Vantage Medical Group. Two other plans, Blue Shield of California and Care1st Health Plan, have issued notices of material breach with an intent to terminate. The plans have filed requests with the California Department of Managed Health Care (DMHC) to transfer their enrollees to other delegated groups. According to IEHP’s block transfer filing with DMHC, Vantage engaged in conduct that resulted in the inappropriate delay, ... July 11, 2018 General, Managed Care, Medi-Cal Blue Shield, Commercial Payors, Department of Managed Health Care, DMHC, Payor Contracting 0 0 Comment Read More »
CMA's Health Law Library updated with 2018 content CMA On-Call—the California Medical Association (CMA) online health law library—has been updated with 2018 content. One of CMA's most valuable member benefits, the health law library contains nearly 5,000 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. The searchable online library contains all the information available in the California Physician's Legal Handbook (CPLH), an annual publication from CMA's Center for Legal Affairs. Recently updated documents of particular interest include: MACRA Overview (#7210) Billing Limitations and Private ... July 11, 2018 CMA California Physician's Legal Handbook, CMA On-Call, CPLH, Health Law Library 0 0 Comment Read More »
CMA to address affordability of health care at annual meeting The 147th Annual Session of the California Medical Association (CMA) House of Delegates (HOD) will tackle one major issue—addressing the cost of health care—when it convenes October 13-14, 2018, in Sacramento. CMA physician delegates meet annually to establish broad policy on current major issues that have been determined to be the most important issues affecting members, the association and the practice of medicine. Because this year’s topic is a large issue, it has been divided up into four categories. Addressing Utilization Through Improved Care Delivery ... July 11, 2018 CMA CMA Policy, House of Delegates 0 0 Comment Read More »
State budget includes 10 new CPT codes eligible for supplemental tobacco tax payments Governor Jerry Brown last week signed a $139 billion California budget for the 2018-2019 fiscal year. The budget continues the Administration’s commitment to using the Proposition 56 tobacco tax funding to provide supplemental payments for Medi-Cal providers, with $500 million in tobacco tax funds allocated to improve provider reimbursement through supplemental payments. The total funding for provider payments is approximately $1.3 billion. DHCS plans to allocate the tobacco tax funds to increase payments for a total of 23 CPT codes, which includes 10 new preventive CPT codes. The supplemental rate ... July 11, 2018 General, Managed Care, Medi-Cal California State Budget, Medi-Cal, Prop. 56 (tobacco tax) 0 0 Comment Read More »
Leading health organizations announce filing of statewide soda tax measure for 2020 Today, a ballot measure to protect public health through a state soda tax was filed for the 2020 ballot by two of California’s leading health care provider organizations – the California Medical Association (CMA), representing 43,000 California physicians, and the California Dental Association (CDA), representing 27,000 California dentists. This announcement comes four days after the multi-billion-dollar soda industry held the state of California hostage with a dangerous ballot threat that jeopardized the fiscal outlook of local governments, forcing the state to pre-empt local authority and pass an unprecedented 12-year moratorium ... July 11, 2018 CMA, General Political Advocacy, Public Health 0 0 Comment Read More »
Blue Shield implements system fix for AB 72 claims Last year, the California Medical Association (CMA) worked with Blue Shield of California to correct two issues affecting accurate payment of claims subject to the state’s new out-of-network billing and payment law (AB 72). The issues were identified as being due to manual claim processing errors, because the payor had not yet updated its system to allow automated processing of claims subject to AB 72. Blue Shield recently announced it was implementing a system update on June 28, 2018, that will allow claims subject to AB 72 to be processed ... July 11, 2018 General, Managed Care AB 72, Blue Shield, Out of Network Care 0 0 Comment Read More »
CDPH revises guidance on Parkinson's reporting requirements Effective July 1, 2018, physicians and licensed independent practitioners will be required to report cases of Parkinson’s disease to the California Department of Public Health (CDPH). Licensed independent practitioners holding the following credentials who diagnose or treat Parkinson’s disease patients are required to report: Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), Physician’s Assistant (P.A.), and Nurse Practitioner (N.P.). All providers required to report must first register with CDPH through the designated gateway at https://hie.cdph.ca.gov/. In April, CDPH issued details about how health care providers can comply with the reporting ... July 11, 2018 General Department of Public Health, Public Health 0 0 Comment Read More »
Are You Ready for CURES! Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their ... June 26, 2018 General CURES 0 0 Comment Read More »
Rare Iron Lung Now on Display at Southern California Medical Museum NEWS RELEASE FOR IMMEDIATE RELEASE Contact: Alison Elsner, 909-273-6000 (W) June 18, 2018 760-413-5053 (C), aelsner@sbcms.org (Inland Empire, CA.) – The Southern California Medical Museum is announcing the acquisition of a rare iron lung, now on display at the Museum, located in the Nursing Science Center on the campus of Western University of Health Sciences in Pomona, California. This remarkable piece of medical equipment was acquired through the generosity of the Rancho Los Amigos Medical Center in Downey, California. The cumbersome mechanical respirator reminds modern day Museum visitors about the ways ... June 26, 2018 General, Press Releases iron lung, Southern California Medical Museum 0 0 Comment Read More »
