Providers who refer, order or prescribe for Medi-Cal beneficiaries must enroll with DHCS Under the Affordable Care Act, all providers who order, refer or prescribe (including but not limited to physicians, nurse practitioners and physician assistants) for Medi-Cal beneficiaries must be enrolled in the Medi-Cal program. Previously, providers needed to enroll only if they wished to furnish (and bill for) covered services for Medi-Cal beneficiaries. If an ordering and/or referring provider (ORP) is not enrolled in Medi-Cal, the "filling providers" (for example, the pharmacy that is filling the patient’s prescription or the specialist you are referring a patient to for treatment) will ... November 19, 2015 Medi-Cal Medi-Cal, Prescription Drugs, Drug Prescribing 0 0 Comment Read More »
CMA Foundation Celebrates "Get Smart About Antibiotics Week" The week of November 16-22, 2015, is "Get Smart About Antibiotics Week" – a campaign to highlight the problem of antibiotic resistance and the importance of appropriate antibiotic use. Every year at least 2 million Americans become infected with antibiotic resistant bacteria and at least 23,000 people die from these infections. This cold and flu season, the California Medical Association (CMA) Foundation's Alliance Working for Antibiotic Resistance Education (AWARE) project reminds physicians and patients to reduce the unnecessary use of antibiotics. AWARE is a long-term project of the California Medical ... November 10, 2015 General antibiotic resistance, CMA Foundation, Get Smart About Antibiotics Week 0 0 Comment Read More »
Ask the expert: If an exchange patient is in the 90-day grace period and fails to pay the premium, is the plan required to pay for services provided? Maybe. Under the Affordable Care Act, exchange enrollees who receive federal premium subsidies to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums. Insurance ID cards for exchange enrollees do not indicate whether the enrollee is subsidized, but Covered California recently reported that 90 percent of California exchange patients are receiving subsidies, so the likelihood of encountering a patient receiving subsidies is very high. In the first month of the grace period, federal law and California regulations require ... November 10, 2015 Managed Care Grace Period, Exchange plans, Health Insurance Exchange 0 0 Comment Read More »
Be prepared for Covered California changes in 2016 In 2015, Covered California, California's health benefit exchange, enrolled approximately 1.3 million individuals in qualified health plans. With Covered California estimating it may enroll an additional 300,000-plus during the 2016 open enrollment period (running November 1, 2015, through January 31, 2016), and two new plans in the mix, it is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2016. To help physicians understand the changes taking place and how they will affect their practice, the California Medical Association ... November 9, 2015 Managed Care Health Insurance Exchange, Surviving Covered California, Covered California 0 0 Comment Read More »
CMA Capitol Insight: Nov. 9, 2015 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. Capitol happenings The legislature may be out of session, but there is plenty of political intrigue swirling about Sacramento. With a new set of rules in place for ballot initiatives, thanks to changes passed by lawmakers last year, the calendar deadline to get final measures into the attorney general’s office for review is fast approaching. Over the last two weeks, we saw a broad coalition (with the backing of Napster founder ... November 9, 2015 General CMA Capitol Insight, Anthony York 0 0 Comment Read More »
DMHC fines Blue Shield and Anthem for provider directory inaccuracies On November 3, the California Department of Managed Health Care (DMHC) announced it had fined two of the state's largest health plans for inaccurate Covered California provider directories. Blue Shield of California was fined $350,000, while Anthem Blue Cross was fined $250,000. These two insurers account for almost 60 percent of patient enrollment in Covered California. Both insurers are also utilizing networks for their exchange/mirror products that are significantly narrower than their regular PPO networks. These narrowed networks, combined with inaccurate provider directories, have led to significant confusion and frustration ... November 9, 2015 Managed Care Blue Shield, Covered California, Department of Managed Health care, Anthem Blue Cross 0 0 Comment Read More »
CMA urges Congress to fix EHR meaningful use program The California Medical Association, the American Medical Association and a coalition of medical societies are urging Congress to immediately reform stage 2 of the electronic health record (EHR) meaningful use program, and to delay stage 3. Frustrated with the Center for Medicare and Medicaid Services' (CMS) refusal to fix the program, organized medicine has turned to Congress to make the necessary reforms before meaningful use drives physicians out of the Medicare program. “We are writing to express our strong concerns with the decision by the Obama Administration to move ahead ... November 9, 2015 Medi-Cal, Medicare CMS, EHR, Meaningful Use, Centers for Medicare and Medicaid Services, Medicare Regulatory Advocacy 0 0 Comment Read More »
CMS extends Physician Compare preview period The Centers for Medicare and Medicaid Services (CMS) has extended the Physician Compare preview to November 16, 2015, to allow more time for physicians to preview their data for the 2014 quality measures that will be reported on the Physician Compare website later this year. The Affordable Care Act required CMS to create a website that would allow consumers to search for and compare physicians and other health care professionals who provide Medicare services. That site—the "Physician Compare" website, initially launched in 2010—provides contact information, specialties and clinical training, hospital ... November 9, 2015 Medi-Cal, Medicare Medicare, Physician Compare, Physician Quality Reporting System, PQRS, CMS 0 0 Comment Read More »
Poll: Majority of California voters back e-cigarette regulations An overwhelming majority of California voters believe e-cigarettes contribute to nicotine addiction in youth and should be regulated, according to the Keck School of Medicine at the University of Southern California (USC). University researchers partnered with the Field Institute to implement five questions on a recent Field Poll regarding proposed regulatory efforts. The Field Poll revealed that 74 percent of voters are in favor of regulating and licensing e-cigarettes similar to combustible cigarettes. The Field Poll also showed that more than two-thirds of respondents—71 percent—consider e-cigarette products a factor in nicotine ... November 9, 2015 General E-Cigarettes, Public Health, Smoking 0 0 Comment Read More »
U.S. Supreme Court will not hear challenge to New York vaccine law The U.S. Supreme Court will not hear a challenge to a New York state law that mandates all children be vaccinated before they can attend public school. This decision leaves in place a federal appeals court ruling that said the New York Law does not violate the constitution. That decision also upheld a trial court ruling that found that children with religious exemptions could still be prohibited from attending school if there is a vaccine-preventable disease outbreak. While this ruling only affects the states within the second circuit appellate court, ... November 9, 2015 General Public Health, Vaccination, Immunization 0 0 Comment Read More »
