Congress passes a number of health care provisions in the current budget Congress narrowly passed a $1.1 trillion federal budget that will fund most of the federal government through September 2015. Below is a summary of key health care provisions in the bill. Within the bill, Congress expressed concern that there had not been adequate opportunity for public comment on bundling of surgical codes in the final rule of the Medicare Physician Fee Schedule. The budget bill says that the appropriate methodology has not been tested to ensure that patient care and patient access are not negatively impacted ... December 16, 2014 General, Medicare Advocacy, Federal Legislation, Medicare, Prescription Drugs, CDC, Ebola, Recovery Audit Contractor 0 0 Comment Read More »
'Patient choice' bill goes down to defeat in the Assembly The California Medical Association (CMA) has defeated a bill that would have imposed unfair contracting conditions on physicians and exacerbated the state's current network adequacy concerns. The bill (AB 2533) would have required health insurers to arrange for, or assist in arranging for, out-of-network care for enrollees who are unable to obtain medically necessary care or services from a network provider, at no additional cost to the patient. Unfortunately, vague language in the bill could have been interpreted to require out-of-network providers to accept the contract reimbursement rates of ... September 5, 2014 General Advocacy, Payor Contracting, Network Adequacy 0 0 Comment Read More »
Legislature passes bill that would require annual reports from insurers on provider network adequacy The legislature has passed a bill that would require Medi-Cal managed plans and insurers offering individual plans through Covered California to provide annual reports to the California Department of Managed Health Care (DMHC) about the adequacy of their provider networks. The bill also requires DMHC to post annual reviews regarding plan compliance on its website. This California Medical Association (CMA) supported the bill, SB 964 (Hernandez), which passed late last week and is now on the governor's desk awaiting his signature. With roughly 1.4 million Californians newly enrolled in ... September 4, 2014 Managed Care Network Adequacy, Advocacy, Covered CA, Health Insurance Exchange 0 0 Comment Read More »
Change in prior authorization form for prescription medications becomes effective October 1 Over the next several months, a new law (SB 866) will take effect that streamlines and standardizes the prior authorization process for prescription drugs. The new law requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications. Additionally, if a health plan or insurer fails to use or accept the prior authorization form, or fails to make a determination within two business days, the prior authorization request is deemed approved. Currently, plans have five business days ... September 4, 2014 General Advocacy, Prescription Drugs, Preauthorization 0 0 Comment Read More »
United Healthcare finally completes PacifiCare recontracting effort after 2006 merger The California Medical Association (CMA) recently learned that United Healthcare (UHC) in April sent notices to over 800 practices that still held contracts under PacifiCare, which merged with UHC in 2006. The notice advised affected physicians that their continued participation status with UHC hinged on signing the new agreement, which includes a new fee schedule. For physicians who chose not to sign the agreement by June 15, the notification served as the required 90-day notice of termination. UHC had first initiated a recontracting of physicians contracted with PacifiCare back in ... August 7, 2014 Managed Care Hunited Healthcare, Insurance/Reimbursement, Managed Care, PacifiCare, Advocacy 0 0 Comment Read More »
CMA Capitol Insight: August 5, 2014 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. -------------------------------------------------------------------------------- They’re Baaaaack After a month-long recess, the California state legislature is back in session, ready for the final month of the legislative year. Gov. Jerry Brown is also back after a four-day trip to Mexico with a massive delegation of business leaders and state officials, preaching the gospel of climate change at every turn. Now that everyone has returned to Sacramento, we are all bracing for the sprint that marks the ... August 7, 2014 General Anthony York, Advocacy, State Legislative Advocacy 0 0 Comment Read More »
Physicians can review Sunshine Act data starting today The Centers for Medicare and Medicaid Services (CMS) announced that starting today physicians can complete part 2 of the registration process to review and dispute disclosures under the Physician Payments Sunshine Act. Physicians have 45 days to review and dispute their data (plus an additional 15 days to resolve disputes). The review and dispute process ends August 27, 2014. The information will be published publicly on September 30, 2014. Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including ... July 15, 2014 General Advocacy, Physician Payment Sunshine Act, Regulatory Advocacy, CMS 0 0 Comment Read More »
Physicians descend on Sacramento to lobby a package of bills to increase access to health care As part of the California Medical Association’s (CMA) 40th Annual Legislative Leadership Conference, more than 400 physicians, medical students and CMA Alliance members have come to Sacramento today to lobby their legislative leaders as champions for medicine and their patients. They will be lobbying a package of CMA-sponsored bills that will increase access to health care throughout the state. The bills include: AB 1805 (Skinner) restores a 10 percent cut made to California’s Medicaid program (Medi-Cal) in 2011. Medi-Cal reimbursement rates are among the lowest in the nation, often reimbursing ... April 23, 2014 General State Legislative Advocacy, Advocacy, Legislative Leadership Day 0 0 Comment Read More »
House passes year-long SGR patch, includes California GPCI fix This morning the U.S. House of Representatives passed a year-long patch to stop the Medicare 24 percent sustainable growth rate (SGR) cut on an unusual 30-second voice vote. Unable to come to an agreement on how to fund a permanent repeal of the badly broken formula, despite a bill with bipartisan, bicameral support, Congress appears poised to kick the can down the road for the 17th time in just 10 years. The California Medical Association (CMA) is extremely disappointed that Congress has been unable to find bipartisan funding sources ... March 27, 2014 Medicare Advocacy, GPCI, Medicare, SGR, Federal Legislation 0 0 Comment Read More »
Anti-MICRA signatures to be submitted today Today, Consumer Watchdog and the state’s trial attorneys announced that by the end of the day they will be submitting signatures in county registrar of voters offices across the state, setting in motion a validation process that will likely land an initiative aimed at gutting California’s Medical Injury Compensation Reform Act (MICRA) on the November ballot. Under California’s constitution, parties seeking to place an initiative on the 2014 statewide ballot are required to submit slightly more than 500,000 valid signatures to registrars of voters in the counties where those signatures ... March 27, 2014 General MICRA, Advocacy 0 0 Comment Read More »
