CMA Capitol Insight: March 28, 2016 CMA Capitol Insight is a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature. ____________________________________________________________________________________________________________ Making the ballot A deal was reached among Democratic leaders in Sacramento late last week on a plan to bring California’s minimum wage to $15 per hour – the highest in the nation and double the national minimum. The deal comes after years of wrestling in the legislature, and a statewide push that began years ago with a handful of public sector unions in Los Angeles. The accord avoids a fight ... March 31, 2016 General Anthony York, CMA Capitol Insight 0 0 Comment Read More »
California physicians oppose health plan mega-mergers, citing reduced access to affordable high-quality health care SACRAMENTO — Eighty-five percent of California’s physicians are opposed to the merger of health insurance giants Anthem and Cigna, according to a new analysis released by the California Medical Association (CMA) on Monday. The CMA survey, conducted in collaboration with the American Medical Association (AMA), sought to gauge California physicians’ perspective on the proposed Anthem-Cigna and Aetna-Humana mergers, as well as gather insight into the tactics undertaken by insurance companies’ in their negotiations with physicians. “California’s doctors could not be more clear: these mergers are bad for patients and bad for ... March 31, 2016 Managed Care Cigna, Mergers, Anthem 0 0 Comment Read More »
2016 Leadership Academy announces dynamic new education tracks The 2016 Western Health Care Leadership Academy is offering five new educational tracks that will provide attendees with a customized conference experience that is most relevant to their unique circumstances. Attendees can follow one track, or mix and match for a personalized education experience. This year's tracks include: Track A: Running Your Practice Geared toward practice and office managers and solo or small group physicians, this track offers important information on how to make your practice successful in an ever-shifting health care climate. Track B: Future Trends and Health Care Innovation This track ... March 31, 2016 CMA, General Continuing Medical Education, Physician Leadership, Western Health Care Leadership Academy, Conferences 0 0 Comment Read More »
Medical students: 2016 loan repayment program application process now open Applications are now being accepted for the National Health Service Corps (NHSC) Students to Service Loan Repayment Program. The program offers up to $120,000 to medical students (M.D. and D.O.) in their final year of medical school in return for a commitment to provide primary health care full time for at least three years or half time for at least six years in a medically underserved area. The 2016 Students to Service application cycle closes on April 5 at 7:30 p.m. For more information and to apply for the program, ... March 31, 2016 General Medical School Loans, Medical Students, Medical School Debt 0 0 Comment Read More »
Blue Shield experiencing multiple claims processing issues, some delaying payment The California Medical Association (CMA) began receiving calls in early February from physicians reporting that the explanation of benefits (EOBs) they were receiving on PPO claims from Blue Shield of California were missing EOB reason codes and information regarding the provider dispute resolution process. Blue Shield reports that only the EOB was affected, not the issuance of payment. CMA has since learned that there were two other system issues causing delays in payment on a large number of Federal Employee Program (FEP) and out-of-state BlueCard claims. All three of these issues ... March 31, 2016 Managed Care BlueCard, Blue Shield 0 0 Comment Read More »
Final regulations requiring health insurers to have adequate networks and accurate directories go into effect The California Department of Insurance (CDI), which regulates most PPOs in the state, issued permanent regulations this week that require health insurers to develop and maintain adequate provider networks. This move comes after emergency regulations were issued in January 2015 to help ensure patients can get timely access to care. While the California Department of Managed Health Care (DMHC), which regulates HMOs and certain PPO products, has had in place network adequacy standards for a number of years, CDI has not. These regulations will thus ensure that Californians, regardless of ... March 31, 2016 Managed Care Medical Provider Networks, Network Adequacy, Provider Networks, Department of Insurance 0 0 Comment Read More »
CMS announces second cycle of Medicare revalidation Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent fraud within the Medicare system. Once a Medicare enrollment application is validated, the clock starts ticking on a five-year revalidation cycle. Now that five years have passed since the ACA's revalidation requirement took effect, the Centers for Medicare and Medicaid Services (CMS) is initiating a second cycle of revalidation requests. According to CMS, Medicare Administrative Contractors (MAC) ... March 31, 2016 Medicare Affordable Care Act, Medicare, ACA 0 0 Comment Read More »
National 'Match Day' largest on record, but many California students must study elsewhere The National Resident Matching Program announced today that the 2016 Match Day for graduating medical students was the largest on record, with 42,370 registered applicants and 30,750 positions filled. The number of United States medical school seniors grew by 221 to 18,668, and the number of available first-year positions rose to 27,860, which is 567 more than last year. "Match Day," an annual rite of passage for future physicians, is the system through which medical school students and graduates obtain residency positions in U.S. accredited training programs. Despite the high ... March 31, 2016 General Match Day, Medical Students, Residents and Fellows, State Legislation, Graduate Medical Eduction 0 0 Comment Read More »
CMA files amicus brief in support of hospital medical staff self-governance The California Medical Association (CMA) has filed an amicus brief in support of the medical staff at Tulare Regional Medical Center in its lawsuit against the hospital alleging violations of state laws when the hospital terminated the entire medical staff and its duly elected officers. The hospital has recognized a replacement medical staff formed by a group of seven physicians led by the vice chairman of the hospital board. This group presented itself as a newly formed medical staff after it selected new bylaws and named officers to the medical ... March 31, 2016 CMA Hospital Medical Staff, Legal Advocacy, Self-Governance, Amicus Briefs 0 0 Comment Read More »
California lawmakers unveil bill to tax MCOs and plug $1.1 billion hole in budget California lawmakers on Monday unveiled two identical bills to replace the soon-to-expire tax on managed care organizations (MCO). The bills, ABx2 20 (Bonta) and SBx2 15 (Hernandez), are the product of 14 months of negations with MCOs. These bills are supported by the California Association of Health Plans, with most member plans either supportive or neutral. The current MCO tax will expire this summer if legislators cannot agree on a replacement. Since 2005, the state has taxed MCOs and used the money to cover the costs of the Medi-Cal program. ... February 16, 2016 Managed Care, Medi-Cal Medi-Cal, State Legislation, Managed Care, Managed Care Organization (MCO) 0 0 Comment Read More »
