UHC to introduce new primary care assessment program United Healthcare (UHC) recently notified approximately 800 contracted primary care physicians, introducing them to its new educational performance evaluation program. Slated to run concurrently with the UHC Premium Designation program, primary care physicians whose claims data demonstrates a high utilization rate in one of the following measures will receive a performance evaluation report: Emergency department utilization Inpatient admission utilization Average length of stay Laboratory/pathology utilization Levels 4 and 5 visits Modifier ... January 15, 2016 Managed Care United Healthcare 0 0 Comment Read More »
New approval timeframes for prescription drug prior authorizations took effect Jan. 1 A new law took effect Jan. 1, 2016, that requires health plans and health insurers to respond to prescription drug prior authorization requests within 72 hours for non-urgent requests and 24 for urgent requests. The law (SB 282) deems such requests to be granted if the payor fails to respond within these timeframes. A previous law (SB 866) had required a determination within two business days or the request was deemed approved. SB 282 also requires the Department of Managed Health Care and the Department of Insurance to create a ... January 15, 2016 General Department of Managed Health Care, Preauthorization, Prescription Drugs, Department of Insurance 0 0 Comment Read More »
HHS modifies HIPAA Privacy Rule as part of executive actions to curb gun violence Last week, the Obama Administration unveiled a number of executive actions to address gun violence in the United States, including an amendment to the Health Insurance Portability and Accountability Act (HIPAA) that would make it easier for mental health providers to disclose the identities of individuals who are disqualified from shipping, transporting, possessing or receiving a firearm. Both the Brady Handgun Violence Prevention Act of 1993 and the Gun Control Act of 1968 prohibit gun ownership and gun sales to individuals that have been involuntarily committed to a mental institution ... January 15, 2016 General Guns, HIPAA, HIPAA Privacy Rule, Mental Health, Public Health, CPLH 0 0 Comment Read More »
AMA publishes guide to physician-focused alternative payment models The legislation that repealed the Medicare sustainable growth rate—the Medicare Access and CHIP Reauthorization Act (MACRA)—created major new opportunities to advance alternative payment models (APM). Starting in 2019, MACRA will provide a 5 percent annual bonus payment to physicians who participate in APMs and it exempts them from participating in the fee-for-service meaningful use and quality reporting programs (MACRA's Merit-Based Incentive Payment System). In addition to accountable care organizations, medical homes and bundled payments for hospital-based episodes, MACRA also provides for the development of “physician-focused” APMs. The American Medical Association ... January 15, 2016 Medicare AMA, American Medical Association, Medicare, Alternative Payment Models (APM) 0 0 Comment Read More »
Governor Brown's 2016-17 budget proposal includes new MCO tax deal On January 7, the Governor unveiled a $122.6 billion budget proposal for the 2016-17 fiscal year, including a new approach to replacing a soon-to-expire tax on managed care organizations (MCO). 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. However, federal officials in 2014 informed California that its MCO tax structure was not compliant with federal requirements. Since then, the California Department of Health Care ... January 15, 2016 Managed Care California State Budget 0 0 Comment Read More »
Campaign to recall Dr. Pan fizzles A campaign to recall California Senator Richard Pan, M.D., the pediatrician who carried Senate Bill 277 in the California state legislature, has failed to gain any support. Proponents of the recall had until December 31, 2015, to collect 35,926 verified signatures from the 436,318 registered voters in his district. According to the Yolo County Clerk Recorder, opponents of the effort did not even file one signature. SB 277, co-sponsored by the California Medical Association (CMA), removed the personal belief exemption from vaccination requirements—allowing only for medical exemptions. The effort drew ... January 15, 2016 General Physician Leadership, Political Advocacy, vaccination, Immunization 0 0 Comment Read More »
Immunization summit coming to Sacramento April 24-25 The 2016 California Immunization Coalition (CIC) Summit, “Celebrating Healthier Tomorrows,” is scheduled for April 24-25 at the Hyatt Regency Sacramento. This annual meeting brings together a wide range of immunization partners from throughout California and beyond to share ideas, discuss issues and learn from one another. The summit is presented by the California Immunization Coalition, a public-private partnership dedicated to achieving and maintaining full immunization protection for all Californians to promote health and prevent serious illness. Speakers for the 2016 event include: Carolyn Bridges, M.D., Associate Director of ... January 15, 2016 General Seminars, Vaccination, Immunization 0 0 Comment Read More »
California Medical Association responds to unveiling of Governor Brown's proposed 2016-17 state budget Sacramento – Steve Larson, M.D., president of the California Medical Association (CMA), representing over 41,000 physicians statewide, issued the following statement in response to the unveiling of Governor Brown’s proposed 2016-17 state budget released this morning: “We are pleased to see the Governor is committed to working with the legislature and health plans to find a solution to the MCO tax. Without that, a gaping hole would exist in the state’s Medicaid (Medi-Cal) fund that would have devastating impacts on patients across the state. “Ensuring that Medi-Cal is better funded ... January 15, 2016 General, Managed Care, Medi-Cal Managed Care, Medi-Cal, Save Lives California, Tobacco Tax, California State Budget 0 0 Comment Read More »
Educate your patients about screenings and vaccinations during Cervical Health Awareness Month January is Cervical Health Awareness Month. During this time, the California Medical Association (CMA) and CMA Foundation encourage physicians to talk to their patients about the risks of cervical cancer – and ways to prevent it, including increased screenings and vaccinations. The main cause of cervical cancer is the human papillomavirus (HPV), which can be prevented through vaccination. Studies have shown that the HPV vaccine has the potential to prevent up to 70 percent of cervical cancer cases and deaths in California annually. Cervical cancer can also be detected through ... January 15, 2016 General Cervical Cancer, HPV, Immunization, Public Health, Vaccination, Women's Health 0 0 Comment Read More »
FDA lifts ban on blood donation by gay and bisexual men The U.S. Food and Drug Administration (FDA) has released final rules that ease restrictions on blood donations by gay and bisexual men. The new rule allows gay and bisexual men to donate blood if they have not had sex with a man for one year. Previously, the FDA banned all blood donations from men who have had sex with another man since 1977. The previous FDA regulations stipulated that gay men were "deferred as blood donors ... because as a group, [they were] at increased risk for HIV, hepatitis B ... January 15, 2016 General California Phyhsician's Legal Handbook, Food and Drug Administration, Blood Donation 0 0 Comment Read More »
