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 »
CMA tells California Supreme Court it must protect patient data in CURES The California Medical Association (CMA) has filed an amicus brief with the California Supreme Court asking that it give meaningful privacy protection to patient data contained in the Controlled Substance Utilization Review and Evaluation System (CURES) database. CMA was joined on the brief by the American Medical Association, California Psychiatric Association, California Dental Association and the American Dental Association. This case, Lewis v. Superior Court (Medical Board), examines the constitutionality of the Medical Board of California's practice of routinely data mining the confidential prescription records of California patients. In response ... November 9, 2015 General CMA Legal Case List, CURES, Amicus Briefs, California Supreme Court 0 0 Comment Read More »
CMS issues final 2016 Medicare payment rule; includes reimbursement for end-of-life discussions On Friday, the Centers for Medicare and Medicaid Services (CMS) released the final 2016 Medicare physician fee schedule. One of the biggest changes in the CMS proposal is the assignment of codes to pay physicians for end-of-life consultations. Key policies finalized in the 2016 payment rule include: Advanced care planning: The final fee schedule includes two CPT codes to reimburse for advance care planning. Compensating health care professionals for time spent with patients discussing treatment wishes and goals of care is a critical step forward in honoring patient treatment preferences, particularly ... November 9, 2015 Medicare Medicare 0 0 Comment Read More »
Next CME Essentials Workshop is December 4 in Orange County Join the California Medical Association's Institute for Medical Quality (IMQ) on Friday, December 4, 2015, for the next CME Essentials Workshop, held at Children's Hospital of Orange County in Orange. This one-day course covers the fundamentals of planning a continuing medical education (CME) activity in compliance with accreditation criteria and policies. The CME Essentials Workshop is designed for individuals who are new to CME or who are seeking a refresher, including CME chairs, coordinators, educators and managers of CME programs. The workshop covers the fundamentals of designing an educational activity ... November 9, 2015 General CME Accreditation, Continuing Medical Education, IMQ, CME 0 0 Comment Read More »
