California physicians oppose elimination of ACA cost-sharing subsidies President Donald Trump announced yesterday that his administration will cease making critical cost-sharing reduction (CSR) payments to health insurers that help low-income Americans afford health care. This announcement also followed yesterday’s executive order seeking to loosen the Affordable Care Act’s (ACA) health insurance regulations. “Rather than taking action to make health care more affordable and accessible, the President’s actions threaten to destabilize the insurance market, increase health care costs and reduce patient access to care,” said California Medical Association (CMA) President Ruth Haskins, M.D. “We urge our leaders in Washington ... October 19, 2017 General ACA, Affordable Care Act 0 0 Comment Read More »
California physicians condemn changes to Affordable Care Act birth control mandate The Trump Administration today announced an interim final rule that permits employers and insurers to claim a religious exemption to the Affordable Care Act’s (ACA) “Birth Control Mandate.” The California Medical Association (CMA), representing over 43,000 physicians in all specialties and modes of practice, issued the following statement, condemning this policy change on the grounds that it undermines the availability of preventative health care for California women. “Access to contraception is a basic preventative health care service that millions of Californians rely on,” said CMA President Ruth Haskins, M.D. “The ... October 13, 2017 General Affordable Care Act, ACA, Federal Legislation, Health Care Reform, Reproductive Issues, Women's Health 0 0 Comment Read More »
CMA, AMA and organized medicine were united in opposing Graham-Cassidy Last week, the latest effort to repeal the Affordable Care Act (ACA) collapsed, after three Republican Senators announced their opposition—Susan Collins (R-ME), Rand Paul (R-KY) and John McCain R-AZ). Further action is unlikely this year, as Senate Republican Leader Mitch McConnell (R-KY) said the Senate would now turn its focus to overhauling the tax code. However, several Republicans vowed to continue to work into next year to repeal the ACA. The California Medical Association (CMA), the American Medical Association (AMA) and all of organized medicine were united in opposing this ... October 13, 2017 CMA, General, Managed Care, Medi-Cal ACA, Affordable Care Act, Affordable Care Act (ACA) Repeal, Covered California, Federal Legislation, Federal Legislative Advocacy, Medicaid, Medi-Cal 0 0 Comment Read More »
AMA urges quick action to stabilize individual insurance market With the window quickly closing to properly price individual insurance products for 2018, the American Medical Association (AMA) is urging President Trump and Congressional leaders to commit to continued funding for the cost-sharing reductions that are critical to stabilizing the individual market. AMA, along with other groups representing insurers, hospitals, health plan purchasers and physicians, sent a letter urging quick action to deliver short-term stability and affordable coverage while broader marketplace stabilization efforts are developed. Nearly 60 percent of all individuals who purchase coverage via the exchange receive financial assistance to ... April 19, 2017 General, Managed Care ACA, Affordable Care Act, AMA, American Medical Association, Health Insurance Exchange, Insurance 0 0 Comment Read More »
U.S. divided about what should be done with ACA A Kaiser Family Foundation poll has found that Americans are divided on the future of the Affordable Care Act (ACA). The survey found that 26 percent of the country wants to repeal the entire law. Meanwhile, 30 percent want to expand the law, 19 percent want to keep it as-is and 17 percent want to scale it back. The poll found that Republican respondents were more likely to want to scale back the law, rather than fully repealing it. Among the 26 percent of Americans who want to see the ... December 14, 2016 General, Managed Care Affordable Care Act, ACA 0 0 Comment Read More »
Blue Shield implements system fix to correctly pay HPV9 claims Under the Affordable Care Act, health plans are required to provide “first dollar” coverage for preventive services. This means that the plan cannot apply patient cost sharing, such as copays, coinsurance or deductibles, to these services. However, in September 2015, the California Medical Association (CMA) was alerted by a physician practice that Blue Shield of California was applying patient cost sharing when it processed HPV9 claims with CPT code 90651. CMA escalated the issue to Blue Shield and has been working with the payor since then to correct the ... August 9, 2016 Managed Care Affordable Care Act, Blue Shield, ACA 0 0 Comment Read More »
Covered California announces plan offerings for 2017 Covered California, the state marketplace for health insurance under the Affordable Care Act, recently announced the qualified health plans that were approved to offer coverage in the exchange market for 2017. All of the plans that offered coverage in 2016 will continue to do so in 2017. Three of the plans will also be expanding into new regions this year. Molina is expanding its HMO coverage into Orange County (region 18) through delegated relationships with Monarch and Heritage Network ... August 8, 2016 Managed Care Affordable Care Act, Covered California, Exchange Plans, Molina, Oscar, ACA, Kaiser Permanente 0 0 Comment Read More »
Last chance to appeal payments under ACA primary care physician rate increase The California Department of Health Care Services (DHCS) announced that it would provide a 90-day appeal window for physicians who believe they were not paid, or paid incorrectly, under the Affordable Care Act’s (ACA) primary care rate increase. In late February 2016, DHCS announced a streamlined appeal process, which opened on March 1. The appeal window is only available under the following conditions: The provider successfully attested for the ACA incentive by December 31, 2014 For previously paid Medi-Cal claims For ... April 12, 2016 General Affordable Care Act, Department of Health Care Services, DHCS, ACA 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 »
Reminder: Exchange patients, eligibility and the 90-day grace period Practices are reminded that under the Affordable Care Act, exchange enrollees who receive federal premium subsidies (approximately 90 percent of enrollees) to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums. In the first month of the grace period, federal law and California regulations require plans to pay for services incurred even if the patient fails to pay the premiums due by day 90 (CCR §1300.65.2(b)(1)(A)). But in months two and three of the grace period, plans can ... February 3, 2016 General, Managed Care Affordable Care Act, Grace Period, ACA 0 0 Comment Read More »
