Duals demonstration project delayed in three counties The California Department of Health Care Services (DHCS) has delayed passive enrollment for three of the eight counties affected by the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The project in these three counties—Alameda, Santa Clara and Los Angeles—will begin instead with a voluntary period, during which patients can choose early enrollment with a Medi-Cal managed care plan, or wait until the automatic passive enrollment period, which will begin no earlier than July 1, 2014. The project—known as Cal MediConnect—was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that would see a large portion of the state's dual eligible beneficiaries transition to managed care plans. The project will impact approximately 450,000 duals in eight counties – Alameda, Los Angeles, Orange, Riverside, San Diego, San Mateo, San Bernardino, and Santa Clara. There is no change to implementation date for the remaining five counties: Orange, Riverside, San Bernardino, San Diego and San Mateo. These five counties will begin passively enrolling patients in a managed care plan beginning April 1, 2014. Once the passive period begins, individuals in all counties except San Mateo will be automatically enrolled over a 12 month period based on birth month. (San Mateo will have a hard start date of January 1, 2014, rather than a 12 month rollout.) Patients have the option to select a specific plan of their choosing or to opt out of the project by notifying the state of this choice. Alameda and Santa Clara will begin their three month voluntary enrollment April 1, 2014, with passive enrollment beginning no earlier than July 1, 2014. Los Angeles will begin its three monthly voluntary enrollment April 1, 2014, with passive enrollment start dates staggered depending on the plan. Health Net will begin passive enrollment no sooner than July 1, 2014, and LA Care will begin passive enrollment no sooner than December 1, 2014. For more information, visit www.cmanet.org/duals and www.calduals.org. Contact: CMA’s reimbursement helpline, (888) 401-5911 or kmarck@cmanet.org. December 16, 2013 Managed Care Dual Eligible, Insurance/Reimbursement, Medicare, Medi-Cal 0 0 Comment Read More »
House passes budget with three month SGR patch The U.S. House of Representatives today passed a bipartisan two-year budget deal that includes a three-month patch that will stop the 24 percent Medicare physician payment cut that would otherwise take effect January 1, 2014—and replace it with a 0.5 percent payment raise—which will give lawmakers a little more time to finalize the long-term Medicare payment reforms currently making their way through Congress. The budget now goes to the U.S. Senate, which is expected to approve the measure next week. December 13, 2013 Medicare Advocacy, SGR, Sustainable Growth Rate, Medicare 0 0 Comment Read More »
Updates to Covered California, the state's health benefit exchange CMA has updated our exchange toolkit, “CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange.” There are significant updates since we last made updates in September that reflect key developments within the exchange including: • Updates on the grace period • Which plans have exited the exchange • How plans are building their networks • Information on how physicians can check their participation status on the Covered California website • Phone numbers of all of the plans in the event physicians have questions about their participation status December 10, 2013 General Health Care Reform, Health Insurance Exchange, Covered California, Insurance/Reimbursement 0 0 Comment Read More »
Medical board says it is not responsible for 'daily deal marketing cease and desist' letters sent to physicians The Medical Board of California issued a statement last week that it did not author a letter apparently coming from its Discipline Coordination Unit warning physicians to immediately "cease and desist " from conducting any daily deal marketing arrangements with sites such as Groupon, Living Social and Amazon. A number of California physicians have called the medical board stating that they have received these letters dated November 6, 2013, on the medical board’s masthead. These letters are fraudulent and were not generated by the medical board. When the medical board receives any complaint regarding a physician—including the use of daily deal marketing or internet-based coupon sites—the complaints are evaluated on a case-by-case basis to determine whether there is a violation of the law. Physicians should, however, use caution when using such sites. While each deal varies, typically the physician agrees to give the coupon company a percentage of the revenue obtained from patients using the coupon (reports suggest as high as 50 percent) in return for the marketing company's promotion of the practice through various types of coupons or "daily deals." Even if patients using such coupons are cash-paying and non-insured, the activity raises significant legal issues for physicians. Accordingly, physicians should act with extreme caution in this area, after obtaining the advice of an attorney experienced in health care fraud and abuse laws. For more information, see CMA On-Call document #0104, "Practice Promotion through Third Party Coupons." On-Call documents are available free to members in CMA's online health law library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2/page. If you receive a cease and desist letter and wish to verify its authenticity, please contact the medical board at (916) 263-2528. December 4, 2013 General Marketing/Advertising, Legal Issues, MBC, Medical Board of California, Professional Development and Licensure 0 0 Comment Read More »
Trial lawyers begin collecting signatures for anti-MICRA ballot initiative Driven by greed and the promise of inflated attorney fees, California trial lawyers have renewed their fight to lift the Medical Injury Compensation Reform Act (MICRA) cap on speculative, non-economic damages, presenting ballot language that seeks to more than quadruple the maximum award for non-economic damages to roughly $1.1 million. If successful, these efforts would be devastating to California’s health care system. More meritless lawsuits will lead to reduced patient access to our health care professionals – and fewer options for affordable, quality health care – especially in rural and underserved communities. From Redding to San Diego, canvassers working to support the trial lawyers’ anti-MICRA ballot language have hit the streets, and have reportedly been gathering signatures at an alarming rate. As expected, the signature gatherers are framing the initiative as an effort to ensure patient safety through mandatory drug testing of physicians, largely ignoring the deceptive and greed-fueled provisions that would see MICRA gutted of its historic reforms and patient protections. "It's a time-honored political technique in the California initiative process, the bait-and-switch," said Sherry Bebitch Jeffe, who teaches at the University of Southern California's School of Public Policy, in a recent interview with the San Francisco Chronicle. Despite being collected through misdirection, every signature gathered puts the trial lawyers’ initiative one step closer toward the November 2014 ballot. There is no doubt that physicians understand how catastrophic a measure like this would be for access to affordable health care. To win this fight, voters, our patients – those we interact with everyday in our practices – must understand the fact that protecting MICRA goes hand-in-hand with protecting access to quality health care in California. The CMA-led collation working to protect MICRA has published a patient education brochure to help inform California voters about the trial lawyers' deceptive ballot initiative. To learn what you can do to help, visit www.cmanet.org/micra. December 3, 2013 General Advocacy, MICRA, Professional Liability, Medical Malpractice 0 0 Comment Read More »
2014 Medicare fee schedule confirms 24 percent cut Demonstrating yet again how broken the Medicare sustainable growth rate (SGR) formula is, physicians will face a 24 percent Medicare payment cut next year if Congress does not seize the opportunity to put a stop to the formula's annual threat of drastic payment cuts. This figure was confirmed by the Centers for Medicare and Medicaid Services (CMS) last week, when the agency released its final physician fee schedule for 2014. The California Medical Association (CMA) is currently reviewing the final rule, which was released much later than usual because of the government shutdown in October. Stay tuned for details. CMA and others in organized medicine continue to press Congress for SGR repeal this year. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. December 3, 2013 Medicare Medicare, SGR, Sustainable Growth Rate, Advocacy, Insurance/Reimbursement 0 0 Comment Read More »
Highlights from AMA's 2013 interim meeting More than 1,000 physicians gathered just outside our nation's capital for the American Medical Association (AMA) interim meeting. The delegates debated a large number of resolutions, establishing new policies related to the Affordable Care Act, culturally and linguistically competent care and the Medicare sustainable growth rate. A number of these resolutions were put forward by the California delegation. Below are highlights of some of the resolutions adopted as policy. Medicare Payment Reform: Following robust discussion in various meeting venues, the AMA House of Delegates passed an amended resolution regarding repeal of Medicare’s sustainable growth rate (SGR) formula. In addition to reaffirming relevant AMA policy, the resolution directed the AMA to support a full SGR repeal and to continue its strong advocacy for positive updates and for its pay-for-performance principles and guidelines. AMA was also directed to advocate with the Centers for Medicare and Medicaid Services and Congress for alternative payment models to be developed in concert with specialty and state medical societies, including a private contracting option. Payments of Penalties to Physicians for RAC Audits: The delegates adopted a California resolution directing the AMA to advocate for penalties and interest to be imposed on the auditor and payable to the physician when a RAC audit or appeal for a claim has been found in favor of the physician. Culturally, Linguistically Competent Care and Outreach for At-Risk Communities: The delegates adopted as amended a California resolution that asks the AMA to encourage greater cultural and linguistic-competent outreach to ethnic communities including partnerships with ethnic community organizations, health care advocates and respected media outlets. Health Exchange Benefit Designs and Tax Deductibility of Out-of-Pocket Expenses: The delegates reaffirmed existing policy asking the AMA to support efforts to develop benefit designs in the health insurance exchanges that appeal to young and healthy people and support legislation allowing full tax deductibility of all out of pocket health care expenses. Health Insurance Exchange and 90-Day Grace Period: The delegates adopted a resolution directing the AMA to oppose efforts to mandate physician participation in health insurance exchange products; support insurance identification cards that contain contact information for verifying eligibility and coverage; support that authorization of eligibility and coverage will be a guarantee of payment for services rendered; oppose the preemption of state law by federal laws relating to the federal grace period for subsidized health benefit exchange enrollees; and support the suspension of coverage in months two and three of the federal grace period for subsidized health benefit exchange enrollees who fail to pay premiums. Opioid-Associated Overdoses and Deaths: The delegates directed the AMA to develop a set of best practices to inform clinical use of these drugs in managing persistent pain. The policy also calls for the Centers for Disease Control and Prevention to collect more robust data on unintentional opioid poisonings and deaths to develop appropriate solutions for preventing such occurrences. ICD-10 Implementation: The delegates adopted two policies related to the Oct. 1, 2014 implementation deadline for the ICD-10 code set. One policy calls for continued advocacy to delay or cancel implementation, and another asks the AMA to seek federal funding assistance for physician practices to alleviate the financial burden associated with implementation costs, including upgrades and staff training. Contact: Nick Birtcil, (916) 551-2570 or nbirtcil@cmanet.org. December 3, 2013 General American Medical Association, Cultural Competency, Health Insurance Exchange, ICD-10, Recovery Audit Contractor, SGR, Sustainable Growth Rate, AMA 0 0 Comment Read More »
Covered CA Materials for Your Patients The CMA Foundation (CMAF) and California Medical Association (CMA) have been awarded a grant from Covered California, the state's new health benefit exchange/marketplace. The purpose of the grant is to educate doctors and their health care team about Covered California and resources that are available for patients on where to go for additional information on programs that may be available based on their specific needs. The CMA Foundation, in partnership with San Bernardino County Medical Society, can provide you with patient education materials to distribute to patients asking for advice and assistance with Covered California. If you are interested in receiving resources for your office, please complete the request form and return to the CMA Foundation. December 2, 2013 General CMA Foundation, Covered CA, Covered California 0 0 Comment Read More »
