Paid family leave coverage extended Beginning on July 1, California's paid family leave (PFL) program will be expanded to provide benefits to workers who take time off of work to care for a seriously ill parent-in-law, grandparent, grandchild or sibling. This change was prompted by the passage of Senate Bill 770, which was signed into law by Governor Brown on September 24, 2013. Currently, PFL is only available to workers who take time off of work to care for a seriously ill child, parent, spouse or registered domestic partner, or to bond with a minor child. Eligible individuals can receive up to six weeks of PFL within a 12-month period. For more information on the PFL program, click here. Physicians are also reminded that they can now certify claims for PFL and disability insurance online via the state's new electronic claim filing system, State Disability Insurance (SDI) Online. The system allows physicians, claimants and voluntary plan administrators to submit claims and other supporting documents online. For more information on SDI Online, click here. March 28, 2014 General Paid Family Leave (PFL), Disabilities, State Disability Insurance (SDI) 0 0 Comment Read More »
House passes year-long SGR patch, includes California GPCI fix This morning the U.S. House of Representatives passed a year-long patch to stop the Medicare 24 percent sustainable growth rate (SGR) cut on an unusual 30-second voice vote. Unable to come to an agreement on how to fund a permanent repeal of the badly broken formula, despite a bill with bipartisan, bicameral support, Congress appears poised to kick the can down the road for the 17th time in just 10 years. The California Medical Association (CMA) is extremely disappointed that Congress has been unable to find bipartisan funding sources and seize the unprecedented momentum of support for permanent Medicare payment reform. The House bill, “Protecting Access to Medicare Act of 2014” (H.R. 4302), provides a 0.5 percent physician payment update through December 31, 2014, and then a 0 percent update until April 1, 2015. It also includes the California Medicare locality update, known as the California geographic practice cost index (GPCI) fix. The GPCI fix holds rural physicians harmless from cuts permanently. The bill also delays for one year the ICD-10 medical billing coding conversion, until October 15, 2015. Yesterday CMA circulated a letter urging the House to take the time to fund the permanent repeal and pass it rather than adopting another year-long patch. The letter supported the “perseverance of the House and Senate Committees to achieve a bipartisan, bicameral agreement to repeal the flawed Medicare SGR and institute a reasonable new payment system.” The letter also asked the House Speaker Boehner and Senate Leader Reid to return “to the negotiating table and finishing the important work to achieve permanent reform.” Practically speaking, Congress has until April 14 to resolve the remaining differences over the bill’s financing before the 24 percent SGR cut actually takes effect. Preventing the SGR cut is imperative to maintaining patient access to physicians in California. Over 90 national, state and specialty physician organizations called for a no vote on this legislation in the House of Representatives. The one-year patch is expected to cost roughly $20 billion. A significant chunk of that money will be generated through a budget gimmick, extending Medicare sequester cuts beyond the 10-year window used for budget scoring purposes. It is also funded with other physician cuts from misvalued codes and imaging criteria. Some funding came from hospitals and nursing homes. The situation in the Senate is still fluid because new Finance Committee Chairman, Ron Wyden (D-OR), wants a vote on the permanent reform before resorting to a vote on another patch. However, the Senate could vote on a patch before the weekend. Despite the welcome delay in the costly, burdensome ICD-10 coding system and the permanent California GPCI locality update, CMA could NOT support another short-term patch and is still pushing for real reform to the SGR. A short-term patch is no longer acceptable to California physicians. Some have argued that a patch will give Congress more time to negotiate permanent reform, but history informs us otherwise. This latest patch is part of a decade long string of patches that have cost U.S. taxpayers $150 billion, close to the cost of a permanent fix. Moreover, many of the physician funding sources in the current patch legislation could be more cost-effectively applied in a permanent reform bill. To see the bill passed by the House, click here. Contact: Elizabeth McNeil, (800) 786-4262 or ecmneil@cmanet.org. March 27, 2014 Medicare Advocacy, GPCI, Medicare, SGR, Federal Legislation 0 0 Comment Read More »
Deadline for 2013 Medi-Cal EHR incentive payments extended The deadline for providers to apply for Medi-Cal electronic health records (EHR) incentive payments for the 2013 program year has been extended by one month to April 30, 2014. After that date, the State Level Registry (SLR) will no longer accept 2013 applications. For the 2014 program year, providers who are attesting to adopting, implementing or upgrading certified EHRs can currently apply to the SLR for 2014 program year incentive payments. However, the SLR is currently unable to accept applications from providers attesting to meaningful use for 2014. The SLR will not begin accepting 2014 meaningful use attestations until June. For more information and updates, visit the SLR website at www.medi-cal.ehr.ca.gov. Contact: CMA's reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. March 27, 2014 Medi-Cal Incentive Payments, Medi-Cal, EHR 0 0 Comment Read More »
HHS develops toolkit to help physicians prepare for online communication with patients The California Health and Human Services Agency (HHS) has developed a toolkit to help medical practices prepare for online patient communications through an electronic health record (EHR) portal, personal health record, mobile app, secure messaging or other electronic means. Data indicates that patients who use health information technologies may be more efficient users of health care resources, better managers of their health behaviors and feel more satisfied with the health care system. The free toolkit, "Preparing for Online Communication with Your Patients," provides checklists and worksheets to help offices collect and organize information needed to create an effective plan for online patient communications. It also provides materials that can be given directly to patients including, a letter that can be customized to explain the medical practice’s electronic communication services; a brochure about electronic communication with physicians; and a video explaining the benefits of communicating online with their health care providers. Click here to download the toolkit. March 27, 2014 General Electronic Health Record, Health Information Technology, HIT, EHR, Mobile Health 0 0 Comment Read More »
Anti-MICRA signatures to be submitted today Today, Consumer Watchdog and the state’s trial attorneys announced that by the end of the day they will be submitting signatures in county registrar of voters offices across the state, setting in motion a validation process that will likely land an initiative aimed at gutting California’s Medical Injury Compensation Reform Act (MICRA) on the November ballot. Under California’s constitution, parties seeking to place an initiative on the 2014 statewide ballot are required to submit slightly more than 500,000 valid signatures to registrars of voters in the counties where those signatures were collected. Consumer Watchdog, the trial attorney front group, has been submitting signatures to smaller counties across California since late last week, and it is expected that today’s submissions will push their initiative over the required threshold. As previous noted, the trial attorneys' ballot measure seeks to more than quadruple MICRA’s cap on non-economic damages, lifting the amount to roughly $1.2 million. The initiative also contains provisions regarding drug testing of physicians and places unrealistic and infeasible requirements on the state’s prescription drug database, which proponents have said were only added because they polled well and are the “ultimate sweetener.” With these signatures submitted, the fight to defend MICRA begins in earnest. Once submitted, the signatures cannot be withdrawn, meaning that, if a sufficient number are validated, an initiative that would increase costs, limit access to care and threaten the existence of community clinics across California will be appearing on the November ballot. California physicians must stand together in opposition of this ballot measure! If successful, the trial attorneys' ballot measure would have devastating effects on California’s health care industry and could also pass on “hundreds of millions of dollars” annually state and local governments, according to an impartial analysis by the state’s Legislative Analyst. For more information on the proposed initiative, as well as how you can help defeat this ballot measure, please visit www.cmanet.org/micra. March 27, 2014 General MICRA, Advocacy 0 0 Comment Read More »
Blue Cross experiencing problems with electronic eligibility and benefits information The California Medical Association (CMA) has received several reports of physician offices being unable to electronically verify eligibility and benefits for Anthem Blue Cross patients. When attempting such verification, the Anthem system returned a message asking the practice to call to obtain the information. However, practices report significant hold times of one hour or more when calling for this information. Anthem has acknowledged a system problem affected the ability of practices to electronically verify eligibility and benefits information for patients with coverage issued on or after January 1, 2014, which mainly affects Covered California/mirror product patients. Adding to the confusion for practices, Anthem also scheduled a transition of eligibility, benefits and claim status functions from its ProviderAccess portal to the Availity website effective March 14, 2014. (Click here for more information on the transition to Availity.) According to Anthem, it is working to restore eligibility and benefits information for affected enrollees. As of today, the insurer reports that the information has been restored for about two thirds of affected enrollees and expects the work to be complete on March 22. CMA is monitoring the issue closely. Physicians are reminded that when unable to verify eligibility and benefits, they can require patients to pay at the time of service and issue a refund to the patient once benefits are verified and the claim is paid. Contact: CMA’s reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. March 27, 2014 General Covered California, Health Insurance Exchange, Anthem Blue Cross 0 0 Comment Read More »
DHCS to automate Medi-Cal provider enrollment The California Department of Health Care Services (DHCS) will soon be automating its Medi-Cal provider enrollment processes. The hope is that the new system, expected to go live this fall, will improve the provider enrollment experience by minimizing errors in the application process and significantly reducing the time required to process provider enrollments. The new enrollment system, called the Provider Application and Validation for Enrollment (PAVE) system, will be a web-based portal that providers can use to submit application and verifications and report changes. Initially, PAVE will only be available for providers that currently enroll to serve fee-for-service beneficiaries directly through the DHCS Provider Enrollment Division. However, DHCS plans to expand access to Medi-Cal providers who enroll through other divisions and departments until all Medi-Cal enrollment activities are directed through the PAVE system. PAVE will also permit online payment of fees, if applicable, allow providers to check application status online, and will use electronic signatures for all provider types. PAVE will include checklists of required attachments that will let the provider know that a complete application has been prepared and will ensure that the provider has provided responses to all required questions before the application is submitted. PAVE will allow providers to attach required supporting documentation electronically and verify that attachments are complete prior to submission. PAVE will also allow providers to quickly revalidate their information in accordance with the Affordable Care Act (ACA). Beta Testers Needed DHCS is seeking providers to assist in testing the PAVE system late in the summer of 2014. A wide variety of providers will be needed to ensure that the system is functioning correctly. This will require a short training period and the ability to connect with DHCS in a test mode. If you are interested in participating as a beta tester, please provide a contact name and phone number, provider type, location, and NPI to dhcspedpave@dhcs.ca.gov. DHCS is also seeking providers to participate in a workgroup to assist in reviewing the “help” information that will be included in the PAVE online application. The purpose of this review is to provide clear direction to the applicant to reduce the potential for errors or misunderstanding in the application process. DHCS plans to conduct the workgroups as conference calls during the week of April 7, 2014. If you are willing to participate in the workgroup, please notify DHCS at dhcspedpave@dhcs.ca.gov. March 27, 2014 Medi-Cal Medi-Cal, DHCS, Medi-Cal Provider Enrollment 0 0 Comment Read More »
Covered California patients have until March 31 to switch plans Covered California patients have until March 31 to switch exchange plans if they made selections based on an inaccurate provider directory. On February 7, following numerous complaints about accuracy from both enrollees and providers, Covered California removed its provider directory from the exchange website. However, some patients had already selected plans based on inaccurate provider directory information. CMA has received multiple inquiries from practices asking whether these patients have any options. The answer is yes. Patients can contact the Covered California’s Service Center at (800) 300-1506 to switch to a different plan before the end of the open enrollment period, which is March 31. For more information on the Covered California, including a document that provides answers to the most frequently asked patient questions about the exchange, please visit CMA’s exchange resource center at www.cmanet.org/exchange. Contact: CMA’s reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. March 27, 2014 General Health Insurance Exchange, Covered California 0 0 Comment Read More »
CMA sponsors bill to increase primary care residency slots in California Today is National Match Day, the day when thousands of California medical students learn whether they can begin their practice of medicine here or must move to training programs in other states. National Match Day is the day graduating medical students nationwide learn the location of their residency programs, the next step in training after four years of medical school. Because of funding constraints, California – where significant areas of the state already face physician shortages, especially in primary care – lacks a sufficient number of primary care residency opportunities for graduating medical students. This means that scores of well-qualified new physicians who would like to train here, instead must leave the state because there are not enough training positions to accommodate them. Legislators and physician organizations in California are partnering to help relieve this shortage of family medicine and other primary care residency program positions and thereby address the primary care physician shortage. The California Medical Association (CMA) and the California Academy of Family Physicians are cosponsoring AB 2458, which would create a graduate medical education (GME) fund to increase the number of medical residency slots in the state. “As millions more Californians gain coverage under health care reform, we will need more physicians to care for them,” said Assemblymember Susan Bonilla (D-Concord), the author of the bill. “The goal [of AB 2458] is to increase the number of medical residency slots in physician training programs that graduate primary care physicians and serve the underserved. This will help address the shortage and ensure that patients can find physicians to provide the care they need.” The National Resident Matching Program matches graduating medical students with residency programs using a mathematical algorithm that pairs the rank-ordered preferences of applicants and program directors to produce a “best fit” for filling available training positions. Federal, state and private funds pay for GME, with Medicare contributing the bulk, about $9.5 billion annually. However, the Medicare portion of the funding has been frozen since 1997, despite a 20 percent growth in California’s population during that time. In addition, many residency program leaders say that funding received from Medicare and Medicaid does not fully cover the cost of even the current residency training slots, so sponsoring institutions must absorb residual costs. “As millions of patients enter the health care delivery system, we need to ensure that access for medical attention is more than an empty promise with an insurance card,” said CMA President Richard Thorp, M.D. “Increasing funding for residency programs in California means immediate relief, as hundreds of physicians will be able to remain in California rather than being forced out of state to begin their medical careers.” AB 2458 was introduced in February and will be heard in the Assembly Health Committee on April 22, 2014, during CMA's Legislative Leadership Day. March 27, 2014 General Physician Workforce, Residents and Fellows, State Legislative Advocacy, Medical Students 0 0 Comment Read More »
Aetna seeks to terminate its proposed $120 million class settlement over use of Ingenix to underpay out-of-network claims Late last year, Aetna, Inc. announced a proposed class settlement of up to $120 million over its use of the flawed Ingenix database. The nationwide settlement would have required Aetna to reimburse providers and Aetna PPO subscribers for losses arising from Aetna's underpayment for out-of-network medical care. A hearing had been scheduled for March 18, 2014, in the U.S. District Court in New Jersey for the court to determine whether final approval of the settlement should be granted. Less than a week before the hearing, however, Aetna notified the court it was invoking a provision of the settlement that gave the insurer the right to terminate the agreement if the settlement claims of providers and subscribers opting out of the settlement exceeded $20 million. Aetna told the court, "Based on the list of Opt-Outs provided by the Settlement Administrator to Aetna and Class Counsel, the Opt-Out levels exceed the threshold." Aetna did not provide specific numbers. The creator of Ingenix, United Healthcare, entered into a $350 million class settlement in 2009 for systematic underpayment of out-of-network claims. The New York Attorney General investigated United and Ingenix and concluded that the database was rigged to understate the value of medical services. The Attorney General settled with United and more than a dozen other health insurers, including Aetna, over their use of the database. Counsel for the settling plaintiff class is in the process of determining whether Aetna has properly terminated the settlement. Assuming it was properly terminated, the class action lawsuits against Aetna will resume toward trial. The California Medical Association (CMA), the American Medical Association and numerous other state medical societies also had sued Aetna over its use of Ingenix but were not parties to this settlement agreement. The medical societies' claims were dismissed after a federal court in Miami determined they were barred under earlier settlements reached with Aetna in 2005 over federal RICO claims. That court's decision is currently on appeal. Contact: CMA Center for Legal Affairs, (800) 786-4262 or legalinfo@cmanet.org. March 27, 2014 General Ingenix, Insurance/Reimbursement, Legal Advocacy, Aetna 0 0 Comment Read More »
