California AG intervenes in lawsuit to dismantle ACA California Attorney General Xavier Becerra, joined by 16 attorneys general, last week filed a motion to intervene in a lawsuit that seeks to dismantle the Affordable Care Act (ACA). The lawsuit, filed in federal district court in Texas, imperils health care coverage for all Americans, particularly more vulnerable groups like children and people with chronic medical conditions or disabilities. In California, millions of people receive quality, affordable health care coverage under the ACA, many for the first time. The California Medical Association (CMA) applauds Attorney General Becerra for intervening in this lawsuit to defend the ACA. To roll back the clock and risk the health of millions of Americans is irresponsible. “We cannot afford to go back to a time when Californians with pre-existing health conditions were priced out of the market, stuck on waiting lists for care or told that they were not covered for life-saving treatments,” says CMA President Theodore M. Mazer, M.D. “We should not force the newly insured to seek care in emergency departments when their conditions have worsened and become more expensive. We stand with AG Becerra and the other states to protect affordable health care coverage and access to physicians for our most vulnerable patients.” The Texas lawsuit seeks to stop the ACA Medicaid expansion; end tax credits that help people afford insurance; allow insurance companies to deny coverage to people with pre-existing conditions; take away seniors’ prescription drug discounts; strip funding from our nation’s public health system, including work to combat the opioid epidemic; and much more. If the ACA were terminated, the state of California would stand to lose $160.2 billion in health care funding. Texas, joined by 19 other states, filed the lawsuit in the United States District Court for the Northern District of Texas, Fort Worth Division, on February 28, 2018. The suit alleges that the ACA is no longer constitutional due to the passage of the Republican tax break bill, passed in December 2017, which eliminated the ACA individual mandate penalty payment. Although Congress recently repealed the individual mandate penalties for 2019, the ACA framework remains the law of the land. In the motion to intervene, Attorney General Becerra argues that the ACA has not been repealed by the passage of the Republican tax break bill, and its constitutionality has been upheld by the Supreme Court. CMA supports the ACA and the expansion of health insurance coverage that it brought to more than 5.5 million Californians. The ACA’s Medi-Cal expansion now covers nearly 4 million Californians, with 1.5 million more insured under Covered California. The ACA reduced California’s uninsured from 17 percent of the population to less than 7 percent. “Dismantling the ACA would be devastating to California’s working families,” said Dr. Mazer. “CMA encourages lawmakers to engage with physicians and other experts to improve on the gains of the ACA in order to increase patient access to care, particularly for our most vulnerable populations.” April 24, 2018 General Affordable Care Act, Affordable Care Act (ACA) Repeal 0 0 Comment Read More »
$1.3 trillion federal appropriations bill loaded with new health care spending Last Friday, President Trump signed a massive $1.3 trillion federal spending bill—the Omnibus Consolidated Appropriations Act of 2018. It is loaded with new spending for health care programs that were supported by the California Medical Association (CMA). Unfortunately, it did not include two bills that CMA was strongly promoting – the Affordable Care Act (ACA) market stabilization bill and a permanent solution for the nearly 700,000 Deferred Action for Childhood Arrivals program recipients. A brief summary of the federal spending bill is below. Bipartisan ACA Market Stabilization: CMA, the American Medical Association (AMA) and other physician groups strongly advocated to include the bipartisan ACA market stabilization bill in the omnibus spending package. Unfortunately, lawmakers could not reach a compromise. It would have funded for two-years the cost-sharing assistance that helps low-income families afford copayments and deductibles that President Trump eliminated in 2017. It would have also provided state waiver flexibility and reinsurance funding to cover high-cost, catastrophic cases. The Congressional Budget Office estimated that the bill would have reduced premiums by 20 percent in 2020. A compromise could not be reached because the Freedom Caucus insisted on placing abortion restrictions on the ACA plans in exchange for the two-year ACA stabilization bill. Opioids: The bill includes nearly $4 billion in new funding for prevention, treatment and law enforcement to address the opioid crisis. With the $6 billion in the Budget Act enacted by Congress in February, new 2018-2019 opioid funding totals $10 billion. The breakdown is as follows: $500 million for National Institutes of Health research on opioid addiction, development of opioid alternatives, pain management and addiction treatment. $27 million for Mental and Behavioral Health Education Training to recruit and train professionals in psychiatry, psychology, social work, marriage and family therapy, substance abuse prevention and treatment, and other areas. $105 million for the National Health Service Corps to expand access to opioid and substance use disorder treatment in rural and underserved areas. $100 million for a new Rural Communities Opioids Response Program to support prevention and treatment of substance use disorder in 220 counties and other rural communities identified by the Centers for Disease Control and Prevention (CDC) as being at high risk. $350 million (for a total of $475 million) to support CDC’s Opioid Prescription Drug Overdose Prevention activities. $10 million must be used to conduct a nationwide opioid education campaign to increase understanding of the epidemic and to increase prevention activities. Also requires CDC to promote the use of prescription drug monitoring programs (PDMP) and expand efforts to enhance the utility of state PDMPs to make them more interconnected, in real-time, and usable for public health surveillance and clinical decision making. CMA aggressively advocated for this provision to ensure that the federal government work with electronic health record (EHR) vendors to link EHRs to state PDMPs. $1 billion in new funding for State Opioid Response Grants $94 million for law enforcement and grants to combat opioid, heroin and other drug trafficking. $94 million to strengthen Food and Drug Administration (FDA) presence at international mail facilities and to fund equipment and technology to increase FDA capacity to inspect more incoming packages to detect illicit fentanyl. Gun Violence: The bill included $2.3 billion in funding associated with the STOP School Violence Act of 2018 to cover mental health services, security training and school safety programs to prevent gun violence. It also fully funds the FBI National Instant Criminal Background Check System. While CDC research promoting gun control is still prohibited, the Omnibus spending bill included a general clarification that there are no restrictions on general research related to gun violence. However, there was no funding appropriated for such research. Finally, it increased funding for the National Violent Death Reporting System to all 50 states to assist researchers and lawmakers. CMA continues to support California Senator Dianne Feinstein’s legislation that would ban assault weapons and high-capacity magazines, as well as efforts to require more extensive background checks and waiting periods. Mental Health Programs: Provides more than $2.3 billion in new funding for various mental health programs. Drug-Related Provisions: Physicians will continue to receive enhanced payments for the first few years a drug/biological is on the market to assist in the costs of adopting new drugs and technology. Graduate Medical Education: The Children’s Hospitals graduate medical education program received a $15 million funding increase, for a total of $315 million. Congress also provided an additional $15 million for the Rural Residency Program to expand the number of rural residency training programs with a focus on developing programs that can be self-sustainable. Other Notable Health Care Spending Increases: The National Institutes of Health received significant increase in funding to support research into Alzheimer’s disease, the Brain Initiative, the universal flu vaccine and antibiotic-resistance efforts. The CDC also received additional funding for diabetes programs. April 5, 2018 General Affordable Care Act, Drug Abuse, Federal Budget, Federal Legislative Advocacy, Firearms, Graduate Medical Education, Guns, Mental Health, Opioids 0 0 Comment Read More »
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 to put patients before politics.” A Covered California study found that eliminating federal funding for CSR payments would raise premiums for Silver plan consumers by 16.6 percent in 2018, requiring patients to seek Advanced Premium Tax Credits in order to afford coverage, switch to lower tiered plans with higher cost-sharing, or forgo health care coverage altogether. Data shows that imposing higher out-of-pocket costs on patients results in patients delaying or skipping recommended medical tests, prescription medication and treatment. Nearly 50 percent of the 1.4 million individuals who are enrolled in Covered California currently receive cost-sharing assistance to reduce out-of-pocket costs, such as copayments for doctor visits and deductibles. “These changes will have devastating consequences for patients,” said Dr. Haskins. “Eliminating CSR payments may cause millions of patients to become underinsured or uninsured by pricing low- and moderate-income families out of the market. We urge the Trump Administration to work constructively with Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) to expeditiously finalize a bipartisan package that stabilizes the individual market and protect affordable care for all.” # # # The California Medical Association (CMA) represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit CMAnet.org, and follow CMA on Facebook, Twitter, LinkedIn and Instagram. 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 Trump Administration’s decision puts the personal beliefs of employers and insurance companies above the fundamental right of women to make medical decisions aabout their own health and their future.” CMA policy supports access, without copays, to all FDA approved contraception as a basic preventative health service. “CMA strongly believes that medical decisions should be made by patients in consultation with their health care providers. This ensures that these decisions are made in the patient’s best interest,” said Dr. Haskins. “In addition to limiting the health options available to women, this policy would have an overall negative impact on public health in California.” # # # The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit CMAnet.org, and follow CMA on Facebook, Twitter, LinkedIn and Instagram. 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 harmful bill, which would have repealed the ACA’s insurance mandate, underfunded health insurance subsidies and made drastic cuts to the Medicaid program. The Graham-Cassidy block grant proposal would have been disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. Even states that initially came out ahead under the block grant framework would have experienced devastating funding cuts over time from the bill’s Medicaid funding caps on children, the elderly and the disabled. Millions of Californians would have lost their coverage, and many others would have been seriously underinsured. Patients without coverage seek more expensive care in overcrowded emergency rooms, passing costs onto states, counties, health care providers and taxpayers. These patients also put off treatment, ending up with more serious conditions that could have been prevented. These problems would be exacerbated by the reduction of subsidies currently provided to poor and middle class families. The Graham-Cassidy bill would also have allowed states to do away with pre-existing condition protections and other essential health benefits that keep Americans healthy. “Congress should engage with physicians and other medical experts on the front lines caring for patients to develop legislation that improves patient access to physicians, protects coverage for our most vulnerable populations and addresses affordability,” said CMA President Ruth Haskins, M.D. In the meantime, bipartisan negotiations have resumed in the Senate between Health Committee Chairman Alexander (R-TN) and lead Democrat Patty Murray (D-WA) to adopt reforms to stabilize the individual market, such as funding cost-sharing subsidies and reinsurance. CMA and AMA support this effort. It has been a long and difficult year for physicians who want to make constructive improvements to the health care system. While the ACA has its flaws, none of the House and Senate proposals thus far have met CMA’s principles for health care reform. CMA and the physicians of California will keep fighting for reforms that increase patient access to health care and maintain coverage for the millions of Californians insured through Medi-Cal and Covered California. 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 »
CMA to tackle three major issues at annual meeting The 146th Annual Session of the California Medical Association (CMA) House of Delegates (HOD) will tackle three major issues—health care reform (on both the federal and state level), physician workforce and mental health care—when it convenes October 21-22, 2017, at the Disneyland Hotel in Anaheim. CMA physician delegates meet annually to establish broad policy on current major issues that have been determined to be the most important issues affecting members, the association and the practice of medicine. Reports on these major issues are now available for comment. All members are welcome to submit comments online at www.cmanet.org/hod. Health Care Reform: While the future of federal health care reform remains unclear, CMA continues to work with federal and state lawmakers to ensure that the health care system works for physicians and patients. The CMA House of Delegates will discuss recommendations and regulations that will assist with health care reform at both the state and national levels. Physician Workforce: Maintaining a physician workforce that ensures all patients have sufficient and timely access to quality medical care continues to be a challenge for California. The delegates will discuss barriers that impact the practice medicine in California and will analyze various strategies and policies that will promote solutions to address the physician workforce problem. Mental Health: For decades, CMA policy has strongly supported adequate funding and provisions for high-quality mental health care. However, despite raised awareness, mental illness continues to go unrecognized and underfunded in California; many people with mental illnesses do not receive the help they need. The delegates will discuss significant factors affecting the mental health system including access and infrastructure, and will consider policies to support and improve the mental health system. September 27, 2017 CMA, General Affordable Care Act, Affordable Care Act (ACA) Repeal, CMA Policy, Health Care Reform, House of Delegates, Mental Health, Physician Workforce, Single Payor 0 0 Comment Read More »
California's physicians oppose Graham-Cassidy repeal bill The U.S. Senate is currently considering the Graham-Cassidy block grant bill, which would repeal the Affordable Care Act’s (ACA) insurance mandate, underfund health insurance subsidies and make drastic cuts to the Medicaid program. Under the bill, traditional Medicaid funding would be capped. Medicaid expansion and ACA subsidies for low- and middle-income families would be subject to an underfunded block grant and phased out in 2027. This bill would be disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. In response, the California Medical Association (CMA), representing over 43,000 physicians in all specialties and modes of practice, called on the California Congressional Delegation to oppose this bill. Congress should work with health care professionals to craft legislation that increases patient access to health care and maintains coverage for the more than 15 million Californians insured through Medi-Cal and Covered California. “This bill would significantly reduce Medicaid funding, which provides health coverage for more than 13 million Californians,” said CMA President Ruth Haskins, M.D. “A vote for this legislation is a vote to deteriorate public health in California – especially in areas like the Central Valley, where approximately half of the population relies on Medicaid for health care.” Patients without coverage seek more expensive care in overcrowded emergency rooms, passing costs on to states, counties, health care providers and taxpayers. These problems would be exacerbated by the reduction of subsidies currently provided to poor and middle class families. The Graham-Cassidy bill also allows states to do away with pre-existing condition protections and other essential health benefits that keep Americans healthy. “Congress should engage with physicians and other medical experts on the front lines caring for patients to develop legislation that improves patient access to physicians, protects coverage for our most vulnerable populations and addresses affordability,” said Dr. Haskins. # # # The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit CMAnet.org, and follow CMA on Facebook, Twitter, LinkedIn and Instagram. September 27, 2017 CMA, Medi-Cal Affordable Care Act, Affordable Care Act (ACA) Repeal, Federal Legislation, Federal Legislative Advocacy, Health Care Reform 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 make health care affordable. These subsidies reduce out-of-pocket costs for patients who might otherwise be unable to afford health care services despite being insured. The funding helps those who need it the most access quality care: low- and middle-income consumers earning less than 250 percent of the federal poverty level. If the cost-sharing subsidies are not funded, Americans will be dramatically impacted: Choices for consumers will be more limited, leaving individuals with fewer coverage options. Premiums for 2018 and beyond will go up by at least 15 percent, both on and off the exchange. Higher premium rates could drive out of the market those middle-income individuals who are not eligible for tax credits. If more people are uninsured, providers will experience more uncompensated care, which will further strain their ability to meet the needs of their communities and will raise costs for everyone, including employers who sponsor group health plans for their employees. Hardworking taxpayers will pay more, as premiums grow and tax credits for low-income families increase. The California Medical Association shares the sentiments of the letter and looks forward to working with Congress and the Trump Administration to take positive actions to stabilize the health care marketplace. April 19, 2017 General, Managed Care ACA, Affordable Care Act, AMA, American Medical Association, Health Insurance Exchange, Insurance 0 0 Comment Read More »
Anthem Blue Cross continuing medical record reviews and patient health assessments through Inovalon In the Anthem Blue Cross December Professional Network Update, the insurer published a reminder about how it is working with Inovalon, a secure clinical documentation service, to meet the patient reporting requirements specified under provisions of the Affordable Care Act (ACA). Physicians continue to report receiving requests for medical records from Anthem related to “risk adjustment.” These record requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to meet the needs of a diverse population. Because the information reported by physicians and other providers is at the heart of payment adjustments, health plans must engage providers by requesting copies of medical records that accurately reflect diagnoses and/or underlying health conditions to comply with risk adjustment program requirements [77 Fed. Reg. 17220, 17241 (March 23, 2012)]. Anthem has contracted with Inovalon to conduct medical chart reviews, utilizing one of several methods of collecting medical record information from physician practices, including: Scanned or faxed medical records that providers’ offices send to Inovalon Onsite medical record reviews by clinical personnel Automated medical record retrieval from providers’ electronic health record system (upon authorization from the practice) Anthem has also announced that it will continue to offer financial incentives to physicians for completing member health assessments for patients with certain exchange/mirror products. The health assessments are voluntary and are separate from anything related to the commercial risk adjustment requests. Anthem will continue to work with Inovalon throughout the year to request that physicians complete the health assessments. The assessments will be completed using Inovalon’s secure, electronic tool (ePASS) or using the Encounter Subjective, Objective, Assessment and Plan (SOAP) Note provided by Inovalon for each identified patient. For patient assessments completed for dates of service on or after June 1, 2015, physicians are now eligible to receive $100 for each properly submitted electronic SOAP note submitted through ePASS, in addition to their normal office visit fee. Physicians electing to submit their patient assessment data to Inovolan via secured fax, instead of electronically, are eligible to receive $50 in addition to the office visit fee. The information is being requested as part of a Covered California requirement that participating health plans collect and maintain information about the health status of their plan enrollees to better manage their health conditions. According to Anthem, there are no penalties for non-compliance with the health assessment at this time. Physicians who have questions regarding the health assessment program can reference the Anthem FAQ or can contact Anthem Provider Services at (855) 854-1438. For specific health assessment questions, contact Inovalon at (877) 448-8125. To help physicians understand commercial risk adjustment, see “What is commercial risk adjustment?” at www.cmanet.org/news. December 21, 2016 Managed Care Affordable Care Act, Anthem Blue Cross 0 0 Comment Read More »
Be prepared for Covered California changes in 2017 In 2016, Covered California, California's health benefit exchange, enrolled approximately 1.4 million individuals in qualified health plans. It is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2017. Some of the most significant changes for Covered California in 2017 are: All Covered California enrollees, including those with a PPO or EPO, will be assigned to a primary care physician. The assignment will either happen by January 1, 2017, or within 60 days of the enrollee’s effective date with the plan. United Healthcare will exit California’s exchange marketplace at the end of 2016, impacting approximately 1,200 enrollees. All other plans that offered coverage in 2016 will continue to do so in 2017. Three plans will be expanding into new regions this year: Molina is expanding its HMO coverage into Orange County (region 18). Oscar is expanding its EPO coverage into San Francisco (region 4); Santa Clara (region 7); and San Benito, Santa Cruz, and Monterey (region 8). Kaiser is expanding into Santa Cruz and Monterey (region 8). Anthem Blue Cross, which offered a PPO product in all geographic regions in 2016, will return to offering only its EPO product for individual/exchange enrollees in the following counties: Region 1: Northern counties Region 2: North Bay Area Region 3: Greater Sacramento Region 4: San Francisco County Region 5: Contra Costa County Region 6: Alameda County Region 7: Santa Clara County Region 8: San Mateo County Region 9: Santa Cruz, San Benito, Monterey Regions 15 and 16: Los Angeles counties Region 17: Inland Empire Region 18: Orange County Region 19: San Diego County Physicians are reminded that the Anthem Blue Cross EPO product does not offer member coverage for services provided by an out-of-network provider except in urgent/emergent situations. The change in product type from PPO to EPO may also result in changes to the provider network network and access to participating hospitals in each region. Click here to see which hospitals will NOT be participating in the Pathway PPO/EPO plans effective January 1, 2017. Physicians in affected counties who are currently contracted with Anthem for the exchange/mirror PPO product are encouraged to check the directory to confirm whether they will be part of the plan’s EPO network in 2017. Anthem Blue Cross will now only offer its PPO product in the five following regions for 2017. Region 10: Central Valley Region 11: Fresno, Kings, Madera counties Region 12: Central Coast Region 13: Eastern counties Region 14: Kern County There are some other minor benefit design changes for 2017, such as some increases and decreases to copays for different plan tiers and visit types. For more information, see the 2016 and 2017 standard benefit design grids. To help physicians understand the changes taking place and how they will affect their practice, the California Medical Association has published a new tip sheet, “Surviving Covered California: Preparing for changes in 2017.” The tip sheet is available free to members at www.cmanet.org/exchange. December 14, 2016 Managed Care Covered California, Affordable Care Act, Exchange Plans, Health Insurance Exchange 0 0 Comment Read More »
