State budget includes 10 new CPT codes eligible for supplemental tobacco tax payments Governor Jerry Brown last week signed a $139 billion California budget for the 2018-2019 fiscal year. The budget continues the Administration’s commitment to using the Proposition 56 tobacco tax funding to provide supplemental payments for Medi-Cal providers, with $500 million in tobacco tax funds allocated to improve provider reimbursement through supplemental payments. The total funding for provider payments is approximately $1.3 billion. DHCS plans to allocate the tobacco tax funds to increase payments for a total of 23 CPT codes, which includes 10 new preventive CPT codes. The supplemental rate proposal is contingent on federal approval, and would be effective July 1, 2018. DHCS has proposed increasing the supplemental payment for the currently eligible CPT codes to 85 percent of Medicare (a 40 percent average increase in payments for these eligible codes compared with 2017 – 2018 payment levels). The 10 newly added preventive CPT codes would be paid at 100 percent of Medicare. The supplemental payments would apply to both fee-for-service and managed care delivery systems. A full list of the eligible CPT codes is listed below. The supplemental rate proposals are effective July 1, 2018, contingent on receipt of federal approval, which was requested through a State Plan Amendment on June 29, 2018. CPT Code 2017 - 2018 SUPPLEMENTAL AMOUNT 2018 2019 SUPPLEMENTAL AMOUNT 99201 $10.00 $18.00 99202 $15.00 $35.00 99203 $25,00 $43.00 99204 $25.00 $83.00 99205 $50.00 $107.00 99211* $10.00 $10.00 99212 $15.00 $23.00 99213 $15.00 $44.00 99214 $25.00 $62.00 99215 $25.00 $76.00 90791* $35.00 $35.00 90792* $35.00 $35.00 90863* $5.00 $5.00 99381 $77.00 99382 $80.00 99383 $77.00 99384 $83.00 99385 $30.00 99391 $75.00 99392 $79.00 99393 $72.00 99394 $72.00 99395 $27.00 * The supplemental payment on these four codes remains unchanged with their existing supplemental payment already between 90 – 120 percent of Medicare. July 11, 2018 General, Managed Care, Medi-Cal California State Budget, Medi-Cal, Prop. 56 (tobacco tax) 0 0 Comment Read More »
DHCS preps contingencies in case of delayed budget approval The California Department of Health Care Services (DHCS) recently announced it will implement a contingency plan for claim payment if the state budget is not enacted before the beginning of the 2017-2018 fiscal year on July 1. Although the state legislature passed a budget by the June 15 deadline, the Governor has not yet signed it. According to DHCS, providers should continue to submit claims for processing as normal, but payments for some programs may be delayed until the budget is signed. Claims for the following services will be processed and adjudicated regardless of dates of service: Medi-Cal program California Children’s Services (CCS) program/Medi-Cal Child Health and Disability Prevention (CHDP) program/Medi-Cal Family Planning, Access, Care and Treatment (Family PACT) Program Abortion Claims submitted after June 22, 2017, for the following programs will be withheld regardless of dates of service. CCS-only (aid code 9D) CHDP services only (aid code 8Y) Genetically Handicapped Persons Program (GHPP) (aid code 9J) Optional Targeted Low Income Children’s Program (OTLICP) Claims submitted by Every Woman Counts (EWC) will continue to be processed until contingency funding is exhausted. June 22, 2017 General Child Health and Disability Prevention Program, Department of Health Care Services, DHCS, Family PACT, Medi-Cal, California State Budget, CHDP 0 0 Comment Read More »
California Medical Association urges legislature to adopt state budget that improves access to care for Medi-Cal patients PRESS FOR IMMEDIATE RELEASE CONTACT: Joanne Adams, jadams@cmanet.org Sacramento, CALIF. – Today, Governor Jerry Brown released his revised state budget, which applies tobacco tax revenues to cover general fund responsibilities in the Medi-Cal program. In response, California Medical Association (CMA) President Ruth E. Haskins, M.D., made the following statement: "We’re disappointed that Governor Brown’s revised budget continues to ignore the clear language of the tobacco tax initiative (Proposition 56) and the will of California voters. "More than a third of Californians, including 50 percent of children in the state, rely on Medi-Cal for health care. Offering increased coverage is a hollow talking point when patients are forced to wait months to secure an appointment with a physician or dentist, can’t access a specialist or have to travel 60-plus miles to their medical appointments. "Instead of improving access to care for the 14.3 million Californians served by Medi-Cal, the budget takes tobacco tax revenues to backfill cuts to the state’s general fund contribution to Medi-Cal. This ‘rob Peter to pay Paul’ approach does nothing to improve California’s health – it maintains the unsustainable status quo and adds more patients to the back of the line in over-crowded waiting and emergency rooms. "By embracing Medicaid expansion, California has made incredible strides to reduce our uninsured population. Building on this important step, we now need to provide Medi-Cal patients with real and equal access to health care. We urge the Legislature to adopt a budget that reflects their values and dedicates Prop. 56 funds to their voter-intended purpose.” The State Legislature has until June 15 to adopt a final 2017-2018 budget. The stakes are high – urge the Legislature to adopt a budget that reinstates tobacco tax revenues for Medi-Cal patient access to care. # # # 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. NOTE: Past tobacco tax-related press releases, op-eds and articles: May 9, 2017: Press Release: Leading California Health Care Providers Call on Governor and Legislature to Keep Promise to Medi-Cal Patients April 17, 2017: #MatchedinCA: Making dreams come true for UCR medical students March 31, 2017: Californians with Medi-Cal face hurdles to see specialists throughout the state March 16, 2017: Press Release: California’s physicians and dentists unveil plan to honor will of tobacco tax voters and increase patient access to health care May 22, 2017 General, Medi-Cal California State Budget, Medi-Cal, Prop. 56 (tobacco tax), State Legislature 0 0 Comment Read More »
California grapples with 'severe' doctor shortage, study shows California doesn't have enough doctors to handle its primary health care demands and the problem is getting worse. A new study by UCSF Healthforce Center finds that California doesn’t have enough primary care physicians in most regions of the state. According to the study, the shortage is becoming more acute because of an aging physician workforce, a growing patient population and expanded coverage through the Affordable Care Act. According to the study, only two regions of California (the Greater Bay Area and Sacramento) have ratios of primary care physicians per population above the minimum ratio recommended by the Council on Graduate Medical Education (60 primary care physicians per 100,000 people). The study also found that two regions (the Inland Empire and San Joaquin Valley) have ratios of primary care physicians to population that are below the minimum required by California law for managed care plans (50 primary care physicians per 100,000 people). Some estimates show that California will need an additional 8,243 primary care physicians by 2030 – a 32 percent increase. In an effort to increase California's primary care physician workforce, the state legislature passed a budget in 2016 that included historic support for and expansion of primary care graduate medical education (GME)—committing to invest $100 million over three years to support primary care residency programs in medically underserved areas. Unfortunately, Governor Jerry Brown’s proposed 2017 budget takes a huge step backward, eliminating $33.4 million of that health care workforce funding and redirecting $50 million in Prop. 56 funding that was intended to go to GME programs. The California Medical Association (CMA) believes these budget cuts are irresponsible and make a bad situation worse. A robust and well-trained primary care workforce is essential to meeting the health care demands of all Californians. Inadequate funding for residency programs exacerbates access problems—every year hundreds of graduating medical students don't find a residency slot in California to continue their training, forcing talented, young doctors who want to stay and practice in California to other states and communities. CMA will be working through the budget negotiation process to restore this critical funding. We are also urging physicians, residents and medical students to ask their legislators to oppose Governor Brown’s budget proposal to eliminate physician workforce funding. For more information on the budget as it relates to health care, including GME funding talking points, see CMA's budget summary. Click here to read the UCSF study. March 2, 2017 General California State Budget, Graduate Medical Education, Physician Workforce, Primary Care, State Legislative Advocacy, Underserved Communities 0 0 Comment Read More »
Leading health care groups deeply concerned that Governor's budget proposal may decimate access to care In his 2017-18 budget proposal, Governor Jerry Brown eliminates $33.4 million in health care workforce funding that would begin addressing the primary care workforce crisis that is gripping California’s underserved communities. This is the first year of a three-year $100 million investment. The budget investment came at the urging of a broad coalition of statewide healthcare organizations including the California Academy of Family Physicians (CAFP), CaliforniaHealth+ Advocates, and the California Medical Association (CMA), who recognized that access to care challenges must be systemically and comprehensively addressed. “While our organizations recognize the health care challenges that may confront America and California this year, we are alarmed to see the Governor’s proposed elimination of health care workforce funding that has already been allocated to help address the dire access-to-care issues facing numerous regions in California,” said Carmela Castellano-Garcia, CaliforniaHealth+ Advocates President and CEO. “We are committed to working with the Legislature and the Governor to forge solutions that protect our state’s most vulnerable communities, but must not turn our back on those we have already committed to helping.” The $100 million appropriation in the 2016-17 State Budget currently is set to support and expand primary care residency training and programs in medically underserved areas through the Song-Brown Workforce Training Program and targeted investment in Teaching Health Centers. The goal is to create a reliable and continuous funding stream that primary care residency programs in California so desperately need. “The Governor’s proposed elimination of funding is of serious concern in California as our primary care residency programs have recently lost more than $60 million,” said CAFP President-elect Michelle Quiogue, MD. “Last year’s appropriation was intended to save these programs, but this proposed cut would be devastating, causing programs to close and exacerbating serious access problems for some of the state’s most vulnerable patients.” Without this appropriation, California primary care training programs cannot replace significant federal and private foundation grants that recently expired, including $18 million in federal Health Resources and Services Administration funding for the Primary Care Residency Expansion program; a $21 million California Endowment grant to the Song-Brown Program; $15 million allotted through the federal Teaching Health Center program; and a one-time $4 million California Health Data and Planning Fund appropriation to Song-Brown. Even if these cuts were replaced dollar for dollar, California would struggle to provide sufficient access to primary care. Only 36 percent of California’s active patient care physicians practice primary care and, according to the Council on Graduate Medical Education (COGME), 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. That’s why this new appropriation is so critical. “A robust, well-trained primary care workforce is essential to meeting the health care demands of all Californians,” said CMA President Ruth Haskins, MD. “The Legislature’s move to restore and stabilize funding for these programs is an important first step toward reversing our shortage of primary care physicians, particularly in the underserved communities that need it the most.” California faces a drastic shortage of primary care physicians. The federally recommended number of primary care physicians per 100,000 people is 70. According to the California Health Care Foundation, the number of primary care physicians participating in Medi-Cal per 100,000 enrollees is 42. With an increase of more than four million individuals in the Medi-Cal program, it has never been more important to fully support the training programs that bring primary care physicians to underserved areas. February 13, 2017 General California State Budget, Medi-Cal, State Legislative Advocacy 0 0 Comment Read More »
Governor Brown's 2016-17 budget proposal includes new MCO tax deal On January 7, the Governor unveiled a $122.6 billion budget proposal for the 2016-17 fiscal year, including a new approach to replacing a soon-to-expire tax on managed care organizations (MCO). The current MCO tax will expire this summer if legislators cannot agree on a replacement. Since 2005, the state has taxed MCOs and used the money to cover the costs of the Medi-Cal program. However, federal officials in 2014 informed California that its MCO tax structure was not compliant with federal requirements. Since then, the California Department of Health Care Services and other administration officials have been negotiating with the health plans to construct a tax scheme that meets federal standards. The loss of the MCO tax and the federal matching funds would mean a devastating loss of over $2 billion for the Medi-Cal program. In his budget proposal, the Governor included a conceptual agreement on a new MCO tax that conforms to federal regulations and reportedly has agreement from the health plan industry. The details of the agreement are still being finalized, but we understand that under this agreement, health plans that pay the MCO tax would be exempt from other non-health care taxes like the gross premiums tax or the corporate tax. “We are pleased to see the Governor is committed to working with the legislature and health plans to find a solution to the MCO tax. Without that, a gaping hole would exist in the state’s Medicaid (Medi-Cal) fund that would have devastating impacts on patients across the state," said CMA President Steve Larson, M.D. “With over one-third of the state’s population relying on Medi-Cal for health care coverage, it’s essential that access to care is a reality for those patients and not just an empty promise with an insurance card.” For more details on the Governor's budget proposal as it relates to health care, see CMA's budget memo here. Contact: Eduardo Martinez, (800) 786-4262 or emartinez@cmanet.org. January 15, 2016 Managed Care California State Budget 0 0 Comment Read More »
California Medical Association responds to unveiling of Governor Brown's proposed 2016-17 state budget Sacramento – Steve Larson, M.D., president of the California Medical Association (CMA), representing over 41,000 physicians statewide, issued the following statement in response to the unveiling of Governor Brown’s proposed 2016-17 state budget released this morning: “We are pleased to see the Governor is committed to working with the legislature and health plans to find a solution to the MCO tax. Without that, a gaping hole would exist in the state’s Medicaid (Medi-Cal) fund that would have devastating impacts on patients across the state. “Ensuring that Medi-Cal is better funded is a priority of CMA, and as sponsors of the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, we will be focused on passing the ballot measure both to help save lives and fund health care programs in California. “With over one third of the state’s population relying on Medi-Cal for health care coverage, it’s essential that access to care is a reality for those patients and not just an empty promise with an insurance card.” January 15, 2016 General, Managed Care, Medi-Cal Managed Care, Medi-Cal, Save Lives California, Tobacco Tax, California State Budget 0 0 Comment Read More »
CMA delegates urge the state to restore public health funding On Friday, October 16th, the California Medical Association (CMA) House of Delegates meeting in Anaheim voted unanimously to urge the State of California to restore public health funding. The resolution (Resolution 112-15) calls on CMA to work with state health and legislative officials, through the state budget process, to develop a plan to repair California’s public health infrastructure and funding for vital prevention services that have been eliminated or drastically reduced since 2007-08. It is estimated that over $226.7 million per year has been lost in California Department of Public Health public health funding for things like HIV prevention, immunizations, domestic violence prevention, teen life skills, children’s dental disease prevention, preventive health care for adults and more. These budget reductions have weakened the state’s public health infrastructure and caused massive reduction in preventive services at the local level. A study published in 2013 by the Centers for Disease Control and Prevention showed that the California cuts to HIV prevention funding alone were associated with an increase in new HIV infections. Public health services save the state money by increasing population health through preventive measures, before acute care is necessary. The state’s fiscal health has improved dramatically since these cuts were implemented, and CMA believes the state’s improved financial condition should correlate to an improvement in the funding levels for these vital public health services. October 31, 2015 CMA, General House of Delegates, Public Health, California State Budget 0 0 Comment Read More »
Governor calls for special Medi-Cal session after budget agreement struck with legislators Governor Jerry Brown has called for a special session of the Legislature to address “Health Care Financing” after he struck a deal with Democratic lawmakers last week. California legislators passed a $115.4 billion budget, part of a deal with Governor Brown to hold back on spending despite the state’s improving financial picture. Left out of the budget agreement were higher rates for Medi-Cal providers. In a typical year, the conclusion of budget negotiations would mean the end of the California Medical Association’s (CMA) hopes of improving access for the over 12 million Californians who rely on the Medi-Cal program, at least for the next 12 months. The special session of the Legislature, however, provides a new opportunity for CMA and other stakeholders to push through a permanent and significant funding increase dedicated to providers of health care services, and to ensure the health care infrastructure exists to care for the Medi-Cal population. The Governor’s special session announcement was made on the same day that the State Auditor released a report finding Medi-Cal managed care provider networks are severely lacking integrity and resulting in barriers to accessing care. The State Auditor found that not only were managed care plans providing the state with inaccurate data on availability and participation of in-network physicians, but the state was not verifying whether the data from the plans was accurate, and thus could not reliably determine whether the Medi-Cal networks meet California’s stringent network adequacy standards. A summary of the audit’s findings can be found here. More information from CMA on this issue can be found here. The budget includes: $40 million to expand Medi-Cal to cover all low-income undocumented children, effective May 1, 2016 ($132 million when fully implemented). $265 million to fund 7,000 additional preschool slots and 6,800 child care slots, plus a rate increase for all child care providers. $97 million over the January budget for the California State University to expand enrollment and focus on increased success. $226 million on a one-time basis to restore the 7 percent reduction in service hours for In-Home Supportive Services. The announcement of the special session allows the Governor and legislative leaders to bypass the traditional legislative and budgetary calendar. CMA will continue to work with its legislative allies and coalitions to push this issue over the finish line. June 26, 2015 Medi-Cal Medi-Cal, Medi-Cal Cuts, State Budget, California State Budget 0 0 Comment Read More »
Governor's revised budget contains no significant increases for Medi-Cal On May 14, Governor Jerry Brown released his revised budget for fiscal year 2015-16, which includes an increase in overall expenditures from the General Fund to $115.3 billion, but does not include any significant increases to Medi-Cal provider reimbursement rates. Overall, the revised plan contains $169 billion in total state spending, up from $164.7 billion in January. The total includes $46.9 billion in special funds and $6.8 billion in bond funds. The California Medical Association and other stakeholders continue to point out that beneficiaries of the Medi-Cal program are having trouble accessing needed care. Despite these concerns, the Governor is proposing an additional $200 million to provide full-scope Medi-Cal coverage, in-home supportive services and other benefits for the individuals who are covered by President Obama’s executive orders relating to undocumented immigrants. Under existing California law, an individual who is lawfully present in the state is entitled to certain health and social services, but the May budget revision assumes the legal challenges surrounding the President’s actions will ultimately be upheld. The Brown budget estimates that the Medi-Cal program will serve 12.4 million people by the middle of 2016, an increase of 200,000 people since January and includes an additional $2.9 billion, split evenly between the state and the federal government, which would cover the enrollment increase. Brown also includes costs ($14 billion) for adults without children and parents/caretakers with incomes up to 138 percent of the federal poverty level. However, currently, the cost for this population has been financed entirely by the federal government (until the 2016-17 fiscal year). The budget revision will open weeks of negotiations at the Capitol before adoption of a spending plan in June. By law, the budget must be passed by the Legislature by June 15. Major spending initiatives outlined by the Governor outside of health care include an increase in the state’s deposit into the Rainy Day Fund to $633 million; an additional $633 million to pay down existing debts and liabilities; the creation of the California Earned Income Tax Credit for low-income Californians, at the cost of $380 million to the state; increases to the Proposition 98 General Fund spending by $5.5 billion for K-12 schools and community colleges; an increase of 4 percent for each of the next four years and additional funding to help with University of California employee pension obligations, in exchange for the UC agreeing to cap tuition for in-state students; and an additional $2.2 billion of one-time funding to continue the state’s response to drought impacts program. Click here to read more about Brown’s budget. May 18, 2015 Medi-Cal State Budget, California State Budget, Medi-Cal 0 0 Comment Read More »
