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Medical Association (AMA) and all of organized medicine were united in opposing this harmful bill, which would have repealed the ACA’s insurance mandate, underfunded health insurance subsidies and made drastic cuts to the Medicaid program.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 pushes top 10 priorities for Medicare/Medicaid regulatory relief California physicians are overwhelmed with unnecessary, burdensome regulations that take time and resources away from providing quality patient care. These regulations are a major contributing factor to the disturbing trend in physician burnout. The California Medical Association (CMA) submitted comprehensive comments urging the Centers for Medicare and Medicaid Services (CMS) to reduce the regulatory burdens under the Medicare and Medicaid programs. As part of the comment period for the proposed Medicare physician payment rule for 2018, CMS is soliciting ideas from physicians to reduce Medicare and Medicaid regulatory hassles. CMA submitted its top 10 priorities for regulatory relief, which were developed by the CMA Health Care Reform and MACRA Technical Advisory Committees. The recommendations submitted by CMA would simplify the Medicare/Medicaid programs, reduce costs, improve quality, increase access to physicians and allow physicians to spend more time with their patients. CMA’s top 10 priorities for regulatory relief are: Reduce the quality and electronic health record (EHR) reporting burdens of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Enforce EHR vendor compliance and interoperability, and limit additional physician fees. Reform the Medicare Recovery Audit Contractor program, and pre- and post-payment review audits. Require Medicaid programs and Medicaid managed care plans to arrange and pay for interpreter services. Reduce health plan data requests of physicians related to Medicare advantage risk adjustment scores. Further delay and simplify the new imaging appropriate use criteria program. Remove lab certification requirements for physicians who use waived tests or physician performed microscopy. Rescind the Two-Midnight/Observation Care rule. Exempt physician in-office drug compounding from the new FDA rule. Change the Stark anti-kickback restrictions to allow more coordinated care alternative payment models. CMA also submitted comments on the proposed 2018 Medicare Physician Fee Schedule. CMA is pleased to note that there are a number of positive proposed changes that would help physicians improve patient care, including reduced penalties under the flawed Value Modifier program, additional coverage for telehealth services, expansion of the Medicare Diabetes Prevention Program, delay in the implementation of the Imaging Appropriate Use Criteria Program, and reduced documentation requirements for the Medicare Shared Savings ACO Program. This year also marks the second year of the CMA-sponsored California Geographic Practice Cost Index (GPCI) fix. The GPCI fix updated California’s Medicare physician payment regions in 2017 and will transition payment levels upwards for 14 urban California counties misclassified as rural, while holding the remaining rural counties permanently harmless from cuts. However, CMA objected to the proposal to report 2016 Physician Quality Reporting System (PQRS) quality data on the public Physician Compare Website because the inaccuracy of the data could mislead patients. Finally, CMA urged CMS to focus fee schedule revisions on the evaluation and management (E/M) guidelines, not the E/M codes, and to remove the new requirement for physician-office labs to report private payor payment data on tests performed for patients. For more details on CMA’s priorities for regulatory relief, and CMA’s comments on the proposed fee schedule, click here. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. September 27, 2017 Medi-Cal, Medicare Medicaid, Medicare, Regulatory Relief 0 0 Comment Read More »
CMA joins coalition to oppose Senate health care bill The California Medical Association (CMA) and a coalition of 9 other state medical associations have joined together to oppose the Republican Senate health care reform bill, the Better Care Reconciliation Act of 2017 (BCRA). CMA and the other associations are concerned that the Medicaid funding cap and inflation index would not keep pace with rising costs beyond physicians’ control. The California Department of Health Care Services estimates that the Senate bill would cut California’s Medi-Cal program by $114 billion. "The proposal places an untenable burden on state budgets and an uncompensated care burden on physicians who are on the frontlines caring for these patients every day," the coalition wrote in a letter to Senate leaders. "We need Congress' help to better care for our patients." The coalition has offered to work with Congress to improve our health care system and ensure access to high-quality, affordable care and coverage. The BCRA would convert federal Medicaid financing to a per-capita cap or a block grant beginning in 2020. It sets the total medical assistance expenditures for a state as the sum of the per-enrollee amounts for the elderly, people with disabilities, children and pregnant women. Under the proposed per-capita cap, the base-year expenditure amount is based on spending between January 2014 and September 2017. The per-enrollee per-capita amounts would increase by medical Consumer Price Index (CPI) for adults and children, and medical CPI plus 1 percent for the elderly and people with disabilities for 2020-24. In later years, the inflation index is reduced. This financing formula would result in a more than 3 percent cut to Medicaid every year. In only five years, the cumulative cut could total more than 15 percent. “These inflation-based Medicaid growth rates are unsustainable for states and physicians. States cannot absorb these tremendous costs," the coalition letter said. "They will be forced to reduce physician payment rates that already are 50 percent less than Medicare rates in many of our states. Access to care is a challenge for Medicaid patients now, and this proposal will only make it worse.” Rather than imposing across-the-board funding cuts, the coalition urges the Senate to consider alternatives to promote efficient Medicaid models of care, such as medical homes, that more effectively address rising health care costs and better address patient needs. Other cosigners of the letter include the state medical societies of Arizona, Florida, Louisiana, New Jersey, New York, North Carolina, Oklahoma, South Carolina and Texas. To read the letter, click here. July 24, 2017 Medi-Cal Advocacy, Health Care Reform, Better Care Reconciliation Act (BCRA), Federal Legislation, Medicaid, Medi-Cal 0 0 Comment Read More »
Spending for federal health programs is expected to remain 'modest' over the next 10 years Total health care spending growth for federal health programs such as Medicare and Medicaid is expected to average 5.8 percent in aggregate over 2014-2024, according to a report published by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. The authors noted that this rate of growth is still substantially lower than the 9 percent average rate seen in the three decades before 2008. “Growth in overall health spending remains modest even as more Americans are covered, many for the first time. Per-capita spending and medical inflation are all at historically very modest levels,” said CMS Acting Administrator Andy Slavitt. In 2014, health spending in the United States was projected to have reached $3.1 trillion, or $9,695 per person, and to have increased by 5.5 percent from the previous year. With new expensive specialty drugs hitting the market, prescription drug spending increased 12.6 percent in 2014, the highest growth since 2002. While more people are getting coverage, annual growth in per-enrollee expenditures in 2014 for private health insurance (5.4 percent), Medicare (2.7 percent) and Medicaid (-0.8 percent) remained slow in historical terms. Other findings from the report included: Medical price inflation averaged 1.4 percent nationally – even with the implementation of the Affordable Care Act (ACA). Hospital and physician and clinical services, which make up the largest portions of medical prices, also increased slowly at 1.4 and 0.5 percent, respectively. Premium growth in private health plans is projected to slow to 2.8 percent in 2015, reflecting the expectation of somewhat healthier marketplace enrollees and the increasing prevalence of high-deductible health plans offered by employers. The authors projected that per-capita premium growth would remain below 6 percent through the end of the projection period (2024). Approximately 19.1 million additional people are expected to enroll in Medicare over the next 11 years as more members of the Baby Boomer generation reach the Medicare eligibility age. In 2014, per capita Medicaid spending was projected to have decreased by 0.8 percent as the newly enrolled were expected to be somewhat healthier than those who were enrolled previously. Overall spending, however, is projected to have increased by 12 percent in 2014 as a result of a 12.9-percent increase in enrollment related to the ACA coverage expansion. While the newly enrolled Medicaid adult population is projected to cost more than adults who were enrolled in the program in 2013, the authors expect that per-enrollee costs will fall below the costs of other adults after pent-up demand for medical care is satisfied. The insured rate is expected to rise from 86 percent to 92.4 percent as the number of uninsured persons is projected to fall by 18 million over the next 11 years. With increases in coverage, the share of health expenses that Americans pay out-of-pocket is projected to decline from 11.6 percent in 2013 to 10 percent in 2024. Click here to read the report. Read the article published in Health Affairs here. July 30, 2015 Medi-Cal, Medicare Centers for Medicare and Medicaid Services, Medicaid, Medicare, Affordable Care Act 0 0 Comment Read More »
Supreme Court limits avenues providers can use to sue states over Medicaid funding In March, a divided U.S. Supreme Court ruled in a 5-4 vote, stating that individual health care providers cannot sue states under the Medicaid Act to challenge how states set reimbursement rates in their Medicaid programs. The California Medical Association (CMA) had filed an amicus brief in Armstrong v. Exceptional Child Center, which went to the Supreme Court last month to determine whether Medicaid providers have a cause of action under the Supremacy Clause of the U.S. Constitution to challenge a state’s compliance with Medicaid laws in setting reimbursement rates. CMA had established good precedent in the Ninth Circuit appellate district on this specific question in our Medi-Cal rate cut litigation, but the Court’s ruling yesterday overturned that precedent. In the late 2000s, Idaho state officials recommended increases in Medicaid reimbursement rates, but they were never implemented because the Idaho legislature declined to appropriate funds. A group of Idaho providers sued the state in 2009, accusing it of maintaining reimbursement rates that were too low and that did not keep up with their rising costs for delivering medical care. The Medicaid Act's equal access provision requires that states must reimburse providers at a level high enough to attract enough providers to participate so that enrollees have the same access to care that private pay enrollees have in the same geographic area. Justice Antonin Scalia, writing on behalf of the majority, said that providers have no right to sue the state under what is known as the Supremacy Clause of the U.S. Constitution, which holds that federal law generally trumps state law. The ability of providers to sue under the Supremacy Clause has been tested in many states that have tried to reduce Medicaid reimbursements in response to budget constraints. However, until yesterday, there was no federal guidance on how to challenge reimbursement rates. While CMA sees the court ruling as unfortunate, a preliminary evaluation of the court's decision shows that a number of viable options remain available, including various legal avenues and working with state and federal regulators. California ranks 47th in the nation's Medicaid rate of reimbursement. Current efforts are focused legislatively through SB 243 (Hernandez) and AB 366 (Bonta), which would restore a 10 percent reimbursement rate cut made to Medi-Cal in 2011 and raise those rates to be on par with Medicare. Click here to read the Supreme Court ruling. Contact: CMA legal information line, (800) 786-4262 or legalinfo@cmanet.org. April 8, 2015 Medi-Cal Medicaid, Medi-Cal, California Supreme Court 0 0 Comment Read More »
CMA files brief in Medicaid case to be heard by the U.S. Supreme Court The California Medical Association (CMA) has filed an amicus brief in a Medicaid reimbursement case (Armstrong v. Exceptional Child Center) that will go before the U.S. Supreme Court this year to determine whether Medicaid providers have a cause of action under the Supremacy Clause of the U.S. Constitution to challenge a state’s compliance with Medicaid laws in setting reimbursement rates. CMA established good precedent in the Ninth Circuit appellate district on this specific question in our Medi-Cal rate cut litigation, but the Supreme Court’s ruling in the Armstrong case could overturn that precedent. The Medicaid Act's equal access provision requires that states must reimburse providers at a level high enough to attract enough providers to participate so that enrollees have the same access to care that private pay enrollees have in the same geographic area. The ability of providers to sue under the “supremacy clause” has been tested in many states that have tried to reduce Medicaid reimbursements in response to budget constraints. There is no federal guidance on how reimbursement rates should be determined. The Supreme Court in this case will examine a decision made by the U.S. Court of Appeals for the Ninth Circuit that allowed Idaho Medicaid providers to sue state Medicaid administrators even though the federal statute does not contain the private right to sue. In the Idaho case, five nursing homes sued the state Department of Health and Welfare for failure to provide the reimbursement levels required under the federal Medicaid Equal Access Requirement. Although Idaho in 2005 created, and the Centers for Medicare and Medicaid Services (CMS) approved, a funding formula that would have increased reimbursement for care provided to developmentally disabled adults, the state never implemented it and continued to pay at the old rate. The state stipulated that it was, in fact, unable to meet the federally mandated standards, as the Idaho Legislature had failed to allocate the necessary funding. After reviewing the facts of the case, the trial court granted summary judgment for the nursing homes and against the state. It found that the inaction of the Idaho Legislature had violated the Supremacy Clause and ordered Idaho Medicaid administrators it to increase reimbursement for providers. The State of Idaho, however, contends that the U.S. Constitution does not allow private parties to enforce federal Medicaid funding laws against states. Idaho officials say it's up to the federal agencies that oversee Medicaid to decide whether a state is in compliance with reimbursement rules. Twenty-seven states, including Idaho, have filed briefs arguing that CMS is the ultimate determiner of rate adequacy. CMA involvement in support of the respondents in Armstrong is critical to uphold and to protect the precedential decisions of the Ninth Circuit and to extend the good law recognized in those cases to the entire country. CMA, along with American Medical Association, the American Dental Association, American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American Academy of Family Physicians and the College of Emergency Physicians have all filed briefs in this case. Click here to read the brief. Contact: CMA legal information line, (800) 786-4262 or legalinfo@cmanet.org. January 22, 2015 Medi-Cal Medicaid, Amicus Briefs, Legal Advocacy, Medi-Cal 0 0 Comment Read More »
California among six states that pay the least for Medicaid beneficiaries, says GAO report According to a report released this week by the U.S. Government Accountability Office (GAO), California is one of six states that spends less than $6,000 per Medicaid (Medi-Cal in California) enrollee per year. The other states include Illinois Alabama, Arkansas, Mississippi and Tennessee. In contrast the report found that eight states, including New York, spend at least $10,500 per beneficiary. The report also found that Medi-Cal fee-for-service pays on average 61 percent of what private insurers in the state pay for the same evaluation and management services, with Medi-Cal managed care paying only 65 percent. These numbers underscore California's dismally low Medi-Cal rates and the need to increase rates, especially with millions of new patients now eligible for Medi-Cal under the Affordable Care Act's Medicaid expansion. Despite having some of the lowest numbers, California continues to move forward with a 10 percent Medi-Cal rate cut, passed by the legislature in 2011. The California Medical Association (CMA) immediately filed a lawsuit seeking to stop the cuts. Though cuts were enjoined for two years while the case was making its way through the court system, the 9th Circuit Court of Appeals cleared the way for implementation of these rate reductions in 2013. In September 2013, CMA filed a petition with the United States Supreme Court, asking them to review the appeals court ruling. The court decided not to take up the case. With 8.5 million beneficiaries estimated to be eligible for the Medi-Cal program this year, or a third of the state’s population, California cannot continue to add millions of people to Medi-Cal and simultaneously cut the resources available to that program. The cuts to reimbursement rates were made when California was facing much more dire fiscal times. With the state's budget in the black for the first time since 2007, the state no longer needs to be balancing the budget on the backs of our poorest and most vulnerable patients. CMA is aggressively urging the legislature and the Governor to restore the 10 percent cut should be restored, ensuring those patients have timely access to quality medical care. CMA is part of an unprecedented coalition of physicians, dentists, health care workers, community clinics, emergency responders and hospitals that maintain a commitment to reversing the cuts. The coalition, called “We Care for California," hosted the largest health care rally in Sacramento history last year, brining 8,000 providers, health care workers and patients to the state’s Capitol to advocate against the cuts. Under the ACA, more than 3 million patients are expected to enter Medi-Cal over the course of the next two years. “As the rest of the nation looks to California for an example of health reform success, we simply cannot move forward with a 10 percent prospective cut to the Medi-Cal program while simultaneously adding new patients to the program," says CMA President Richard Thorp, M.D. “CMA and our stakeholder partners will look toward reforms that will result in real access to care so that health reform is more than an empty promise of an insurance card." As this new GAO study confirms, California's Medi-Cal provider payment rates were among the lowest in the nation even before the cuts. Low reimbursement rates have forced many of California’s providers to stop seeing Medi-Cal patients. As a result, 56 percent of Medi-Cal patients report difficulty finding a doctor. If these cuts are not stopped, Medi-Cal will become nothing more than a broken promise of access to care. To read the report click here. July 22, 2014 Medi-Cal Insurance/Reimbursement, Medicaid, Access to Care, Medi-Cal 0 0 Comment Read More »
