CMA comments on proposed protections for conscience rights and religious freedom In January, the U.S. Department of Health and Human Services (HHS) released a proposed rule that would expand protections for physicians and other health care providers who object to performing certain procedures. The proposal covers a wide array of existing federal laws that provide “conscience” protections, including those related to abortion, sterilization, assisted suicide and the performance of advance directives. While the California Medical Association (CMA) is a strong advocate for the conscience rights of physicians, we do not believe this proposed rule accomplishes its purported aims. We are concerned that it may lead to discrimination that is prohibited under both federal and California law, adversely impact patient access to comprehensive care, and inappropriately insert politics into the patient-physician relationship. Moreover, current federal and California law provide extensive protections for the conscience rights of health care providers, and the supplemental administrative burdens imposed by this rule do not add any meaningful benefit. CMA is also concerned that the overly broad language in the proposed rule would allow any entity involved in a patient’s care—from a hospital board of directors to the receptionist that schedules procedures—to use their personal beliefs to dictate a patient’s access to care. CMA policy has always sought to balance the rights of patients to access needed health care with the rights of physicians to exercise their conscience. CMA believes that the proposed rule would undermine anti-discrimination protections, especially regarding reproductive health, sexual orientation and gender identity. California law explicitly prohibits discrimination based on sex, sexual orientation or gender identity. The proposal lays the groundwork to preempt California laws that have been put into place to ensure that patients in the state have access to comprehensive health care. Existing federal and state laws protect the rights of physicians by allowing states to take nuanced positions on protecting the conscience rights of health care workers, particularly with regard to abortion, sterilization and aid-in-dying. “The Proposed Rule’s provisions are not only redundant but will have a chilling effect on the enforcement of and passage of state laws that protect access to health care,” CMA wrote in comments submitted to HHS on the proposed regulations. “California law already properly balances the rights of physicians and their patients…Adding a confusing and unnecessary layer of federal regulations may prevent [other] states from successfully passing and implementing their own conscience protections.” View CMA’s comments here. April 5, 2018 CMA Regulatory Advocacy 0 0 Comment Read More »
HHS issues "provider conscience" regulations Last week, the U.S. Department of Health and Human Services (HHS) announced it would form a new division within the HHS Office of Civil Rights to focus on provider conscience and religious freedom exemptions. Following this announcement, HHS released a proposed rule that would expand existing protections for physicians and other providers who object to performing certain health care procedures. The proposed rule covers a wide array of existing federal laws that provide conscience protections, including those related to abortion, sterilization, assisted suicide and the performance of advance directives. The California Medical Association (CMA) and the American Medical Association (AMA) have long-standing policy supporting a woman’s access to reproductive services. We have also strongly supported access to care for patients who may experience discrimination when receiving medical care. CMA and AMA will be closely tracking the activities of this new division and we will continue to defend access to women’s reproductive services and health care without discrimination. CMA and AMA are reviewing the proposed regulation in more detail and will keep physicians informed as the regulations are developed. January 30, 2018 General Abortion, Regulatory Advocacy, Reproductive issues, U.S. Department of Health and Human Services 0 0 Comment Read More »
Join CMA to learn how to challenge the interim payment for out-of-network services at in-network facilities On July 1, 2017, a new law (AB 72) took effect that changes the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. The new law requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. However, it also includes mechanisms for physicians to challenge the interim payment. To dispute the interim payment, physicians must first appeal to the plan/insurer. If the physician is unable to resolve the issue through the payor’s internal appeal process, the new law requires the Department of Managed Health Care (DMHC) and California Department of Insurance to establish an Independent Dispute Resolution Process (IDRP) by September 1, 2017. To view the California Medical Association’s (CMA) comments to the DMHC on the IDRP, click here. CMA has published a number of resources to help physicians navigate this new system, including a sample letter physicians can use to appeal to the plan/insurer and an FAQ. These resources are available free to members only in our AB 72 Resource Center at www.cmanet.org/ab-72. CMA is also hosting a free members-only webinar on the different options for challenging the interim payment on September 27, 2017. The webinar will include an overview of the dispute options, details on how the IDRP will work and CMA resources available to assist physician members. Click here to register for the webinar. If your practice has experienced a change in payor behavior regarding contract negotiations, claims payment or network adequacy concerns, or is experiencing other challenges, CMA wants to hear from you. For more information, visit www.cmanet.org/ab-72 or call our Reimbursement Helpline at (888) 401-5911. August 8, 2017 CMA AB72, Out of Network Care, Regulatory Advocacy, Webinars 0 0 Comment Read More »
CMS releases proposed Medicare physician fee schedule for 2018 The Centers for Medicare & Medicaid Services (CMS) recently released the proposed 2018 Medicare Physician Fee Schedule. The California Medical Association (CMA) is pleased to note that there are a number of positive proposed changes that would help physicians improve patient care. CMS is also soliciting ideas from physicians to reduce Medicare and Medicaid regulatory hassles. Highlights of the proposed rule include: Request for information on regulatory relief: CMA applauds CMS’ invitation for physicians to submit ideas for regulatory, policy, practice and procedural changes to improve the health care system to reduce unnecessary burdens for clinicians, patients and their families. CMA has met with CMS on several occasions this year to urge the agency to reduce regulatory burdens on physicians. CMA is compiling a list of regulatory reforms and will provide comments urging CMS to make it a top priority to provide regulatory relief to physicians in the Medicare and Medicaid programs. CMA’s list of reforms includes: reduced electronic health record (EHR) reporting; more EHR vendor accountability and assistance with usability; Medicare RAC and prepayment audit reforms; and requiring states and health plans to arrange and pay for Medicaid interpreter services. Expansion of the Diabetes Prevention Program (DPP): The proposal would expand coverage of the Medicare DPP model to all Medicare patients at risk of developing type 2 diabetes. This expansion will ensure at-risk seniors and people with disabilities have access to evidence-based DPPs that can help them lower their risk factors and prevent or delay the progression to type 2 diabetes. The new proposal provides more flexibility to DPP providers in supporting patient engagement and attendance, and by making performance-based payments available if patients meet weight-loss targets over a longer period of time. The Medicare DPP pilot program projected an estimated savings of $1.3 billion, prompting CMS to conclude last year that the expanded coverage would result in significant cost savings. This is a groundbreaking policy decision to cover and provide additional payment for evidenced-based prevention activities that improve patient health and reduce total health expenditures. Delayed implementation of appropriate use criteria: The proposal would delay implementation of a program created under the Protecting Access to Medicare Act that would have denied payment for advanced imaging services unless the physician ordering the service documented that they had consulted the appropriate use criteria. CMS has decided to postpone the implementation of this requirement until 2019 and to make the first year an opportunity for testing and education, where consultation would not be required as a condition of payment for imaging services. California Geographic Practice Cost Index: 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. For more information, see the CMS Fact Sheet or read the full rule. CMA is currently reviewing the proposed rule and will provide more information at a later date. CMS is accepting comments on the proposed rule through September 11, 2017. The final rule is expected to be released in early November. July 24, 2017 Medicare CMS, Fee Schedule, Medicare, Regulatory Advocacy 0 0 Comment Read More »
CMA urges strong regulatory system for medical cannabis In 2015, the legislature passed and the governor signed into law a series of bills to create a licensing and regulatory framework for medical cannabis. The Bureau of Medical Cannabis Regulation and California Department of Public Health (CDPH) have issued proposed regulations as they begin to construct the medical cannabis regulatory system. The California Medical Association (CMA) submitted written comments on the proposed medical cannabis regulations, which will affect medical cannabis dispensaries, manufacturers, distributors and transporters. While California became the first state to decriminalize the cultivation and use of medical cannabis back in 1996, there has been very little regulation, in part due to its current federal illegality. As it stands, the present system of medical cannabis is detached from public safety oversight, and a new approach to regulation, research and enforcement is needed to protect public health and patients. CMA supports a state framework with robust regulations, strong patient safety and quality standards, and legally-sanctioned medical research into the potential benefits and risks of medical cannabis. In order to devise such a framework, CMA believes that great weight and consideration should be paid to protecting public health and adopting a strict approach to the regulation of the medical cannabis system. A strong regulatory system that standardizes and regulates medical cannabis is even more needed with the recent legalization of the recreational adult use of cannabis. As an organization, CMA has developed extensive policy, through the deliberation of our diverse physician membership, regarding medical and recreational cannabis. CMA recently adopted policy that supports a tightly restricted regulatory system with recommendations that include advertising and marketing restrictions, monitoring and enforcement of industry practices, warning labels, and a strong data collection system to evaluate the consequences of use in an ongoing capacity. CMA believes that the proposed regulations are a good start in achieving these goals, and has offered some suggestions to ensure that California has a strong regulatory system for cannabis that prioritizes public health and takes into consideration the needs of our diverse state. Click here to read CMA's comments on the proposed regulations. July 21, 2017 General Medical Marijuana, Regulatory Advocacy, Adult Use of Maijuana 0 0 Comment Read More »
Significant improvements in 2018 MACRA rule The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Though not perfect, the California Medical Association (CMA) is pleased that CMS has listened to physician feedback and has made changes that will significantly reduce the administrative burdens on physicians, particularly for small and rural practices. Under the proposed rule, 2018 will be another transition year like 2017. This means that physicians who report only one quality measure in 2018 can avoid all penalties in 2020. MACRA repealed the fatally flawed sustainable growth rate (SGR) payment system, which governed how physicians and other clinicians were paid under Part B of the Medicare program. It replaced the SGR and its fee-for-service reimbursement model with two paths: The Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). CMS will begin measuring performance for eligible clinicians in 2017, with payments based on those results beginning in 2019. CMS estimates that under the proposed 2018 MACRA rule, 94 percent of physicians will earn either a positive or neutral payment adjustment in 2020 for the 2018 reporting year. Major highlights: Allows the creation of virtual groups to assist small practices. Significantly expands the low-volume threshold to $90,000 or less in Medicare Part B allowed charges OR 200 or fewer Medicare Part B patients (previously the threshold was $30,000 in allowed charges or 100 patients). CMS estimates that only 37 percent of clinicians who bill Medicare will be subject to MIPS with this larger exception. Provides automatic bonus points for small practices. Adds a hardship exemption from the electronic health records (EHR) category for small practices. Provides opportunities to achieve bonus points in the EHR category, with physicians only needing to report on Stage 2 measures instead of Stage 3. Provides bonus points for treating complex patients, such as dual eligibles. Physicians will not be scored on "resource use" (physician cost) in 2017. Reduces the Medicare revenue and patient threshold to qualify for APMs. CMA will submit comments on the proposed rule and will continue to fight for improvements to the MACRA regulations to reduce administrative burdens and open up more opportunities for fair payment. For more details on the new rule, see the CMS Fact Sheet. July 21, 2017 Managed Care, Medicare CMA, MACRA, Medicare, Regulatory Advocacy 0 0 Comment Read More »
CMS delays reporting deadline for physician labs The Centers for Medicare and Medicaid Services (CMS) has announced that it will delay the deadline for physician office-based laboratories to meet new reporting requirements. Qualified laboratories now have until May 30, 2017, to complete reporting of private payor payment data for clinical testing services, as required by the Protecting Access to Medicare Act (PAMA). Under PAMA, laboratories that meet revenue thresholds are required to report private payor payment rates and associated volumes for tests they perform that are paid on the Clinical Laboratory Fee Schedule (CLFS). CMS said it will use data collected to set new payment rates for these tests, a move that is expected to result in decreased reimbursement for these services. In an effort to preserve point-of-care testing and to stave off the decrease in rates, the American Medical Association (AMA) sent a letter requesting a one-year delay in the implementation of the new CLFS and that CMS work with the physician community to find an appropriate path forward that would preserve point-of-care testing in physician office-based laboratories. The California Medical Association supports AMA’s actions. More information on the announcement by CMS and the PAMA reporting requirements are available on the CMS website. April 19, 2017 General Centers for Medicare and Medicaid Services, Clinical Laboratories, CMS, Medicare, Regulatory Advocacy 0 0 Comment Read More »
California Medical Association responds to final MACRA implementation rule The Centers for Medicare and Medicaid Services (CMS) today released the final implementation rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which aims to reform the Medicare physician payment system. The California Medical Association (CMA), American Medical Association (AMA) and nearly every other physician organization supported the bipartisan legislation because it was intended to provide stable payment updates, significantly reduce the quality reporting program burdens, reinstate bonus payments and allow innovative, physician-led alternative payment models. “Physicians, particularly small and rural practices, need a modernized, flexible and streamlined system to support high-quality patient care,” said CMA President Steven E. Larson, M.D., MPH. “From day one, CMA urged CMS to delay the MACRA reporting period and provide a longer transition timeline for small medical practices, as well as exempt them from penalties. We applaud today’s announcement, which included additional exemptions and the elimination of penalties during the first year of implementation even for physicians that attempt to report on a few measures, as well as the delay in the 2017 reporting period. We also appreciate that CMS will offer full participation and bonus payment eligibility to medical practices ready for MACRA on January 1, 2017.” Today’s final rule reflects additional steps taken by CMS to reduce the regulatory burden on physicians, but concerns remain. Physicians already spend 785 hours a year on quality reporting activities. For every hour physicians provide direct clinical face time with patients, nearly two additional hours are dedicated to paper and desk work. “CMA is reviewing and assessing the impact of the complex final rule,” said Dr. Larson. “We remain committed to ensuring that MACRA allows more innovative, physician-led alternative payment models and lessens the reporting burdens on everyone.” Physicians should visit CMA’s MACRA resource center to better understand the payment reforms and access resources for the transition. The resource center is a one-stop-shop with tools, checklists and information from CMA, CMS, AMA and national specialty society clinical data registries. The final rule is nearly 2,400 pages – the result of a CMS listening tour with nearly 100,000 attendees and 4,000 public comments. CMA will add an updated summary and materials, including additional webinars, to the resource center in the coming weeks. TWEET THIS NEWS .@cmaphysicians applauds CMS for including additional exemptions/eliminating penalties in 1st year of implementation http://cal.md/2dPZLoJ .@cmaphysicians remains committed to ensuring #MACRA allows more innovative/physician-led alternative payment models http://cal.md/2dPZLoJ “Physicians need a modernized, flexible and streamlined system to support high-quality patient care.” @cmaphysicians http://cal.md/2dPZLoJ # # # The California Medical Association represents the state's physicians with more than 42,000 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 and YouTube. October 27, 2016 Medicare MACRA, Medicare, Regulatory Advocacy 0 0 Comment Read More »
CMA fights federal bill that would allow VA to preempt state telemedicine laws The California Medical Association (CMA) and the American Medical Association (AMA) are fighting a provision in the National Defense Authorization Act (NDAA) for fiscal year 2017 that would preempt state telemedicine laws and dismantle accountability mechanisms needed to ensure patient protection. The NDAA is an annual piece of legislation that primarily authorizes the federal government to spend money for war operations and military base operations. The two houses of Congress passed their own versions of this annual legislation over the summer. The version passed by the U.S. Senate includes language that CMA believes would allow the Veteran's Administration (VA) to preempt state laws governing medical licensure, medical practice, professional liability and reimbursement by altering the applicable state law from where the patient receives the medical services to the location of the physician providing the services. Because of a multitude of differences between the two bills, a formal conference committee will be convened in September to reconcile the differences. CMA and AMA are working to get this language removed from the final bill. “Changing the applicable state laws from the location where the patient is located to the state where the health care provider is located for purposes of state licensure, medical liability and reimbursement does not achieve the intended outcome,” CMA and AMA wrote in the letter. “Namely, it would create confusion by altering well-established legal principles and open new conflicts of law questions, degrade important patient protections, and create confusion with regard to payment and coverage. If enacted, section 705(d) would dismantle accountability mechanisms needed to ensure patient protection because (1) state licensing boards where the patient is located would lack authority over practitioners licensed in another state and (2) state boards where the practitioner is licensed would have no authority to conduct investigations in a different state where the patient is located.“ Currently, patients and others may file complaints with the state medical board where medical care is rendered. Altering the applicable law to the state where the provider is located would place the burden solely on the patient to navigate through the complaint filing and investigatory process (once they have identified the state of licensure of the physician and applicable state medical practice laws) across one or more state lines. CMA and AMA strongly believe that enhancing access to care through telemedicine must be done so in a manner that ensures patient safety and accountability. New innovations to expand access must be designed to ensure the delivery of safe, quality care where clear lines of accountability are maintained. To read the letter, click here. September 22, 2016 CMA, General Telemedicine, Veterans, Regulatory Advocacy 0 0 Comment Read More »
CMA urges CMS to recalculate practice expense data to reflect California's higher practice costs As required by law, at least every three years the Centers for Medicare and Medicaid Services (CMS) adjusts payments under the Medicare physician fee schedule to reflect local differences in practice costs. In the proposed 2017 Medicare physician fee schedule, CMS made nationwide updates to the geographic practice cost indices (GPCI) based on new wage, rent and malpractice expense data. Unfortunately, according to CMS, the malpractice and practice expense GPCIs went down in nearly every region of California, which would result in a 0.48 percent GPCI payment reduction in all but a few regions of California. The California Medical Association (CMA) is urging CMS to review the data for accuracy, as physician office expenses in California have increased in recent years relative to the rest of the nation. "California’s real estate market has experienced a remarkable recovery in most regions of the state over the last several years," CMA wrote in comments submitted to CMS last week. "We find it unfathomable that California physicians would be taking a pay cut in 2017 because practice expenses decreased relative to the rest of the nation." CMA also urged CMS to reconsider the inappropriate weighting of the rent expense category, which was given only an 8 percent weight in the practice expense GPCI. "Office 'rent' is one of the largest and most expensive cost components for physicians, and we would argue that it should be given a much larger weight to more accurately reflect its impact on physician practice expenses," CMA wrote in its comments. The proposed Medicare payment rule also begins to implement the California "GPCI fix," which will overhaul California’s outdated geographic payment localities. It transitions the payment localities to Metropolitan Statistical Areas, which is consistent with the way Medicare pays hospitals. The localities will be updated annually. This long-overdue fix updating California’s Medicare physician payment regions will raise payment levels for 14 urban California counties misclassified as rural, while holding the remaining rural counties permanently harmless from cuts after 2017. The transition to the new localities starts next year, with the higher locality payments being phased in over a six-year period starting in 2017. Unfortunately, because of the overall GPCI practice expense and malpractice expense reductions, most California physicians will not see payment increases in 2017. However, without the CMA-led locality change, California physicians would be receiving an even larger payment cut. CMA has reviewed all of the implementation calculations and provided some minor corrections to ensure that the GPCI fix is implemented accurately. CMA will continue to work closely with CMS on the transition to the new California payment localities. For more details, including a corrected payment impact chart by locality, see CMA's comments. Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org. September 22, 2016 Managed Care, Medicare Fee Schedule, Geographic Practice Cost Index, GPCI, Medicare, Regulatory Advocacy, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
