Health Net Federal Services experiences significant challenges with TRICARE transition On January 1, 2018, Health Net Federal Services (HNFS) became the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region, serving approximately 2.9 million beneficiaries in 21 western states, including California. HNFS took over the contract previously held by UnitedHealthcare Military and Veterans’ Services (UMVS). The California Medical Association (CMA) has learned that HNFS has experienced implementation issues related to provider contracting and credentialing, beneficiary reassignment to new primary care managers (PCM), and provider directory inaccuracies. The contracting and credentialing issues in California are reportedly related ... July 24, 2018 General, Managed Care Payor Contracting, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
Medical staff prevails in legal battle over medical staff self-governance A settlement has officially been reached in the case of the Tulare hospital embroiled in a bitter legal battle over the self-governance rights of its medical staff. The case stems from actions taken in 2016, when hospital administrators at Tulare Regional Medical Center (TRMC) terminated the entire medical staff and its duly elected officers. The hospital then adopted new medical staff bylaws in secret and without input from physicians at the hospital. The hospital dictated leadership and standards of medical care, seized control of the disciplinary process without legal or ... July 24, 2018 CMA, General Advocacy, Medical Staff Self Governance 0 0 Comment Read More »
Reminder: CURES duty-to-consult takes effect October 2, 2018 Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a ... July 24, 2018 General Drug Prescribing/Dispensing, CURES 0 0 Comment Read More »
SBCMS Member Benefit: Take advantage of 30% off new print items When was the last time you evaluated your practice's printed material? Are you running low on an item or need to refresh an item? Professional Office Services is a SBCMS' Business Partner dedicated to offering special services or discounts to SBCMS members on various products and services designed to accommodate the business needs of physicians. Take advantage of 30% off new print items! Click here for the flyer and promo code; offer expires September 28, 2018. Contact your Regional Territory Manager, Curtis Stickfort at 909-505-2770 ext 1. July 23, 2018 General Business Partner Program 0 0 Comment Read More »
2017 MIPS performance scores and 2019 payment adjustments now available Physicians can now log in to the Medicare Quality Payment Program (QPP) website to view their final 2017 Merit-based Incentive Payment System (MIPS) performance scores and payment adjustment information for the 2019 payment year. It is important to note the Centers for Medicare and Medicaid Services (CMS) will not be sending out letters this year, so physicians are encouraged to log into the QPP website to learn about any payment adjustments they will receive in 2019. Physicians should be aware that the MIPS payment adjustment is required to be budget neutral. That means ... July 23, 2018 Medicare MACRA, Public Health 0 0 Comment Read More »
First infant death from Pertussis (whooping cough) confirmed News from the Department of Public Health San Bernardino County www.sbcounty.gov For Immediate Release July 17, 2018 Contact: Lana Cao Public Health Information Officer San Bernardino County Department of Public Health Phone: 909.387.9147 Email: Lana.Cao@dph.sbcounty.gov First infant death from Pertussis (whooping cough) confirmed Pertussis, also known as whooping cough, has claimed the life of a San Bernardino County infant less than six months of age. This is the first confirmed death from the disease in California since 2016. “This infant’s death is a tragedy for the family and our community. My sincerest condolences are extended to the family at this difficult time,” ... July 17, 2018 General, Press Releases Immunizations, Public Health 0 0 Comment Read More »
Welcome to the Next Generation of CMA The California Medical Association (CMA) is proud to launch the next generation of our brand and website – powerful recruitment and engagement tools to keep CMA at the forefront of an ever-changing health care landscape. The website functionality, design and content strategy have been reimagined for easier, more intuitive navigation and loaded with a suite of digital tools that will help you get the most from your membership. Highlights of the new website include: One Login: Simplified joint CMA/county login process so you don’t have to keep track of multiple usernames ... July 16, 2018 CMA California Medical Association, CMA 0 0 Comment Read More »
Federal opioid package receives bipartisan support in the U.S. House On June 22, the U.S. House of Representatives passed HR 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. It includes more than 55 opioid-related bills intended to help combat the nation’s opioid crisis by advancing treatment and recovery initiatives, improving prevention, protecting our communities and bolstering our efforts to fight deadly illicit synthetic drugs. HR 6 also includes several Medicaid, Medicare and public health reforms to help combat the opioid crisis. The California Medical Association (CMA) aggressively advocated for more funding ... July 11, 2018 General Prescription Drugs, Drug Prescribing, Federal Legislative Advocacy 0 0 Comment Read More »
DHCS requires enrollment for all Medi-Cal managed care providers In January 2018, the California Department of Health Care Services (DHCS) began requiring that all Medi-Cal managed care providers be enrolled through the Medi-Cal program. Medi-Cal managed care plans have the option to develop and implement a managed care physician screening and enrollment process that meets federal requirements, or they may direct their network physicians to enroll through the DHCS fee-for-service (FFS) enrollment portal. (Enrolling through DHCS does not obligate managed care network providers to also see FFS patients.) Some physicians have already reported receiving notices from Medi-Cal managed care ... July 11, 2018 Managed Care, Medi-Cal DHCS, Medi-Cal, Medi-Cal Provider Enrollment, Department of Health Care Services 0 0 Comment Read More »
Health plans terminate relationship with Vantage Medical Group The California Medical Association (CMA) has learned that two health plans, the Inland Empire Health Plan (IEHP) and Molina Healthcare, are terminating their contracts with Vantage Medical Group. Two other plans, Blue Shield of California and Care1st Health Plan, have issued notices of material breach with an intent to terminate. The plans have filed requests with the California Department of Managed Health Care (DMHC) to transfer their enrollees to other delegated groups. According to IEHP’s block transfer filing with DMHC, Vantage engaged in conduct that resulted in the inappropriate delay, ... July 11, 2018 General, Managed Care, Medi-Cal Blue Shield, Commercial Payors, Department of Managed Health Care, DMHC, Payor Contracting 0 0 Comment Read More »
