DHCS suspends planned passive enrollment for duals project The Department of Health Care Services (DHCS) announced last week that it would not move forward with its planned annual passive enrollment of dual eligible beneficiaries under the Coordinated Care Initiative (CCI) after it received feedback from the California Medical Association (CMA) and 40 other stakeholders asking the agency to pursue enrollment strategies that support voluntary "opt-in" enrollment. Instead, DHCS said it will implement a voluntary "opt-in" enrollment effort beginning in July 2016. The new streamlined enrollment strategy will include mandatory Managed Medi-Cal Long-Term Supports and Services (MLTSS) plan enrollment. ... June 8, 2016 Managed Care, Medi-Cal, Medicare Medi-Cal, Medicare, Cal-MediConnect, Department of Health Care Services, Dual Eligible 0 0 Comment Read More »
Maintaining your Medicare opt-out status Physicians who intend to opt-out, or who have previously opted-out of Medicare, should be aware of changes to the Medicare opt-out period as a result of the Medicare Access and CHIP Reauthorization Action of 2015 (MACRA). Validated opt-out affidavits signed on or after June 16, 2015, will automatically renew every two years. Previously, physicians who opted out of the program would have to renew their affidavit every two years to maintain their opt-out status. Under the new rules, affidavits will automatically renew every two years unless the physician cancels ... June 8, 2016 Medicare Medicare 0 0 Comment Read More »
CMS releases draft MACRA regulations The Centers for Medicare and Medicaid Services (CMS) on Wednesday released a 962-page proposed rule that lays out the agency's plan for implementing last year's groundbreaking Medicare reform law, the Medicare Access and CHIP Reauthorization Act (MACRA). Ahead of CMS’ release of the rule, physician leaders testified before the U.S. House of Energy and Commerce Committee’s Subcommittee on Health during a special MACRA hearing last week. The physicians expressed cautious optimism and said the law represents a critical opportunity to enhance flexibility and innovation in health care that can lead ... April 29, 2016 Medicare Regulations, Regulatory Advocacy, CMS, MACRA, Medicare 0 0 Comment Read More »
Physicians show cautious optimism for MACRA during Capitol Hill meeting Physician leaders expressed cautious optimism for the landmark Medicare payment reform law (known as MACRA) during a key congressional committee hearing on April 19. The physicians said the law represents a critical opportunity to enhance flexibility and innovation in health care that can lead to improved care and better outcomes for patients, but the law also needs to allow physicians to focus on practicing medicine by aligning and simplifying quality reporting programs. “MACRA makes significant improvements over the current system, including the repeal of the flawed sustainable growth rate formula ... April 28, 2016 Medicare MACRA, Medicare 0 0 Comment Read More »
CMA opposes proposed changes to duals demonstration The Department of Health Care Services (DHCS) recently released a series of proposals that would change the Coordinated Care Initiative (CCI) enrollment process to 1) passively enroll beneficiaries into Cal MediConnect; and to 2) streamline enrollment by allowing plans to eliminate or dramatically reduce the role of the enrollment broker. The California Medical Association (CMA), in partnership with Justice in Aging and other patient advocacy groups, signed a joint letter strongly opposing the proposals. The Coordinated Care Initiative was authorized by the state in July 2012 in an effort to save ... April 28, 2016 General, Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, DHCS, Regulatory Advocacy 0 0 Comment Read More »
Reminder: Deadline to review Open Payments data is May 15 Drug and medical device manufacturers have completed their submission of data to the Open Payments system on payments or transfers of value made to physicians and teaching hospitals during 2015. Physicians and teaching hospitals now have until May 15, 2016, to review and dispute records attributed to them. The review and dispute process is voluntary, but encouraged. The Centers for Medicare and Medicaid Services (CMS) will publish the 2015 payment data and updates to the 2013 and 2014 data on June 30, 2016. Under the Sunshine Act, drug and medical device ... April 28, 2016 General, Medi-Cal, Medicare CMS, Physician Payments Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS announces new primary-care payment and health care delivery model The Centers for Medicare and Medicaid Services (CMS) this week announced a new payment model aimed at transforming and improving how primary care is delivered and paid for in America. The Comprehensive Primary Care Plus (CPC+) model will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the ... April 18, 2016 Medi-Cal, Medicare Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMA meets with CMS on implementing California GPCI fix California Medical Association (CMA) physician leaders recently traveled to Baltimore, MD, to meet with the Centers for Medicare and Medicaid Services (CMS) leaders responsible for implementing the California Geographic Practice Cost Index (GPCI) fix, which will overhaul California’s outdated geographic payment localities. CMA was represented at the GPCI meeting by Larry DeGhetaldi, M.D., division president of the Palo Alto Medical Foundation in Santa Cruz, and Edward Bentley, M.D., a gastroenterologist in solo practice in Santa Barbara. Both physicians have worked on the GPCI issue for CMA for more than a decade. ... April 4, 2016 Medicare CMS, Federal Legislative Advocacy, Geographic Practice Cost Index, Centers for Medicare and Medicaid Services, GPCI 0 0 Comment Read More »
Open Payments review and dispute period now open Drug and medical device manufacturers have completed their submission of data to the Open Payments system on payments or transfers of value made to physicians and teaching hospitals during 2015. Physicians and teaching hospitals now have 45 days to review and dispute records attributed to them. The review and dispute period is open from April 1 until May 15, 2016. The review and dispute process is voluntary, but encouraged. The Centers for Medicare and Medicaid Services (CMS) will publish the 2015 payment data and updates to the 2013 and 2014 ... April 4, 2016 General, Managed Care, Medi-Cal, Medicare CMS, Physician Payments Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS announces second cycle of Medicare revalidation Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent fraud within the Medicare system. Once a Medicare enrollment application is validated, the clock starts ticking on a five-year revalidation cycle. Now that five years have passed since the ACA's revalidation requirement took effect, the Centers for Medicare and Medicaid Services (CMS) is initiating a second cycle of revalidation requests. According to CMS, Medicare Administrative Contractors (MAC) ... March 31, 2016 Medicare Affordable Care Act, Medicare, ACA 0 0 Comment Read More »
