Special session on Medi-Cal financing underway in the Capitol In June, Gov. Jerry Brown convened a special legislative session on "health care financing." Specifically, legislators will be working to come up with new funding for developmental disability services, in-home supportive services and the Medi-Cal program, which is facing a shortfall of at least $1.1 billion through the loss of the managed care organization (MCO) tax. Since 2005, the state has taxed MCOs and used the money to cover the costs of provider reimbursement. However, last summer federal officials informed California that its MCO tax structure was not compliant with ... July 20, 2015 Medi-Cal Medi-Cal Cuts, State Legislative Advocacy, Medi-Cal 0 0 Comment Read More »
CMS publishes 2014 open payment data On June 30, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Open Payments data of financial transactions between drug and medical device makers and health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals nationwide, totaling $6.49 billion. The Sunshine Act requires drug and medical device manufacturers and group purchasing organizations to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Last year’s inaugural launch of ... July 14, 2015 Medi-Cal, Medicare CMS, Physician Payments Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CalHIPSPO receives Medi-Cal EHR incentive program award The California Department of Health Care Services has awarded the California Health Information Partnership & Services Organization (CalHIPSO), founded by the California Medical Association (CMA), the California Primary Care Association and the California Association of Public Health Hospitals and Health Systems, a Medi-Cal electronic health record (EHR) incentive program technical assistance contract for $15 million. Other organizations also given EHR technical assistance awards include the Health Information Technology Regional Extension Center, the CalOptima Regional Extension Center and Object Health. Over the next three years, these organizations will assist more than ... July 6, 2015 Medi-Cal Electronic Health Record, CalHIPSO, EHR 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 ... June 26, 2015 Medi-Cal Medi-Cal, Medi-Cal Cuts, State Budget, California State Budget 0 0 Comment Read More »
California State Auditor releases report outlining flaws with Medi-Cal program The California State Auditor’s office released a report on Tuesday expressing a need for better monitoring of the health plans participating in California’s Medicaid program, Medi-Cal, in order to improve beneficiaries’ access to care. Among the key findings of the audit was that the California Department of Health Care Services (DHCS), which administers Medi-Cal, “has not consistently monitored health plans to ensure that they meet beneficiaries’ medical needs—it did not perform any annual medical audits before 2012 and performed medical audits on less than half of the health plans in ... June 26, 2015 Medi-Cal DHCS, Medi-Cal, Network Adequacy, Provider Networks, Department of Health Care Services 0 0 Comment Read More »
CMS rule reduces Meaningful Use burdens; CMA advocates for more change On June 15, the California Medical Association (CMA) submitted comments to the Centers for Medicare and Medicaid Services (CMS) on proposed rules modifying Stage 1 and Stage 2 Meaningful Use criteria of the federal electronic health records (EHR) incentive programs. Under the federal EHR incentive programs, qualifying Medicare and Medi-Cal providers are eligible to receive incentive payments for adopting and demonstrating “Meaningful Use” of certified health information technology. The proposed rule aligns Stage 1 and Stage 2 Meaningful Use objectives and measures for 2015 through 2017 with proposed Stage 3 ... June 26, 2015 Managed Care, Medi-Cal, Medicare CMS, EHR, Electronic Health Record, HIT, Meaningful Use 0 0 Comment Read More »
CMA President's Message: A Critical Year for Health Care We haven’t quite hit the halfway mark, but 2015 is already shaping up to be an important year for health care. In just these past few months, legislators have repealed the Medicare sustainable growth rate (SGR), saving physicians from an imminent 21 percent payment cut, and have considered an abundance of new bills aimed at solving several major health issues across the state. The topic of health has been filling front-page headlines at every leading newspaper in California recently, reaffirming my belief that this is truly an exciting time to be ... June 15, 2015 General, Medi-Cal, Medicare President's Message, Physician Leadership 0 0 Comment Read More »
DHCS extends meaningful use attestation deadlines for 2014 The Centers for Medicare and Medicaid Services (CMS) published a final rule on September 4, 2014, that revised the meaningful use timeline. Under the rule, eligible professionals can use 2011 Edition certified EHR technology (CEHRT) or a combination of 2011 and 2014 Edition CEHRT for the 2014 EHR reporting period to demonstrate meaningful use. Eligible professionals who were scheduled to begin stage 2 in 2014 will not be required to begin stage 2 until 2015, if they could not fully implement 2014 Edition CEHRT due to delays in availability ... June 5, 2015 General, Medi-Cal EHR, Electronic Health Record, Meaningful Use, Medi-Cal, CMS 0 0 Comment Read More »
CMS to issue new Medicaid managed care rules for comment For the first time since 2002, the Obama administration has announced that it will propose new federal regulations for Medicaid managed care. The Centers for Medicare and Medicaid Services (CMS) is slated to issue a Notice of Proposed Rulemaking sometime in 2015. Industry stakeholders have already submitted input and recommendations to CMS to consider in the final drafting of the new rules. Indications from those who have already commented on agency drafts are that the new rules will address rate setting, stronger beneficiary protections and easing beneficiary transitions between Medicaid ... May 26, 2015 Managed Care, Medi-Cal CMS, Long Term Care, Medi-Cal, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
DHCS reopens window for NICU/PICU claims submission under ACA PCP rate increase On May 18, the California Department of Health Care Services (DHCS) released additional information about Medi-Cal payment increases for primary care physicians under the Affordable Care Act (ACA) who file claims for patients treated in neonatal intensive care units (NICU) or pediatric intensive care units (PICU). In the past, NICU/PICU claims were billed to Medi-Cal using a local code. In order to be eligible for the ACA enhanced payments, physicians were required to submit claims with ACA modifiers beginning April 11, 2014, that linked the local code to an eligible ... May 26, 2015 Medi-Cal Affordable Care Act, Medi-Cal, Pediatrics, ACA 0 0 Comment Read More »
