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U.S. Supreme Court hears arguments in challenge to California's Reproductive FACT Act

A California law that requires specified facilities providing pregnancy-related services and counseling to disclose information about the availability of comprehensive reproductive health care services is currently being challenged before the United States Supreme Court. At issue in this case—NIFLA v. Becerra—are efforts by the State of California to ensure that patients receive accurate information about the availability and accessibility of free and low-cost comprehensive reproductive health services. Passed in 2015, the California’s Reproductive Freedom, Accountability, Comprehensive Care and Transparency (FACT) Act requires licensed health-care centers to notify patients of the availability ...

CMA survey finds rampant health plan payment abuses

Despite a California law passed in 2000 to address widespread payment abuses by health care service plans, many payors continue to flout the law. A recent survey by the California Medical Association (CMA) confirms that health plans regularly engage in unfair payment practices, with two-thirds of physician practices reporting routine payment abuses in violation of state law. The Department of Managed Health Care (DMHC) has been slow to address provider complaints and has taken few enforcement actions against health plans that unlawfully underpay providers. When DMHC has acted, the penalty ...

Payors report system changes to comply with AB 72

When California’s new out-of-network billing and payment law (AB 72) took effect on July 1, 2017, the California Medical Association (CMA) began receiving calls from physician offices concerned that Anthem Blue Cross and Blue Shield of California were not correctly paying claims. In both cases the incorrect payments were linked to manual processing of AB 72 claims. CMA worked with Blue Shield to ensure affected claims through October of 2017 were automatically reprocessed. Blue Shield also committed to conducting weekly audits to catch any additional claims that were processed erroneously. ...

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 ...

CMA physicians travel to D.C. to advocate on critical health care issues

A California Medical Association (CMA) contingent of two dozen physician and medical student leaders recently traveled to Washington, D.C., to participate in the American Medical Association’s (AMA) National Advocacy Week. They met with 24 members of the California Congressional Delegation and top leadership of the Centers for Medicare and Medicaid Services (CMS) to advocate for many health care issues critically important to California physicians.  While in Washington, California physicians focused on promoting the bipartisan Affordable Care Act (ACA) market stabilization bill that would reinstate the cost-sharing reduction payments and ...

$1.3 trillion federal appropriations bill loaded with new health care spending

Last Friday, President Trump signed a massive $1.3 trillion federal spending bill—the Omnibus Consolidated Appropriations Act of 2018. It is loaded with new spending for health care programs that were supported by the California Medical Association (CMA). Unfortunately, it did not include two bills that CMA was strongly promoting – the Affordable Care Act (ACA) market stabilization bill and a permanent solution for the nearly 700,000 Deferred Action for Childhood Arrivals program recipients. A brief summary of the federal spending bill is below.  Bipartisan ACA Market Stabilization: CMA, the American Medical ...

Medical board looking for expert reviewers

The Medical Board of California is looking for physicians interested in becoming expert reviewers. Experts assist the board by providing reviews and opinions in medical board investigations, conducting professional competency examinations, and performing medical and psychiatric evaluations. The medical board is currently looking for experts in the following specialties: addiction medicine with added certification in family medicine or internal medicine or psychiatry; colon/rectal surgery; dermatology; family medicine; gastroenterology; neurological surgery; neurology; OB/GYN; pathology (anatomic/clinical); forensic pathology; pain medicine; pediatric gastroenterology; pediatric surgery; pediatric cardiac surgery; pediatric pulmonology; plastic surgery (hair ...

Health Net announces significant policy changes to Medicare Advantage and Medi-Cal managed care product lines

Health Net recently announced several new payment policies for its Medicare and Medi-Cal lines of business, effective May 16, 2018. The California Medical Association (CMA) is very concerned with the adverse impact these policies would have on physician practices. The new policies would: Reduce reimbursement of evaluation and management (E&M) services when billed with modifier 25 under the following circumstances: When a minor surgical procedure code is reported on the same day as an E/M code by the same physician, payment for the E/M ...

Patient outcomes shortchanged by prior authorization

More than nine in 10 physicians (92 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes, according to a new physician survey by the American Medical Association (AMA). The survey results further bolster a growing recognition across the entire health sector that prior authorization programs must be reformed. According to the AMA survey, which examined the experiences of 1,000 patient care physicians, nearly two-thirds (64 percent) report waiting at least one business day for prior authorization decisions from insurers—and nearly a third (30 percent) said ...

Tip: Get ready for the new Medicare beneficiary cards and ID numbers

The Centers for Medicare and Medicaid Services (CMS) will begin mailing new identification cards to California Medicare beneficiaries between April and June 2018, as required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The new cards will contain a unique, randomly assigned Medicare Beneficiary Identification (MBI) number replacing the current Social Security-based number.   CMS will allow a 21-month transition period beginning April 2018, where health care providers will be able to use either the patient’s current Medicare number or the patient’s new Medicare number. CMS has developed ...