SBCMS News

rss

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 ...

Fresno ER physician announces run for State Assembly

On May 11, Joaquin Arambula, M.D., an emergency room physician at Adventist Medical Center in Selma, located in rural Fresno County, announced he is running for the California State Assembly. “I am running for Assembly to make our community a healthier place to live, work and raise a family,” Dr. Arambula said. “I will go to Sacramento to fight for access to quality health care, public education and our fair share of water.” Both the current Assembly representative from District 31, Henry T. Perea, who is not eligible to run because ...

California Medical Association supports the Fair Medical Audits Act of 2015

The California Medical Association (CMA) issued a strong endorsement for the “Fair Medical Audits Act of 2015,” introduced today by U.S. Representative George Holding of North Carolina. The legislation addresses many concerns that physicians have with regard to the extraordinary lack of transparency and expensive, time-consuming and often unfair processes that plague the current Medicare audit program.   Representative Holding declared it time to fix the broken audit program: “Put simply, patients achieve the best health outcomes when practicing physicians do just that – practice medicine. My bill will bring transparency ...

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 ...

California seniors' state of health ranks 29th in national health study

According to a study released June 20 from America’s Health Rankings, California’s seniors have decreased exercising in the past two years, have begun drinking more alcohol and are experiencing more mental health issues. Over the past two years, California’s senior population decreased exercising and dropped stopped from a national ranking of 18th in the nation to 29th -- this according to a study conducted by the United Health Foundation, a nonprofit arm of the United Health Group, which also owns the insurer United Healthcare. The study tracked 35 measures for senior ...

Ask the Expert: If Medicare pays for a procedure, does a Medicare Advantage plan also have to pay?

The California Medical Association (CMA) has received this question from physician practices many times over the past few years. The answer is – it depends. Title XVIII of the Social Security Act established regulations for the Medicare program, which includes provisions affecting Medicare Advantage (MA) plans. The Centers for Medicare and Medicaid Services (CMS) has interpreted these provisions through the Medicare Managed Care Manual (Chapter 4 – Benefits and Beneficiary Protections). The Manual provides guidance for MA plans under Internet-only manual (IOM) 100-16. These guidelines reflect CMS’ current interpretation ...

United Healthcare to deactivate inactive physician TINs as part of provider directory cleanup

Beginning August 1, 2015, United Healthcare (UHC) will initiate a cleanup of its participating provider database and directory. Participating physicians who have not submitted a claim to UHC for a period of one year will be deemed to have voluntarily ceased participation in the UHC physician network; United will initiate a termination of the physician agreement. UHC will contact impacted providers to advise of the termination and to clarify any concerns from the physician. The California Medical Association has inquired about when and how physicians will be notified. Additionally, ...

California Medical Association removes opposition to physician aid in dying bill

Sacramento – Today, the California Medical Association (CMA) announced that it has become the first state medical association in the nation to change its position on the long-debated issue of physician aid in dying. By removing decades-old organizational policy, CMA has eliminated its historic opposition and is now officially neutral on Senate Bill 128 (Monning/Wolk), the End of Life Option Act. “As physicians, we want to provide the best care possible for our patients. However, despite the remarkable medical breakthroughs we’ve made and the world-class hospice or palliative care ...

Survey: Is your practice ready for ICD-10?

With less than five months left until the October 1, 2015, implementation date of ICD-10, physician practices should be well into the preparation and planning process for the ICD-10 transition. Congress has reaffirmed that it intends on moving forward with no delays in the implementation date. In an effort to gauge members’ preparedness, the California Medical Association (CMA) is surveying physicians on their readiness for ICD-10 implementation. The survey will take less than five minutes, and your participation will help in directing our advocacy efforts around additional ICD-10 training and ...

United Healthcare to alter Premium Designation criteria

The California Medical Association (CMA) has learned that United Healthcare (UHC) has altered the criteria for meeting the physician cost efficiency component of its Premium Designation program. UHC will now designate a physician as “Cost Efficient” when he or she has met the episodic cost benchmark, even if the physician did not achieve the population cost benchmark. The change only impacts those physician specialties that are evaluated on both population cost and episode cost, which include: Family medicine, Internal medicine ...