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Prop. 56 webinar: Are you getting your share of the supplemental Medi-Cal funds?

The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop. 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. A total of $325 million was allocated for physician payments in the budget for 2017-18, with $488 million proposed for 2018-19. The California Medical Association (CMA) is hosting a webinar with the California Department of Health Care Services on Wednesday, November 7, to discuss the status of distribution of ...

CMA Applauds the Enactment of Federal Opioid Legislation

The California Medical Association (CMA) applauded the enactment of H.R. 6 – a sweeping bipartisan bill that addresses nearly every component of the national opioid epidemic. The legislation would improve access to preventive services, opioid use disorder treatment programs, medication-assisted treatment (MAT) and non-opioid therapies, including mental health services. It would lift restrictions on using telemedicine for treatment of substance use disorders. To address the escalation in overdose deaths, it would also strengthen law enforcement efforts to crack down on international shipments of illicit drugs such as fentanyl. H.R. 6 ...

CMA proposes site-neutral payments for some physician services

The Centers for Medicare and Medicaid Services (CMS) has proposed eliminating the Medicare site of service payment differential for physician services. Under the proposed policy, Medicare would pay the same amount for office visit services provided by physicians in “off-campus” hospital outpatient departments as it would for the same office visit service provided in a physician’s office. Currently, Medicare pays a “facility fee” that results in a much higher rate for the same service when performed in outpatient clinics owned by hospitals, rather than in a physician’s office. For example, ...

CMA pushes back on CMS' proposed Medicare payment changes

The California Medical Association (CMA) recently submitted comprehensive comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule. CMA is supporting CMS’s proposal to substantially reduce the Evaluation and Management (E/M) documentation requirements because it would reduce note bloat, improve workflow, and allow physicians to devote more time to their patients. However, CMA is strongly opposed to the proposal to restructure payment and coding for (E/M) office visits by collapsing the codes from five to two for ...

CMA urges CMS to simplify the Quality Payment Program

The California Medical Association (CMA) has submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed changes to the Medicare Quality Payment Program for 2019. CMA is disappointed that CMS did not reduce the reporting burdens in the Merit-based Incentive Payment System (MIPS) program in a more meaningful way. We also oppose the confusing new scoring tiers (gold, silver and bronze) and have urged CMS to simplify and overhaul the complex MIPS scoring system. CMA strongly urges CMS to maintain the 10 percent weight of the cost ...

DHCS receives approval on Medi-Cal supplemental tobacco tax payments for FY 2018-2019

The California Department of Health Care Services (DHCS) recently received federal approval on its plan to increase Medi-Cal fee-for-service physician payments for the 2018-2019 fiscal year. The supplemental payments—made possible by the Proposition 56 tobacco tax funding—will raise payments for a total of 23 CPT codes, including 10 new preventive CPT codes. DHCS will be increasing the supplemental payment for the previously eligible CPT codes to 85 percent of Medicare (a 40 percent average increase in payments for these eligible codes compared with 2017 – 2018 payment levels). The 10 ...

Have you received your supplemental Medi-Cal managed care payments?

The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes.  While the California Department of Health Care Services (DHCS) began disbursing FY 2017-2018 supplemental fee-for-service payments in January 2018, federal approval of the supplemental Medi-Cal managed care payments was delayed. This resulted in delayed payment for Medi-Cal managed care services. DHCS began dispersing the FY 2017-2018 funds to the plans ...

Vote on Senate opioid package expected this week

The U.S. Senate is expected to vote this week a bipartisan package of over 70 proposals intended to help combat the nation’s opioid crisis. Known as the Opioid Crisis Response Act of 2018, the package includes legislation intended to reduce opioid use, encourage recovery, support caregivers and families, and drive innovation and long-term solutions. The California Medical Association (CMA) is working with AMA and our other partners to resolve several outstanding issues, such as the mandate to e-prescribe opioids, despite the difficult DEA process. We have, however, successfully stopped all ...

CMA calls on CMS to reverse step therapy decision

The California Medical Association (CMA) and an American Medical Association (AMA)-led coalition of 94 medical societies delivered a letter to the Centers for Medicare and Medicaid Services (CMS) about the serious concerns physicians have with the agency’s recent decision to allow Medicare Advantage plans to use step therapy for Part B drugs.  The letter calls on CMS to reinstate its 2012 policy prohibiting Medicare Advantage plans from utilizing step therapy protocols for Part B physician administered medications. The growing burdens generated by step therapy and prior authorization programs create a ...

CMA and AMA oppose CMS proposal to collapse E/M codes

More than 150 health care organizations, including the California Medical Association (CMA) and the American Medical Association (AMA), sent a joint letter to the Centers for Medicare and Medicaid Services (CMS), opposing the agency’s proposal to collapse evaluation and management (E/M) code and payment levels. The proposal was included in the draft 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule released earlier this summer. CMA and AMA appreciate CMS’s genuine desire to reduce documentation burdens on physicians to allow them to focus on patients over paperwork. Several ...