September 10 is last day to dispute Sunshine Act data Wednesday, September 10 is the last day that physicians can review and if necessary dispute their financial interactions as reported under the Physician Payments Sunshine Act. The Sunshine Act is a provision of the Patient Protection and Affordable Care Act that requires drug and medical device manufacturers and group purchasing organizations (GPOs) to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online ... September 5, 2014 General Physician Payment Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
'Patient choice' bill goes down to defeat in the Assembly The California Medical Association (CMA) has defeated a bill that would have imposed unfair contracting conditions on physicians and exacerbated the state's current network adequacy concerns. The bill (AB 2533) would have required health insurers to arrange for, or assist in arranging for, out-of-network care for enrollees who are unable to obtain medically necessary care or services from a network provider, at no additional cost to the patient. Unfortunately, vague language in the bill could have been interpreted to require out-of-network providers to accept the contract reimbursement rates of ... September 5, 2014 General Advocacy, Payor Contracting, Network Adequacy 0 0 Comment Read More »
Encourage your patients to participate in 'National Prescription Drug Take Back Day' Sept. 27 Abuse of prescription drugs, including pain relievers, continues to be a significant problem in United States. In California, 4.7 percent of persons aged 12 or older nationwide reported having used pain relievers nonmedically in the past year according to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health. SAMHSA data also reveals that 69 percent of people abusing prescription pain relievers got them through friends or relatives, a statistic that includes raiding the family medicine cabinet. Proper disposal of unused prescription drugs helps ... September 5, 2014 General Public Health, Prescription Drugs 0 0 Comment Read More »
Legislature passes bill that would require annual reports from insurers on provider network adequacy The legislature has passed a bill that would require Medi-Cal managed plans and insurers offering individual plans through Covered California to provide annual reports to the California Department of Managed Health Care (DMHC) about the adequacy of their provider networks. The bill also requires DMHC to post annual reviews regarding plan compliance on its website. This California Medical Association (CMA) supported the bill, SB 964 (Hernandez), which passed late last week and is now on the governor's desk awaiting his signature. With roughly 1.4 million Californians newly enrolled in ... September 4, 2014 Managed Care Network Adequacy, Advocacy, Covered CA, Health Insurance Exchange 0 0 Comment Read More »
United to make some changes to Premium Designation program, but serious concerns remain United Healthcare (UHC) has agreed, at the urging of the California Medical Association (CMA), to make some changes to its Premium Designation program. However, UHC refused to address many critical problems that CMA had identified, and CMA still believes the program continues to have serious shortcomings. CMA continues to urge UHC to make additional, more meaningful changes with its physician rating and tiering program. "In its current form, the program will not only confuse patients but will also fail to provide them with meaningful information that could actually assist them ... September 4, 2014 Managed Care Managed Care, Insurance/Reimbursement, United Healthcare 0 0 Comment Read More »
Medical board gives priority licensing review to physicians practicing in underserved areas The Medical Board of California will give priority review and processing of license applications to any physician who has received or accepted an offer of employment to work in an area of California designated as underserved. In order to be considered for this process, applicants need to submit the initial application forms, fingerprint cards (out-of-state applicants) or Live Scan (California applicants), application fees, primary source documents and supporting documents. Physicians also need to supply the additional documentation: An original signed and dated letter from the applicant to ... September 4, 2014 General Medical Board of California, Rural Health, Licensure 0 0 Comment Read More »
CMA Capitol Insight: Sept. 2, 2014 End of Session The final two weeks of the 2014 legislative session may have been void of the mega-deals of years passed, but there was plenty of last-minute deal-making, inside plays, and highs and lows for the scores of lobbyists who gathered daily outside the Senate and Assembly chambers during the final days. Gov. Jerry Brown has until September 30 to deal with the hundreds of bills that found their way to his desk, and we’re all banking on a few colorful veto messages that have become a Brown trademark. The ... September 4, 2014 General CMA Capitol Insight, Anthony York 0 0 Comment Read More »
DHCS releases Medi-Cal concept paper that proposes risk-based health home models and malpractice subsidies The California Department of Health Care Services (DHCS) has released a proposal in the form of a concept paper for the state’s next 1115 Section Medicaid Waiver for public for comment. California is currently in the fourth year of its current Section 1115 waiver that was approved by the federal government so California could expand Medi-Cal coverage in accordance with the Affordable Care Act in 2010 and implement a variety of delivery reform projects like the duals demonstration project. The concept paper outlines new ideas to modify provider payments and save ... September 4, 2014 Medi-Cal DHCS, Medi-Cal, Affordable Care Act 0 0 Comment Read More »
CMA urges court to protect patient privacy The California Medical Association (CMA), joined by the Litigation Center of the American Medical Association (AMA) and state medical societies, has filed a letter in support of a petition before the California Supreme Court to review a Court of Appeal opinion finding that patients have no reasonable expectation of privacy in their prescription data. In Lewis v. Superior Court (Medical Board of California), the Court of Appeal held that a law allowing law enforcement and other government agencies broad access to the state’s electronic prescription drug monitoring program’s database did ... September 4, 2014 General CURES, Legal Advocacy, Physician-Patient Relationship 0 0 Comment Read More »
Change in prior authorization form for prescription medications becomes effective October 1 Over the next several months, a new law (SB 866) will take effect that streamlines and standardizes the prior authorization process for prescription drugs. The new law requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications. Additionally, if a health plan or insurer fails to use or accept the prior authorization form, or fails to make a determination within two business days, the prior authorization request is deemed approved. Currently, plans have five business days ... September 4, 2014 General Advocacy, Prescription Drugs, Preauthorization 0 0 Comment Read More »
