Governor Brown's 2016-17 budget proposal includes new MCO tax deal On January 7, the Governor unveiled a $122.6 billion budget proposal for the 2016-17 fiscal year, including a new approach to replacing a soon-to-expire tax on managed care organizations (MCO). The current MCO tax will expire this summer if legislators cannot agree on a replacement. Since 2005, the state has taxed MCOs and used the money to cover the costs of the Medi-Cal program. However, federal officials in 2014 informed California that its MCO tax structure was not compliant with federal requirements. Since then, the California Department of Health Care ... January 15, 2016 Managed Care California State Budget 0 0 Comment Read More »
California Medical Association responds to unveiling of Governor Brown's proposed 2016-17 state budget Sacramento – Steve Larson, M.D., president of the California Medical Association (CMA), representing over 41,000 physicians statewide, issued the following statement in response to the unveiling of Governor Brown’s proposed 2016-17 state budget released this morning: “We are pleased to see the Governor is committed to working with the legislature and health plans to find a solution to the MCO tax. Without that, a gaping hole would exist in the state’s Medicaid (Medi-Cal) fund that would have devastating impacts on patients across the state. “Ensuring that Medi-Cal is better funded ... January 15, 2016 General, Managed Care, Medi-Cal Managed Care, Medi-Cal, Save Lives California, Tobacco Tax, California State Budget 0 0 Comment Read More »
CMA files amicus brief in case that could weaken physician protections from silent PPOs The California Medical Association (CMA) and nine other physician organizations filed an amicus brief asking the Supreme Court of California to review an appeals ruling that would have significant, widespread negative impact on the health care industry, undermining a California law designed to protect physicians from "silent PPOs." Robust managed health care provider networks and reasonable reimbursement for medical services are vital to ensuring adequate accessibility and the highest quality of medical care. A historical and ongoing threat to these goals is the silent PPO problem, whereby health plans unilaterally ... January 15, 2016 Managed Care Legal Advocacy, Payor Contracting, Provider Networks, Silent PPOs, Amicus Briefs 0 0 Comment Read More »
Why it's important to verify your patients' eligibility and benefits for 2016 With the new year soon upon us, physicians are urged to be diligent in verifying patients' eligibility and benefits to ensure they will be paid for services rendered. The beginning of a new year means calendar year deductibles and visit frequency limitations reset. With open enrollment there may also be changes to patients’ benefit plans, or patients may even be covered by a new payor. The new year also brings a host of other challenges that could affect your ability to be paid: Medicare patients can modify ... December 7, 2015 Managed Care Eligibility, Covered California, United Healthcare 0 0 Comment Read More »
Anthem asking physicians to affirm participation in workers' comp MPNs by Dec. 31 Anthem Blue Cross recently sent a request to physicians who participate in various workers’ compensation medical provider networks (MPN) through their Prudent Buyer agreements, asking them to affirm their continued participation in each of these networks. This request is required as part of the reforms instituted under SB 863, which mandates that MPNs obtain written acknowledgement from each participating physician that the provider elects to be a member of the network. Under the resulting regulations, physicians who have entered into contracts with workers’ compensation payors prior to August 27, 2014, and ... December 7, 2015 Managed Care Medical Provider Networks, MPN, Workers' Compensation, Anthem Blue Cross 0 0 Comment Read More »
United Healthcare issues amendment to physicians participating in Core network United Healthcare (UHC) recently issued a contract amendment to practices participating in the California health benefit exchange through its UHC Core network. The new contract language amends (or replaces) the prior Appendix 2 of the UHC participating physician agreements. UHC also advised the California Medical Association (CMA) that the only option for physicians who wish to opt out of the Core product network is to terminate the underlying UHC commercial agreement. There is no option to opt out of just the Core network. The Core network, introduced earlier this year, ... December 7, 2015 Managed Care Payor Contracting, United Healthcare, Covered California 0 0 Comment Read More »
New law requiring accurate provider directories includes provider obligation to update information On July 1, 2016, a new law will take effect that requires plans and insurers to comply with uniform standards, and provide timely updates, for their provider directories. The law (SB 137) includes multiple components aimed at providing patients with more accurate and complete information to identify which providers are in their payor’s network. Specifically, the law requires: Plans/insurers must offer an online provider directory available to the public, including physicians, without any restrictions or limitations. ... December 7, 2015 Managed Care Network Adequacy, Payor Contracting, Provider Networks, Commercial Payors 0 0 Comment Read More »
ACA results in $2.4 billion in consumer rebates since 2011 American consumers have received more than $2.4 billion in premium rebates since 2011 because of the Affordable Care Act (ACA), according to a recent report from the Centers for Medicare and Medicaid Services (CMS) . The rebates are the result of the ACA provision that requires health insurance companies to spend at least 80 percent of premium dollars on health care. In 2014 over 5.5 million consumers received nearly $470 million in rebates, for an average of $129 per family. California consumers received approximately $98 million in rebates for a ... December 7, 2015 Managed Care Affordable Care Act, Medical Loss Ratio 0 0 Comment Read More »
United Healthcare to delay Premium Designation assessment until January 2017 United Healthcare (UHC) has announced it will delay the next version of its Premium Designation physician quality and cost assessment program until January 2017. The program uses clinical information from health care claims to evaluate physicians against various quality and cost-efficiency benchmarks. Originally scheduled to publish its latest results in January 2016, UHC has stated it is delaying in order to allow for improvements to the quality measures and cost-efficiency metrics in response to feedback provided by physicians. This means that the currently posted ratings will remain in place through ... December 7, 2015 Managed Care Quality reporting, United Healthcare, Quality of Care 0 0 Comment Read More »
Blue Shield fee schedule changes took effect November 1 n August, Blue Shield announced changes to its physician fee schedule that became effective November 1, 2015. In a notice sent to physicians, the insurer said that it was increasing payments for the more commonly billed office visit codes. The new rates are available on the Blue Shield website (go to www.blueshieldca.com/provider and log in, then select the “Professional Fee Schedule” link located under the "Claims" section menu). Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or ... November 19, 2015 Managed Care Fee Schedule, Blue Shield 0 0 Comment Read More »
