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1. CMA Campaign to Stop the Medi-Cal Cuts – Doctors Needed
CMA and the Alliance for Patient Care (APC) coalition are ramping up efforts to stop the 10 percent cut to Medi-Cal provider rates, scheduled to take effect July 1.
We need your help to educate the public and elected officials about the harmful impacts this cut will have on access to health care in your area. If your practice and patients will be impacted by these cuts take a few moments to fill out the brief questionnaire at the APC website and we will plug you and your story into our communications efforts.
Your stories will be a key part of our efforts to humanize the impact of these cuts, a critical component of our campaign. You don’t have to see Medi-Cal patients for your patients to be impacted by these cuts or for your story to be helpful. But, if you do see Medi-Cal patients, and particularly if you plan on reducing your Medi-Cal practice due to these cuts, we need to hear from you!
We are still facing an uphill battle given California’s $16 billion budget shortfall. But, the public is on our side. With your help, we have a shot at galvanizing that public opinion into legislative action which puts a stop to these cuts.
Click here for more information.
Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
2. CMA Objects to DMHC Attempt to Legitimize
Illegal Discount Health Plans
The Department of Managed Health Care (DMHC) recently proposed regulations that would regulate “discount health plans” in California. CMA recently submitted comments on the proposed legitimization of these illegal referral services.
“CMA has serious reservations about the legitimacy of discount health plans in California,” wrote Armand Feliciano, CMA Associate Director of Medical and Regulatory Policy, in the comments. “Not only do we believe that they are illegal, but we also remain unconvinced that DMHC has jurisdiction to regulate them. Also, from a public policy perspective, we believe they bring little value to consumers, as the benefit they purport to provide is illusory at best.”
CMA emphasized the fact that the California Attorney General in 2001 concluded that the discount health plan business model was illegal under California law, which prohibits a person or business from referring or recommending a person to a health care provider for any form of medical care or treatment for a profit.
“There are no sufficient safeguards to protect consumers from discount health plans because the product is inherently deceptive,” wrote CMA. “We believe that discount health plans have too many structural deficiencies, and that those deficiencies are incurable.”
CMA believes that the appropriate course of action is for DMHC to enforce the law and to stop the deceptive and illegal marketing of these “health plans” in California.
Click here for more information.
Contact: Armand Feliciano, 916/444-5532 or afeliciano@cmanet.org.
3. Office of Administrative Law Rejects
DMHC’s Timely Access Regulations
The Department of Managed Health Care (DMHC) has submitted final regulations relating to timely access to health care for patients. The goal of the regulations is to establish maximum waiting times for routine care, preventive care, urgent care, as well as referral and telephone waiting time. Although the proposed final regulations were an improvement from previous versions, CMA continues to have serious concerns with the regulations.
Most significantly, CMA is concerned that the proposed regulations fail to establish standards to ensure that health plans maintain sufficient provider networks. “A patient’s timely access to care goes hand in hand with the availability of physicians in a plan’s network; to simply address one without the other is unreasonable and unworkable,” wrote Armand Feliciano, CMA Associate Director of Medical and Regulatory Policy, in comments submitted to DMHC.
The initial draft regulations published last year proposed dozens of specific time standards, including standards for scheduling routine and urgent care appointments, office waiting time, and timely telephone access. While CMA is pleased DMHC has recognized that inflexible one-size-fits-all waiting times are ill advised, the proposed final regulations would let health plans establish their own appointment waiting time standards. Not only would this essentially allow health plans to regulate themselves, but it would also be unnecessarily burdensome for physicians who contract with multiple plans.
The Office of Administrative Law last week rejected the new regulations, saying DMHC failed to provide adequate opportunity for public comment. Although the department did hold two public hearings on the issue last year, OAL determined that the final regulations were substantially different from previous version and that DMHC must allow a full 45 days for stakeholders to comment on the revised regulations.
Click here for more information.
Contact: Armand Feliciano, 916/444-5532 or afeliciano@cmanet.org.
4. Medi-Cal Prescriptions Must Be Written
on Tamper-Resistant Pads Effective April 1
New federal security prescription rules that take effect April 1 require most Medi-Cal prescriptions to be written on tamper proof pads. As you may recall, these new rules were originally scheduled to take effect October 1, but Congress postponed implementation for six months to allow physicians and pharmacists time to make sense of the new and somewhat confusing rules and to ensure that patient care and access to prescription drugs was not negatively impacted.
There are a number of exemptions to this rule. Security prescriptions are not required for:
- Drugs paid for by a managed care entity
- Prescriptions provided in nursing homes and some other institutional settings
- Phoned, faxed, or electronically transmitted prescriptions
Although prescriptions paid for by Medi-Cal managed care plans are exempt from the new federal security prescription rules, County Organized Health Systems (COHS) must comply. Drugs dispensed within a COHS (with the exception of the Health Plan of San Mateo) are defined under the law as “covered outpatient drugs” and must be written on tamper-resistant prescription pads. Therefore, prescriptions for patients enrolled in CalOPTIMA, Santa Barbara Health Initiative, Partnership Health Plans, and Central Coast Alliance for Health must be written on tamper-proof pads.
Of course, all prescriptions for controlled substances, regardless of the payor, must be written on secure tamper-proof pads under California Law.
Recognizing that this new law is very confusing, and that physicians may not be able to easily determine when Medi-Cal fee-for-service is the secondary payor to private insurance, or if a prescribed drug is carved out of managed care, the California Department of Health Services is recommending that prescribers use tamper-proof prescription pads for all Medi-Cal beneficiaries.
For more information on this new law, see CMA ON-CALL documents #0510, Drug Prescribing (Not Schedule II-V Drugs) and #0509, Controlled Substance Prescribing. ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore.
CMA remains concerned, however, that the additional hassle and cost involved will force physicians to leave the Medi-Cal program, where access to care is already a problem. CMA continues to seek to reverse the law or at least make it consistent with current state law, which requires security prescriptions only for controlled substances.
Members Get 15% off Security Prescriptions
CMA members receive 15 percent off security prescription pads from RxSecurity. Special pricing is available for hospitals, clinics, and other high-volume purchasers. Members pay $2.77 - $4.99 per pad for one-part pads, and $4.39 - $4.77 for two part pads, depending on the total number of pads ordered. While some printers charge extra setup and other fees, RxSecurity’s prices include everything, and shipping is free.
Click here for more information.
Contact: Samantha Pellon, ,916/ -551-2872 or spellon@cmanet.org.
5. New Laws of Interest to Physicians
Despite failed health reform efforts, the legislative session produced ample, and at times significant changes to laws affecting physicians. CMA has posted on its website a summary of the most significant legislation, along with references to the CMA ON-CALL documents that discuss the topics in more detail.
ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore.
Contact: Samantha Pellon, ,916/ -551-2872 or spellon@cmanet.org.
6. Insurance Commissioner to Keynote
CMA’s Legislative Leadership Conference
California Insurance Commissioner Steve Poizner will keynote CMA’s 34th Annual Legislative Leadership Day, April 15, in Sacramento. Poizner will speak about his office’s aggressive efforts on behalf of doctors and patients to stop the unfair business practices of health insurance companies.
Legislative Leadership Day is a unique event for California physicians and is free of charge to all CMA members. Attendees will receive a CMA health policy briefing and a short course on “Lobbying 101,” which will train them to become strong physician advocates and prepare them for the legislative meetings later in the day.
Don’t miss the opportunity to meet one-on-one with your elected officials in the State Assembly and Senate to discuss important health policy issues that affect the practice of medicine in California.
If you plan on attending, please RSVP no later than April 2.
Click here to download an agenda.
Contact: Jennifer Williams, 916/444-5532 or jwilliams2@cmanet.org.
7. IMQ Recruiting Correctional Health Surveyors
CMA’s Institute for Medical Quality (IMQ), which administers the preeminent correctional health care surveying and accreditation program in the state, is seeking physicians to provide expert review of health services provided in California detention facilities. As a correctional health surveyor, you would be part of a highly respected team that would perform 2 to 4 surveys per year. Surveys require one or two days on site at the facility. Physician surveyors are not responsible for report writing, and an honorarium is provided.
Contact: Howard Lunche, 415/882-5132 or hlunche@imq.org.
8. CAIC Accepting Nominations for Immunization Leadership Award
The California Adult Immunization Coalition (CAIC) has established the Immunization Leadership Award to honor the dedication and service of CMA Past-President Ronald P. Bangasser, M.D., who passed away last year after battling cancer. Dr. Bangasser, a national spokesperson on influenza issues and a vigorous advocate for immunization, served as CAIC Chair from 2003 to 2007.
The Ronald P. Bangasser, M.D., Immunization Leadership Award will be given annually at the California Immunization Coalition Summit to a practicing clinician who exemplifies the leadership, professionalism and commitment that Dr. Bangasser brought to his work in promoting immunizations.
Nominations for the 2008 award must be submitted by March 25.
Click here for more information, including a nomination form.
Contact: Catherine Martin, CAIC, cmartin@communitycouncil.org.
9. Member Benefit of the Week: 30 - 50% off Epocrates
CMA members receive 30 percent off one-year subscriptions and 35 percent off two-year subscriptions to any Epocrates product. Students and residents receive 50 percent off all Epocrates products. Group discounts are also available.
Epocrates provides physicians with point-of-care access access (via PDA/smartphone, or online) to up-to-date information on drugs, diseases, and diagnostics. Epocrates allows physicians to make better clinical decisions, saving time and improving quality of care
To receive your discount, click here to log into the members-only website and follow the links to the Epocrates website.
Click here for more information on your membership benefits.
Contact: CMA’s member service center, 800/786-4CMA or info@cmanet.org.
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