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1. Medical Board Changing CME Requirements
The Medical Board of California is changing its continuing medical education (CME) requirements for physicians. Though it is unclear exactly when the new requirements will take effect, the medical board has announced that physicians will be required to complete 50 CME hours during every two-year licensure period. Currently, physicians are required to complete 100 every four years.
The medical board has also clarified that CME are to be calculated based on the physician’s personal license renewal date (the last day of the month of your birthday), not the calendar year.
We will let you know as soon as additional details are available.
Physicians are reminded that CMA’s Institute for Medical Quality (IMQ) certifies physicians’ CME activity for credentialing purposes to the Medical Board of California, as well as to hospitals, health plans, specialty societies, and others. CME certification is $29 a year for members, $49 for nonmembers.
Click here for more information.
Contact: Paulette Richardson, 415/882-3387 or prichardson@imq.org.
2. End to Healthy Families/Medi-Cal Bridge May
Interrupt Access to Care for Poor Children
Physicians should be aware that the Managed Risk Medical Insurance Board (MRMIB) will soon be eliminating the Healthy Families-to-Medi-Cal “Bridge,” which currently allows children transitioning from Healthy Families to Medi-Cal to continue to receive Healthy Family benefits for two months while their Medi-Cal paperwork is processed. The elimination of the bridge program was mandated by the California Legislature last year, under pressure from the Federal Government.
Impacted children will be those who, at their annual Healthy Families eligibility review, are determined to qualify for the Medi-Cal program. These children will be immediately “deemed eligible” for Medi-Cal and will no longer be covered by Healthy Families. Although the regulations are not yet final, they are expected to be finalized soon. Once the regulations take effect, physicians should periodically check the eligibility of their Healthy Families patients to prevent billing problems and payment delays.
CMA is concerned that eliminating the bridge program while simultaneously cutting Medi-Cal rates by 10 percent will make it even more difficult for poor children to get the care they need. California’s Medi-Cal rates are already among the lowest in the nation and additional reductions would force doctors and other providers out of the Medi-Cal program.
CMA and the Alliance for Patient Care (APC) continue to aggressively fight the 10 percent Medi-Cal cut 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 (http://www.allianceforpatientcare.org) and we will plug you and your story into our communications efforts.
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Contact: David Ford, 916/444-5532 or dford@cmanet.org.
3. CMA Finds Serious Problems with
United Healthcare’s
Imaging Accreditation Requirements
United Healthcare has announced plans to implement a new imaging accreditation program in the third quarter of 2008. Once the program is implemented, United will require accreditation as a condition for reimbursement for most imaging services performed in freestanding outpatient facilities and physician offices.
While CMA supports legitimate efforts to improve quality of care, we are concerned that this new program has significant structural deficits and is being inappropriately used as a cost saving mechanism. Among CMA’s concerns are:
- Accreditation is not available for at least two of the procedures for which accreditation is required (magnetic resonance angiography and computed tomography angiography).
- The cost of accreditation is prohibitively steep for many physician practices, particularly given the insufficient health plan payment rates in today’s marketplace.
- The information available to physicians regarding these new accreditation requirements is unclear and confusing.
“CMA believes that the significant costs, confusion, and discrepancies that surround this program will hinder access to care and unnecessarily and significantly increase physicians’ costs without improving quality or patient safety,” wrote CMA President Richard S. Frankenstein, M.D., in a letter to United’s Chief Medical Officer Paul Mills, M.D.
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Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.
4. CMA Objects to the Department of Public Health’s
Refusal to License Physician-Owned Surgery Centers
The California Court of Appeals last fall ruled that physician-owned surgery centers are exempt from the state’s clinic licensure requirements. The Department of Public Health has wrongly interpreted the appellate court ruling to mean that the department does not have jurisdiction over these surgery centers, and has subsequently refused to license physicians seeking voluntary licensure for their clinics. Because the Department of Health Services requires licensure for participation in the Medi-Cal program, this misinterpretation will have a serious negative effect on access to care for Medi-Cal patients.
CMA has urged the department to reconsider its decision to refuse licensure to physician-owned ambulatory surgical centers, as it is unsupported by the law and deprives Medi-Cal beneficiaries access to needed services.
“The department’s interpretation … is wreaking financial havoc on physician-owned ambulatory surgical centers throughout the state that are being told that they need a license in order to treat Medi-Cal patients but are nonetheless unable to obtain one just because they are physicians,” wrote CMA legal counsel Astrid Meghrigian in a letter to Bonita Sorensen, M.D., DPH’s Chief Deputy Director of Policy and Programs. “But even apart from the financial ramifications that these centers are experiencing, the net impact of the Department’s decision is to further limit the already constrained access to care that Medi-Cal beneficiaries experience.”
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Contact: Samantha Pellon, 916/551-2872 or spellon@cmanet.org.
5. HealthNet Agrees to Amend Contract
to Comply with RICO Settlement
CMA and CMA member Richard Jones, MD, have successfully challenged number of provisions in HealthNet’s standard physician contract that do not comply with the terms of the RICO settlement.
HealthNet is one of seven insurance companies that settled CMA’s class action civil racketeering (RICO) lawsuit against for-profit health plans. The settlement agreements required the health insurers to change their business practices to effect transparency and fairness in their relationships with physicians.
HealthNet’s physician contract conflicts with the settlement agreement in a number of ways. Among other things, the contract’s definition of “medically necessary” is inconsistent with the definition agreed to in the settlement. The contract also requires contracting physicians to participate in all of Health Net’s products, despite the fact that the plan agreed in the settlement not to require universal participation in its products. Additionally, the contract allows HealthNet to make unilateral changes to the contract without prior notification, despite agreeing in the settlement that it would provide at least 90days advance notice of material adverse changes.
CMA and Dr. Jones filed a dispute with the settlement compliance dispute facilitator. As a result, HealthNet agreed to mail contract addendums – addressing these issues and others – to all contracting physicians with standard Health Net contracts in California and 6 other states. The addendum will be distributed within 90 days of its approval by regulators. We will let you as soon as this date is known so that you can be on the lookout for this important document.
CMA continues to have concerns with the HealthNet contract that do not fall under the RICO settlement. CMA is working with the insurer to resolve these issues.
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Contact: Aileen E. Wetzel, 916/444-5532 or awetzel@cmanet.org.
6. DMHC Proposes New Balance Billing Rules
The Department of Managed Health Care (DMHC) recently withdrew its previously proposed balance billing regulations and proposed new regulations, the fourth such proposal in three years.
The new regulation defines “unfair billing patterns” to include the practice of balance billing patients when their HMOs fail to pay fairly for emergency services provided to their enrollees. In other words, balance billing by hospitals and hospital-based physicians – including on-call specialists – would be considered unfair and therefore illegal billing practice. The proposal neither provides for interim payment in the event of a billing dispute, nor does it mention a dispute resolution process.
CMA is preparing written comments in response to the proposal, which continues to favor health insurers at the expense of physicians, patients, and the future health of emergency services in California. CMA also plans to seek a public hearing to provide doctors an opportunity to express their views about the proposed regulation.
Click here for more information.
Contact: Armand Feliciano, 916/444-5532 or afeliciano@cmanet.org.
7. Member Benefit of the Week: 15% off Security Prescriptions
CMA members get a 15 percent discount off tamper-proof prescription pads from
Rx Security that meet state and federal security prescription requirements.
Place your order online at http://www.rxsecurity.com/cma.php or by phone at 800/667-9723.
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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