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1. FDA Approves First Bird Flu Vaccine
The U.S. Food and Drug Administration Tuesday approved the first-ever bird flu vaccine. The vaccine will not be available commercially, but will be stockpiled by the government for use in the event of a bird flu pandemic.
The two-shot vaccine appears to provide protection to 45 percent of adults at the highest dose. By comparison, seasonal flu shots typically protect more than 90 percent of healthy adults.
Should an influenza pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced. The government plans to buy and stockpile enough vaccine for 20 million people, including emergency and health care workers.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
2. California Healthcare Networks Not Bound
by Unfair Payment Practices Law
Physicians have recently reported receiving “provider network participation agreements” from an unregulated network PPO called California Healthcare Networks (CHN). The agreement, which is in many ways inconsistent with California’s unfair payment practices law, also claims that physicians who do not want to participate must opt out in writing and that inaction is considered acceptance of the contract terms. Physicians should be aware that insurers cannot deem participation in absence of a signed contract.
Among the contract terms that are inconsistent with California’s unfair payment practices law:
- No fee schedule disclosure: Regulated payors in California are required to fully and regularly disclose to contracting physicians their fee schedules and payment rules, including instructions for submitting claims and filing provider disputes.
- Requires that claims be submitted within 45 days: State law prohibits claim submission deadlines that are less than 90 days from the date of service for contracted physicians and 180 days for noncontracted physicians.
- Allows unilateral modification of contract terms without notice: State law requires regulated health plans to notify contracted physicians in writing 45 days before instituting any changes to fee schedules and payment rules.
Physicians are advised, before signing any new contract, to review it carefully. Among other things, physicians should ensure that the proposed compensation, including the payor’s payment policies and the rules it uses to adjudicate claims, will be sufficient to maintain the medical practice. Without doing this analysis, you cannot make an informed decision about signing the contract.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or awetzel@cmanet.org.
3. What Physicians Need to Know about
California’s New Language Access Regulations
The State of California recently implemented regulations intended to improve access to care for patients with limited English proficiency (LEP). The regulations, adopted by the Department of Managed Health Care and the Department of Insurance, require insurers to provide free interpretation and translation services to LEP patients. Previously proposed regulations would have placed the burden on physicians to provide these services.
It is important to note, however, that the regulations do allow health plans to delegate the responsibility for providing language access services to their contracted physicians. Although such delegation must be negotiated separately, physicians are urged to carefully review any new or renewing contracts or addendums for provisions related to language access.
The regulations also require health plans to assess the language needs of their members and provide language assistance in “threshold languages.” Threshold languages will vary by plan based on the needs of plan members.
CMA is pleased that the final regulations do not prohibit the use of a minor family member as an interpreter, as was proposed in previous versions of the regulations. The regulations do, however, require that patients be informed of the availability of qualified interpreters at no charge. If the patient instead chooses to use a family member or friend as an interpreter, the patient’s choice must be documented in his or her medical record.
Health plans regulated by DMHC must assess the language needs of their enrollees by March 2008 and implement language assistance programs by January 1, 2009. Insurers regulated by DOI must develop and implement their language assistance programs by January 1, 2008.
Unfortunately, the regulations do not require that insurers notify their members of the availability of translation and interpretation services. Instead, patients must be informed at the point of service.
These new regulations do not change physicians’ obligations under federal law. Physicians who receive “federal financial assistance” are still required to take “reasonable steps” to ensure “meaningful access” to LEP patients.
Click here for more information.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
4. New Cell-Based Flu Vaccine May Be Ready in 2008
A preliminary study published last week in the Journal of the American Medical Association found that a flu vaccine made in caterpillar cells is as effective as, and can be produced more efficiently than traditional vaccines that are produced with embryonated hens' eggs.
This vaccine, from Protein Sciences, has been “fast-tracked” by the U.S. Food and Drug Administration and could be on the market by next year.
Recent concerns that the avian influenza virus could mutate into a strain that is lethal to humans have increased the urgency of developing new methods of manufacturing flu vaccines. Currently, all flu vaccines licensed in the United States are made with eggs and take six to eight months to produce. The egg-based method is also vulnerable to contamination, which caused the massive flu shot shortage of 2004.
Cell-based vaccine production is believed to be less vulnerable to contamination and is capable of producing more vaccine in a shorter period of time.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
5. Sign Up for CMA’s Legislative Hot List
CMA’s Legislative Hot List, distributed weekly during the legislative session, follows the progress of CMA-sponsored bills and other bills of interest to physicians as they move through the legislative process.
Among the bills being followed this year:
HIV Screening: This bill (AB 682) would streamline the HIV testing process, so that HIV screening can become a routine part of medical checkups, as recommended by the CDC.
CMA Position: Sponsor
Motorcycle Helmet Exceptions: This bill (AB 425) would exempt drivers 18 years of age or older from the motorcycle helmet law upon completion of a motorcycle rider training program.
CMA Position: Oppose
Retroactive Policy Cancellation: This bill (AB 1324) would confirm that it is illegal for insurers to rescind or modify authorization after services are rendered in good faith. It would also require that physicians be paid for services provided in good faith with prior authorization.
CMA Position: Sponsor
Physicians’ Right to Fair Payment: CMA opposes this bill (SB 389), which would prohibit hospital-based physicians from seeking payment from patients, even if the patients’ HMOs fail to fairly reimburse for services provided to enrollees.
CMA Position: Oppose
Physician-Assisted Suicide: This bill (AB 374) would allow physicians in California to prescribe lethal doses of pharmaceutical drugs to people who have been diagnosed with a terminal illness and are in intractable pain.
CMA opposes physician-assisted suicide, believing that assisting in someone’s death is in direct conflict with a doctor’s ethical duties. CMA has taken and reaffirmed its position against physician-assisted suicide five times since the 1980s, most recently this February.
CMA Position: Oppose
If you would like to be notified via e-mail when the hot list is updated, contact Susan Bassett at 916/444-5532 or sbassett@cmanet.org.
You can also view the latest hot list online.
6. Highlights of April 12 CMA Board Meeting Available
The CMA Board of Trustees met April 12 in Monterey. Among the issues discussed was CMA’s role in a national Medicare reform campaign.
Click here for a summary of the board’s major actions.
Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
7. Benefit of the Week: Innovative Retirement Income Strategy
Professionals’ Retirement Strategy is offering a series of educational dinner programs to introduce physicians to its “California Physicians Retirement Strategy” product, a tax-efficient approach that allows physicians to monetize the value of their practice today to provide retirement income for tomorrow.
Upcoming dinner programs:
- May 1: San Fran., Boulevard Restaurant
- May 2: San Mateo, Kingfish Restaurant
- May 3: San Jose, Fairmont
- May 22: Beverly Hills, Beverly Wilshire
- May 23: Pasadena, Ritz-Carlton
These events are hosted and spouses are welcome. Registration is required. Sign up online at http://www.prsplan.com.
Click here for more information on your membership benefits.
Contact: CMA’s membership hotline, 888/233-2937 or lgodward@cmanet.org.
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No. 2091
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