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1. Medi-Cal: CMA Files Suit Against State over Medi-Cal Rate Cuts
On May 5, a coalition of health care providers led by CMA sued the state of California to stop the percent cut in Medi-Cal reimbursements scheduled to take effect on July 1.
The class action lawsuit, filed jointly by CMA, the CA Hospital Assoc., the CA Dental Assoc., the California Assoc. for Adult Day Services, the California Chapter of the American College of Emergency Physicians, the CA Pharmacists Assoc., and the CA Assoc. of Public Hospitals seeks an immediate injunction to block the reduction in Medi-Cal reimbursement rates. In February, the Legislature approved and the Governor signed into law a total of $1.3 billion in cuts to the Medi-Cal program in an effort to stem the state’s budget crisis.
The lawsuit, filed in Los Angeles County Superior Court, contends that the planned cuts violate state and federal laws which require that Medicaid (Medi-Cal) payments “must be sufficient to enlist enough providers so that services under the (state’s Medicaid) plan are available to recipients at least to the extent that those services are available to the general public.”
According to the complaint, the reimbursement cuts authorized in February were implemented “solely due to state budgetary woes, without regard to the impact on the availability of Medi-Cal services.” Such cuts are illegal, according to the complaint, and are “being imposed on a system already in crisis, wherein inadequate payment levels have resulted in a scarcity of willing providers, creating serious access hurdles for Medi-Cal beneficiaries.”
California already ranks dead last in the nation when it comes to payments to doctors, hospitals, and other providers who care for Medicaid (Medi-Cal) patients. According to the Kaiser Family Foundation, California spends $2,701 per Medicaid beneficiary – the lowest rate in the nation. The national average is $4,662. With the lawsuit filing, the state has 30 days to file a response to the allegations. At that point, court will schedule a hearing.
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Contact: Ned Wigglesworth, 916/444-5532 or nwigglesworth@cmanet.org.
2. FRONTLINE - HMOs: Your Oral Testimony or Written Comments Needed for DMHC ‘Balance Billing’ Proposal
In March, the Department of Managed Health Care proposed a new regulation which attempts to prohibit physicians from billing patients for the unpaid balance of bills only partially paid by HMOs for non-contracted emergency services. Unlike previous proposals, this version does nothing to regulate or obligate HMOs in any manner – failing to address both fair payment of physicians and inadequate physician networks. The proposal is a giveaway to the HMO industry at the expense of physicians and emergency care.
On May 2, the DMHC notified CMA that it would be holding the only public hearing on the proposal in Irvine on May 14 – just eight business days later. After CMA protested, the DMHC agreed to schedule an additional hearing in San Diego on May 19, and is considering a hearing in Sacramento on May 20.
CMA strongly urges you to plan on testifying or submitting written comments to the DMHC to protest its proposed anti-physician regulations. If you are interested in testifying in person, please contact Armand Feliciano, Esq. at afeliciano@cmanet.org or (916) 444-5532 as soon as possible. Armand will provide you with talking points and instructions on how to testify and file written comments.
Irvine - May 14
When: 10:30 a.m. to 5 p.m. or as soon as all verbal testimony is heard.
Where: Irvine Marriot, 18000 Von Karman Avenue, Irvine CA 92612
San Diego – May 19
When: 10 a.m. to 5 p.m., or as soon as all verbal testimony is heard.
Where: Mission Valley Marriot, 8757 Rio San Diego Drive, San Diego, CA 92108
Sacramento – May 20
When: May 20, 10 a.m. to 5 p.m., or as soon as all verbal testimony is heard
Where: Radisson Hotel, 500 Leisure Lane, Sac, Ca 95815
Contact: Armand Feliciano, 916/444-5532 or afeliciano@cmanet.org
3. MEDICARE - Northern California Physicians: Are Medicare Payments to Your Group At Risk?
Medicare payments to some Northern California groups are at risk. According to NHIC, as many as 5,000 physicians who work for groups or contract with groups in Northern California must update the required 855R form, which reassigns their Medicare payment to their group(s). Until an updated 855R form is filled out and submitted for each of the groups for which a physician bills, that group will not get paid for the physician’s Medicare services after June 1. This impacts groups of all sizes.
To avoid payment problems, CMA strongly urges all physicians who work for groups or contract with groups in Northern California to contact the NHIC hotline at 1-877-527-6613 to ensure that you have filled out the required 855R form for each of the groups to which you want to reassign your Medicare payments. For those physicians who enrolled as Medicare providers prior to 2006, you should also check to ensure you have filled out the 855I form in order to update your records.
Groups may be able to assist physicians in filling out these forms, but the physician must sign them. To complete the 855R, physicians will need their NPI, the Tax ID # for each of the groups to whom they want to assign payments for their Medicare services, and the signature of the groups’ authorizing agent.
CMS provider enrollment forms can be downloaded at http://www.medicarenhic.com/cal_prov/enroll_forms.shtml
Contact: Frank Navarro, 888/401-5911 or Gfonseca@cmanet.org
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4. PRACTICE MANAGEMENT – CONTRACTING: Physicians
Urged to Read Carefully Before Signing New Blue Cross
Contract Amendment
CMA has learned that many physicians renegotiating their contracts with Blue Cross of California have been asked to sign an amendment to the insurer’s Prudent Buyer Plan Participating Physician Agreement.
Before signing any new contract or contract amendment, it is critical that you review it carefully and make sure the terms of the agreement are mutually beneficial. This particular amendment contains several onerous provisions. For example,
- Physicians can not close their practice to new Blue Cross patients unless they also stop taking new patients from all other contracted health plans.
- Physicians are not allowed to disclose or discuss the terms of the amendment with anyone, even their own attorneys or business managers. Doing so will constitute a material breach of the agreement and Blue Cross may unilaterally and without notice reduce the physician’s fee schedule, terminate the agreement, and/or take legal action against the physician.
- The contract term is 3 years and physicians do not have the right to renegotiate or terminate the agreement until the contract expires.
Physicians should also be aware that Blue Cross considers the amendment to be an “individually negotiated contract.” Physicians who sign individually negotiated contracts do not qualify for protection under the Wellpoint RICO settlement.
To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” The toolkit is available free to members at the members-only website, http://www.cmanet.org/member (click on “Reimbursement Advocacy” under “Physician Advocacy”). Nonmembers can purchase the toolkit for $100 in the CMA bookstore, http://www.cmanet.org/bookstore.
Contact: Aileen E. Wetzel, 916/551-2037 or awetzel@cmanet.org.
5. MEDICARE: New Medicare Contractor Hosting Conference Calls on Transition Issues
Palmetto GBA is hosting a series of conference calls to provide physicians and other providers with the most recent information about the transition. The next call is May 20, at 12:30 pm Pacific time. Advance registration is required.
Providers are encouraged to submit questions in advance by email to j1mac@palmettogba.com (put “PTT questions” in the subject line of your e-mail).
Register online at http://www.palmettogba.com/j1.
Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.
6. PRACTICE MANAGEMENT – CONTRACTING: Beware of Rental Network PPO Solicitations
A number of physicians have recently reported to CMA that they have received solicitations from Integrated Health Plan (IHP) inviting them to join its “network.” The solicitation, received via mail advertises a “special limited time offer” during which its credentialing fee will be reduced from $150 to $100. IHP is a discount PPO network that allows more than 1,700 payors and 10,000 employer groups to access your rates.
The solicitation received by physicians does not include the proposed contract or fees and only includes a partial list of third-party payors that lease the IHP network. Before joining any network, particularly one that is leased or rented by other payors, you should carefully review the contract, including the list of payors that would have access to the discounted rates.
For more information, read CMA’s “Silent PPO Action Guide,” which contains an overview of physician discount contracts and discusses the laws that regulate PPO network leasing. The guide is available through CMA ON-CALL (document #1907). ON-CALL documents are available free to members at CMA’s members-only website. Nonmembers can purchase ON-CALL documents for $2 per page at the CMA bookstore.
Contact: Aileen E. Wetzel, 916/551-2037 or awetzel@cmanet.org.
7. PROFESSIONAL DEVELOPMENT: Reminder, Make Sure CME Are Offered by Accredited Providers
When selecting your continuing medical education (CME) courses, it is very important to choose courses offered by accredited CME providers. The Medical Board of California will not recognize CME from unaccredited providers. Accreditation can be granted by the Accreditation Council for Continuing Medical Education (ACCME) or by a state medical association.
All accredited providers are required to include on their marketing materials how many “AMA PRA Category 1 CreditsTM ” the activity has been granted. If this language (including the trademark sign) is not on the materials, beware.
A regularly updated list of accredited CME providers is available at the ACCME website, http://www.accme.org.
Contact: Sara Shimer, 415/882-5182 or sshimer@imq.org.
8. CMA LEGAL RESOURCES: The 2008 CPLH Is Here
The 2008 California Physician's Legal Handbook (CPLH) is now available. CPLH—an annual publication of CMA’s Center for Legal Affairs—answers the legal questions most frequently asked by physicians. CPLH 2008 offers more than 4,500 pages of comprehensive legal information including current laws, regulations, and court decisions related to medical practice in California.
The handbook is available in a 7-volume print format and on CD-ROM. The CD-ROM offers all of the content of the print version, plus many enhancements including fully searchable content, fully searchable content and hyperlinks that let you navigate within the CD-ROM and onto the web, as well as links to Findlaw for information on the cited court cases.
The CD-ROM is priced at $398 for members ($480 for nonmembers), the print version costs $798 ($960 for nonmembers), and the CD-ROM/print combo combination costs $898 ($1080 for nonmembers). To place an order, visit http://www.cmanet.org/bookstore or call 800/882-1262.
Don’t forget, CMA members can access most of the CPLH content FREE via CMA On-Call, CMA’s online library of medical-legal information, at http://www.cmanet.org/member.
Contact: CMA’s Publications Line, 800/882-1262.
9. Highlights from CMA Board of Trustees Available
The CMA Board of Trustees met May 1st in Anaheim. A summary of the board's major actions is now available online.
The board highlights offer a brief summary of major action and informational items discussed by the board. The highlights are not intended to be all-inclusive of items discussed, and these documents are not official CMA policy.
Members can access complete and official board-approved minutes at CMA's members-only website. (Official board meeting minutes are not posted until approved at the following meeting.)
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Contact: Ginnie Yee, 415/882-5170 or gyee@cmanet.org.
10. Member Benefit of the Week: : Save 10% on Auto Insurance
Mercury Insurance offers some the lowest auto insurance rates in California, and now CMA members can save an additional 10% off Mercury’s already great rates! Contact a local, independent Mercury agent today to see what Mercury can do for you.
To get a fast, free quote please call (866) 602-5259 or go online to www.mercuryinsurance.com.
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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