1. State Court Denies Preliminary Injunction to Stop Medi-Cal Cuts
Last week, a state court failed to reverse the 10 percent Medi-Cal reimbursement cut that took effect on July 1. While the court agreed with CMA and the other plaintiffs that these cuts would irreparably harm access to health care for nearly 7 million Californians, it denied the preliminary injunction on the grounds that the state court lacks the authority to enforce the federal law in state court.
The decision as an enormous setback for the health and lives of the millions of Californians who rely on the state’s safety net. We are considering all options, including filing an emergency appeal with the second district appellate court in Los Angeles. Additional cases are pending in other courts seeking to stop the Medi-Cal cuts.
“This is the fourth court in five years to find that the state of California has put at risk the access to health care for millions of Californians by underfunding the Medi-Cal program,” Dr. Richard Frankenstein, MD, president of the California Medical Association. “We are hopeful that should the courts be unable for technical procedural reasons to grant some relief to millions of Californians who rely on Medi-Cal for their health care needs, the governor and legislature will act to do so.”
The 10 percent cut was proposed by the Schwarzenegger Administration and agreed to earlier this year by the State Legislature in an emergency budget session as part of their efforts to address the $15 billion shortfall facing the state. CMA’s lawsuit, filed in May, alleges that the state has failed to set Medi-Cal reimbursement rates at a level that ensures access to health care for Californians on Medi-Cal, in violation of federal law.
CMA continues to work on other fronts to oppose the cuts. Together with a coalition of health care providers and health care consumer groups, CMA is airing ads in key areas of the state telling legislators to stop the cuts. (Click here to view one of the ads.)
These paid ads are supplementing and reinforcing the messages from stories CMA has successfully generated in newspapers across the state which describe the impact the cuts will have on health care in California. Together, the earned and paid media efforts support the continued work by our government relations team to convince legislators to overturn the cuts.
Click here for more information.
Contact: Francisco Silva, 916/444-5532 or fsilva@cmanet.org.
2. DMHC Finalizes "Balance Billing" Regulation; CMA Calls Regs a Giveaway to HMO’s at Expense of Physicians and Patients
After several months of receiving and reviewing comments on its proposal, the Department of Managed Health Care (DMHC) today finalized its balance billing regulation. The regulation defines “unfair billing patterns” to include the practice of balance billing patients
for the unpaid balance of bills only partially paid by HMOs for noncontracted emergency services
. While the DMHC describes the regulation as an attempt to “restrict the practice of balance billing,” DMHC has no statutory authority to enforce or promulgate such a regulation.
This regulation must now go to the Office of Administrative Law (OAL), which has 30 business days (roughly 45 calendar days) to review the regulation for necessity, authority, clarity, consistency, reference, and nonduplication. If OAL finds that the regulation does not meet these standards, it will be sent back to DMHC to try to correct the deficiencies. If OAL approves the regulation, CMA will take legal action to stop it from being implemented. CMA has already assembled an outside legal team and is in the process of raising funds for the legal fight.
After DMHC proposed this regulation in March, CMA organized physicians to appear at hearings around the state to voice our opposition to these physician-unfriendly and unlawful regulations. Additionally, CMA filed extensive comments explaining our opposition to the regulation and why we believe DMHC to be overstepping its authority. The issues raised in these comments will serve as the basis for much of the OAL review and for our legal opposition.
Essentially, DMHC has used a law intended to protect physicians to promulgate a regulation that attempts to prevent physicians from getting fully paid for the services they provide. Unlike previous proposals on balance billing, this version does nothing to regulate or obligate HMOs in any manner – failing to address both fair payment of physicians and inadequate physician networks. This regulation is an attempt by the Schwarzenegger Administration to appear to be defending the interests of patients, when in fact it is simply a giveaway to HMOs at the expense of physicians and patients.
CMA will continue to provide updates as OAL completes its review.
Click here for more information.
Contact: Armand Feliciano, 916/444-5532 or afeliciano@cmanet.org.
3. Blue Cross Switches to AIM for Imaging Authorizations
On September 1, American Imaging Associates (AIM) will begin administering Blue Cross of California’s radiology utilization management program, which requires precertification/preauthorization for advanced diagnostic imaging procedures performed in an outpatient setting. AIM is a wholly owned subsidiary of Anthem/Wellpoint, Blue Cross of California’s parent company.
Before scheduling outpatient imaging procedures (including CT/CTA scans, MRI/MRA scans, PET scans, and Nuclear Cardiology studies) with dates of service on or after September 1, you must contact AIM to obtain a preauthorization number. Requests may be made by phone at 877/291-0360, or via Blue Cross’s provider portal at http://www.anthem.com/ca.
Please note that effective Sept 1, preauthorization will no longer be required for treadmills (CPT code 93350).
Physicians who provide advanced diagnostic imaging services should have received additional details via mail regarding the transition. If you did not receive a letter or have any questions or comments about the radiology utilization management program, contact your local Blue Cross provider contracting representative.
Click here for more information.
Contact: CMA’s Reimbursement Helpline 888/401-5911 or gfonseca@cmanet.org.
4. Is Your Medical Group Having Medicare Payment Problems?
As we’ve reported a number of times over the past few months, Medicare payments for thousands of Northern California physicians are at risk. Affected are physicians who work for or contract with groups in Northern California and need to submit an updated 855R form to reassign their Medicare payments to their group(s).
CMA has learned that some physicians who have already submitted the proper paperwork are still not being paid, largely because of a backlog of reenrollment forms from Northern California physicians. If your Medicare payments have been denied or delayed, first check the Center for Medicare & Medicare Services’ list of top NPI-related error codes. (Click here to view this list, including instructions on how to correct the errors.) If your payment problems are not related to these common billing errors, and you believe you are among those physicians affected by the group reassignment issue, please call CMA’s Reimbursement Helpline, 888/401-5911. CMA may be able to help expedite the enrollment process and get your payments back on track.
To help CMA assess the extent of this problem, county medical societies will be surveying members. If you have not received a survey from your county, you may request a copy by calling CMA’s Reimbursement Helpline.
Click here for more information.
Contact: Michele Kelly, 888/401-5911 or mkelly@cmanet.org.
5. IMQ Seeking Physicians for Dept. of Correction
Review Committees
The Institute for Medical Quality (IMQ) is recruiting physicians to serve on California Department of Corrections and Rehabilitation (CDCR) Judicial Review Committees. These committees will hear evidence regarding the quality of care provided by CDCR physicians.
To be eligible, you must be an actively practicing physician or a retired physician (with a valid California license) who is still active in the medical community. There is a particular need for family physicians, internists, and general surgeons, especially those with correctional health experience.
Hearing panels will be scheduled in various geographic regions around the state, with each hearing lasting one week. If you are selected, you will be given three to four weeks’ notice of the hearing date.
Selected physicians will be trained and credentialed by IMQ and employed as Special Consultants to the State (and afforded civil liability protection). Physicians will be paid for their time and travel expenses.
Contact: Leslie Iacopi, 415/882-5167 or liacopi@imq.org.
6. Tomorrow Is Deadline to Submit Resolutions to
2008 House of Delegates
The deadline to submit resolutions to this year’s House of Delegates is tomorrow August 5. Any CMA member may author a resolution, but a delegate, alternate delegate, component medical society, or specialty delegation must submit the resolution.
Before authoring a resolution, physicians are strongly encouraged to review CMA’s Policy Compendium (available at CMA’s members-only website), to determine whether policy already exists on a particular topic.
Resolutions must be submitted by e-mail to resolutions@cmanet.org by August 5. For more information on submitting a resolution, contact your county medical society.
Detailed instructions (including required format, allowed subject matter, and submission rules), are available at CMA’s HOD website.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
7. Benefit of the Week: Reduced Loan Administration Fees
CMA members get reduced loan administration fees from Banc of America Practice Solutions™ (a subsidiary of Bank of America). For more than 20 years, Bank of America has served the needs of physicians by offering financial products and services tailored to meet the needs of the medical community.
The expertise of our financial specialists and the convenience of a simple express application can help you secure equipment and electronic medical record financing in as little as three hours.
Whether you own a practice or are just getting started, Banc of America Practice Solutions™ can provide customized financial solutions for your short- and long-term needs. For more information, call Banc of America Practice Solutions™ at 800/497-6076.
A members-only code is needed to take advantage of this discount. Visit CMA’s members-only website, or call the member helpline at 800/786-4CMA (4262) to get your code.
Click here for more information on your membership benefits.
Contact: CMA’s Member Helpline, 800/786-4CMA or info@cmanet.org.
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