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1. All Medi-Cal Prescriptions Must Be Written on
Tamper-Resistant Pads Effective October 1
A federal law that takes effect October 1 will require that all Medicaid prescriptions be written on tamper-resistant prescription pads. The new law, which was buried in a supplemental Iraq war spending bill passed earlier this year, is designed to make it more difficult for patients to illegally obtain controlled substances. Federal budget estimates indicate it will save $510 million in Medicaid prescription fraud over a 10-year period.
California law currently requires the use of secure prescription pads for Schedule II to V drugs. This new law will require all physicians treating Medi-Cal and Healthy Families patients to use tamper-resistant pads for all outpatient prescription drugs, not just controlled substances. Phoned, faxed, or electronically transmitted prescriptions are not impacted by this new law.
CMA and others in organized medicine urged the Centers for Medicare & Medicaid Services to delay implementation to allow physicians and pharmacists time to prepare for this substantial change. Unfortunately, CMS last week told state Medicaid directors that the law would take effect as scheduled on October 1.
CMA is very concerned that the short notice will lead to confusion among physicians and pharmacists, and negatively impact patient care and access to prescriptions. CMA is also concerned that the additional hassle and cost involved will force physicians to leave the Medi-Cal program, where access to care is already a problem. The association is working on federal urgency legislation to reverse the law or at least make it consistent with current state law. Stay tuned to CMA Alert for more details.
Physicians are reminded that CMA partner RxSecurity provides members with significant discounts on tamper-resistant prescription pads. CMA members get 15 percent off RxSecurity’s already low prices. Depending on the number of pads purchased, members pay as little as $2.55 per one-part pad (100 scripts per pad) or $4.16 per two-part pad (50 scripts per pad). Special pricing is available for hospitals, clinics, and other high-volume purchasers.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3176 or emcneil@cmanet.org.
2. Manufacturers Start Shipping This Season’s Flu Vaccine
The first doses of influenza vaccine for the 2007-2008 flu season are now being shipped to health care providers across the country. These initial shipments are the first of an expected 132 million doses that will be produced this season.
Manufacturers are predicting an ample supply of vaccine this year, primarily because of additional manufacturers entering the vaccine market. To date, all three vaccine strains are performing well and manufacturers foresee no delays in vaccine availability for the upcoming season.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
3. Blue Cross Begins Paying PPO Patients Directly
CMA last week learned that Blue Cross has begun reimbursing patients, rather than physicians, for nonemergency out-of-network PPO services. Letters regarding this policy change, which took effect June 23, went out to brokers and employers but neither patients nor physicians were notified of this change.
In the past, Blue Cross paid nonnetwork physicians directly for services that were covered under a patient’s benefit plan. Now, Blue Cross will send the patient a check, and the patient will be responsible for paying the physician.
The new policy applies only to Blue Cross PPO products. The insurer’s state sponsored point-of-service and HMO products are excluded from this policy. Also unaffected are small group members covered through Blue Cross Life and Health Insurance Company. However, the direct-pay policy does apply to individual members covered through Blue Cross Life and Health Insurance Company. Blue Cross’s “administrative services only” (ASO) clients with groups of 100 or more have the option to either pay noncontracted physicians or to pay the patient directly.
As you can imagine, it will be very difficult and time consuming for noncontracted physicians to determine when and how they will be reimbursed for services provided to Blue Cross PPO patients. CMA reminds noncontracted physicians that it is best practice to collect directly from patients before the service is provided.
Click here for more information, including details on the exceptions to this policy.
Contact: CMA’s reimbursement help line, 888/401-5911 or gfonseca@cmanet.org.
4. Medicare/Healthy Families Bill Includes New Specialty Hospital Ban
The Children’s Health and Medicare Protection (CHAMP) Act that recently passed the U.S. House of Representatives contains a provision that would ban new physician-owned specialty hospitals. CMA is seeking to eliminate this onerous provision.
The bill (HR 3162) would also prohibit preexisting physician-owned specialty hospitals that treat Medicare patients from adding additional beds. Additionally, it would require physician-owned specialty hospitals to reduce their physician ownership to no more than 40 percent within 18 months, with no individual physician having more than 2 percent ownership.
To help CMA in this very difficult battle, we need to hear from physician owners of specialty hospitals. We also need information on any physician-owned hospitals that are under development.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
5. State Legislature Finally Passes 2007-2008 Spending Plan
CMA and the hospitals, clinics, and other health care providers not receiving payment due to a delayed state budget were relieved Tuesday afternoon when the state Legislature finally approved a spending plan. The approval comes more than 10 weeks past the constitutional June 15 deadline and over seven weeks into the new fiscal year.
The state constitution requires that the budget be approved by a two-thirds vote in each house before it can be sent to the governor for signature. The Assembly was able to pass a budget on July 20, but the spending plan was stymied in the Senate until an agreement was reached on Tuesday.
Although the Governor is expected to sign the bill by the end of the week, it is likely he will reduce or eliminate individual appropriation items. Overturning a line item veto requires a two-thirds vote of the Legislature.
Stay tuned for more details on the budget as it relates to health care.
Click here for more information.
Contact: Lisa Folberg, 916/444-5532 or lfolberg@cmanet.org.
6. Last Chance to Submit a Resolution to the 2007 House of
Delegates; Deadline Is Next Tuesday, August 28
The most effective way an individual member can influence CMA’s policies and activities is to submit resolutions to the House of Delegates, the association’s legislative body. The delegates meet annually to debate and act on resolutions and reports dealing with myriad medical practice, public health, and CMA governance issues. This year’s annual meeting is October 27 to 29 in Anaheim.
The deadline to submit resolutions to this year’s House of Delegates is August 28. 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 to make sure that the association is not already addressing the issue.
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’smembers-only website.
Contact: Roger Purdy, 916/444-5532 or rpurdy@cmanet.org.
7. Member Benefit of the Week: 15% Off Hertz Car Rentals
CMA members can save up to 15 percent off daily Hertz car rental rates*. Special international discounts are also available. Visit Hertz.com or call Hertz at 800/654-2200. Frequent traveler miles and bonus points may be earned for qualifying rentals.
A members-only code is needed to take advantage of this discount. Visit CMA’s members-only website, or call the member service center at 800/786-4CMA (4262) to get your code.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or lgodward@cmanet.org.
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