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1. You Wanted to Know:
Do State-Approved Security
Prescriptions Meet Federal Medicaid Standards?
Answer: Yes. California’s security prescription requirements exceed the new federal Medicaid security prescription standards.
A federal law that takes effect October 1 requires that all Medicaid prescriptions be written on tamper-resistant prescription pads. Specifically, the law requires that Medi-Cal prescriptions be written on pads that have one or more industry-recognized features that prevent unauthorized copying, erasure or other modification, or counterfeiting. By October 1, 2008, pads must meet all three standards.
As you know, California law currently requires the use of secure prescription pads for controlled substances (Schedule II to V). California’s security prescription requirements exceed federal requirements and California’s Department of Justice-approved security prescriptions can be used for writing Medi-Cal prescriptions.
While you could opt to use a “lower-grade” security prescription pad when writing noncontrolled substance prescriptions for Medi-Cal patients, there is no need to add yet another administrative burden to your busy practice. CMA has confirmed that DOJ-approved pads from its security prescription partner RxSecurity are competitively priced compared to other printers’ lower-grade pads.
And don’t forget, 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. CMA is also currently negotiating an additional discount for CMA members during this transition period. Stay tuned for details.
CMA and others in organized medicine urged the Centers for Medicare & Medicaid Services to delay implementation of the new law to allow physicians and pharmacists time to prepare for this substantial change. Unfortunately, CMS recently announced 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. We are 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. CMA is working on federal urgency legislation to reverse the law or at least make it consistent with current state law.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3176 or emcneil@cmanet.org
2. California Physicians and Groups Received RICO
Settlement Checks Worth $18.6 Million this Month
As reported two weeks ago in CMA Alert, checks were recently mailed to the nearly 12,000 California physicians and physician groups that filed claims under the Health Net settlement. CMA has learned that California physicians received a total of $13.5 million, which represents over one third of the $40 million settlement.
Physicians who filed claims under the Humana settlement have also begun receiving their checks. While Humana is not a major insurance industry player in California, more than 6,000 California physicians and physician groups who filed claims will receive more than $5 million collectively.
Of even greater significance is the RICO settlements’ prospective relief, which is valued at $1 billion. Humana, Health Net, and the other settling health plans have made binding commitments to change the way they do business with physicians and to put a stop to business practices that were used to deny or delay payment to physicians for legitimate claims. These changes are expected to result in increased predictability and speed of claims payment, creating significant value for physicians by reducing time-consuming and costly administrative burdens.
This settlement is the direct result of a long legal battle fought by CMA on behalf of its member physicians and their patients. In a historic action six years ago, CMA filed a civil racketeering (RICO) lawsuit against for-profit HMOs in California, alleging that HMOs were using fraud and other illegal activities to interfere in the physician-patient relationship. The case, which became the largest class-action health care lawsuit in U.S. history, forced into the open the unfair practices of an industry that had harmed physicians and negatively affected patient care more than a decade.
Of the 10 defendants named in the lawsuit, six have settled (including the merged Anthem/WellPoint/Blue Cross), and three had their cases dismissed by the court. The dismissals of the cases against United Healthcare and Coventry have been appealed.
Please help us ensure that these plans abide by the terms of their settlements. If you believe that a health plan is not living up to the terms of its settlement, contact CMA at 800/786-4CMA (4262).
Click here for more information.
3. Governor Schwarzenegger Joins CMA in Fight to
Continue Healthy Families Coverage for Uninsured Kids
With the White House threatening to veto CMA-supported legislation that would reauthorize the State Children’s Health Insurance Program (SCHIP) and proposing new SCHIP eligibility restrictions, Governor Arnold Schwarzenegger is fighting back.
“As you rally governors to do more to help fix our broken health care system, your administration has repeatedly modified existing Medicaid and SCHIP rules, harming states’ capacity to help you achieve our shared objectives,” wrote Governor Schwarzenegger and New York Governor Eliot Spitzer in a joint letter to President George Bush.
SCHIP has provided health insurance to hundreds of thousands of California’s uninsured children for a decade. CMA has been urging Congress to reauthorize this very important program at current eligibility levels. (In California, families at or below 250 percent of federal poverty level are currently eligible for Healthy Families coverage.) Governor Schwarzenegger has previously proposed expanding Healthy Families coverage in California to individuals at or below 300 percent of the federal poverty level, an idea that CMA wholeheartedly supports.
With the SCHIP program set to expire on September 30, this will be a hot topic next month in Washington, D.C.
A bill (HR 3162, the Children’s Health and Medicare Protection Act) passed by the U.S. House of Representatives earlier this month would reauthorize the Healthy Families program at current levels and stop the 15 percent Medicare physician pay cut. It would also update California’s geographic payment localities and prevent any geographic payment reductions for three years.
The Senate, however, passed a scaled-down version of the House bill, without the Medicare provisions. Because of this discrepancy, the physician payment reforms are at risk of being scaled back. It is important for physicians to make their congressional representatives understand that stopping the 15 percent payment cuts planned over the next two years is critical to preserving access to care for Medicare patients.
CMA urges physicians to contact their congressional representatives and ask them to protect access to care by reauthorizing SCHIP and stopping the Medicare physician payment cut. Call AMA’s grassroots hotline at 800/833-6354, enter your zip code when prompted, and you will be automatically connected with your representative.
Click here for more information, including sample letters and talking points.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
4. NPI Lookup Goes Live September 4
As payors begin making the transition from legacy provider numbers to the new universal National Provider Identifiers (NPIs), physicians will not only have to include their own NPIs on claims, but also will have to include the NPIs of referring physicians and health care facilities.
Obtaining NPIs from referring providers can be a time-consuming hassle. To facilitate this process, the Centers for Medicare & Medicaid Services (CMS) on September 4 will finally launch its online NPI registry. The online tool will allow physicians and other covered entities to look up NPIs simply by entering the provider or facility name into an online database.
The online registry will return NPIs and relevant demographic information, but it will not disclose Social Security numbers, dates of birth, or IRS taxpayer identification numbers, according to CMS..
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-4911 or gfonseca@cmanet.org.
5. Governor Signs $146 Billion 2007-08 Spending Plan,
Uses Line-Item Veto to Reduce Health Care Spending
Governor Schwarzenegger made sizable reductions to the health care budget last week before ultimately signing a $146 billion state spending plan for 2007-2008. The governor’s line-item vetoes totaled $700 million, with the largest line-item reduction ($332 million) coming from from the Medi-Cal reserve account. The administration predicted a surplus in reserve funding for the $14 billion Medi-Cal program, so the reduction should not affect Medi-Cal services or provider reimbursement.
Despite these line-item cutbacks, funding for most health care programs remains similar to previous years.
Click here for more information on the budget as it relates to health care.
Contact: Lisa Folberg, 916/444-5532 or lfolberg@cmanet.org.
6. Health Reform Faces Significant Hurdles
as
Legislative Session Draws to a Close
With just two weeks left to go in the legislative session, health care reform continues to be a priority and CMA remains at the center of the continuing discussion on how to fix California’s broken health care system. CMA has been in constant negotiations with all of the major players, making sure that the interests of physicians and their patients are well represented. Negotiations will continue until the final days of the legislative session and will likely reach a frantic pace next week.
Though CMA’s main focus has been on the overall structure of the reform proposals, we have also been advocating, among other things, for major insurance market reform, for the removal of the pay-for-performance provisions found in all of the major plans, and for adequate provider network requirements.
Recent news stories have highlighted the growing divide between the Governor and Democratic and Republican leadership in the Legislature on the best way to increase access to care for the state’s uninsured. Earlier this week, the Governor declared that he would veto the main democratic reform proposal (AB 8) authored by Assembly Speaker Fabian Núñez and Senate Pro-Tem Don Perata.
One of the most contentious issues has been the issue of how to pay for health system reform. Given the Republicans’ strong opposition to any tax increase and the legislative requirement for a two thirds vote to approve any tax, legislative funding mechanisms are limited. Recently, the California Restaurant Association called for a ballot initiative imposing a one cent increase in the sales tax to support health system reform. Several groups, including the California Small Business Association, have come out in support of the proposal as a way to truly share the costs and benefits of expanded access to care.
CMA remains committed to moving health reform forward this year and to the belief that universal access and stable long-term funding are critical to achieving comprehensive reform.
Click here for more information.
Contact: Lisa Folberg, 916/444-5532 or lfolberg@cmanet.org.
7. Tickets Now on Sale for CMA Foundation’s Annual Dinner
The CMA Foundation’s 2007 President’s Reception and Dinner Dance is October 28 at the Disneyland Hotel in Anaheim, during CMA’s annual meeting. Proceeds will support CMA Foundation, a charitable organization that links physicians and their communities to raise awareness about important public health issues, including appropriate antibiotic use, childhood obesity, diabetes, smoking cessation, and health disparities.
Honored at the dinner will be incoming CMA President Richard Frankenstein, M.D., and the foundation’s leadership award recipients, Condessa Curley, M.D. (Robert D. Sparks, M.D., Leadership Award), Kwabena Adubofour, M.D. (Adarsh S. Mahal, M.D. Access to Health Care and Disparities Award), and Edward Chow, M.D. (Ethnic Physician Leadership Award).
Tickets are on sale now. Individual tickets are $125, 10-person tables are $850. Even if you will not be able to attend, consider placing an ad in the dinner program to recognize Dr. Frankenstein, your organization, the leadership award recipients, or even a colleague or loved one. It’s up to you! The foundation is a nonprofit charitable organization, and all ads are tax deductible. The ad deadline is September 14.
Visit http://www.calmedfoundation.org for more information.
Contact: Liz Burdick, 916/551-2886 or lburdick@cmanet.org
8. 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, Banc of America has served the needs of physicians by offering financial products and services tailored to meet the needs of the medical community.
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 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 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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