Group Dental Insurance Annual group dental open enrollment is underway now! CLICK FOR DETAILS
THIS WEEK'S FEATURED JOB LISTINGs
PHYSICIAN NEEDED as the Medical Director of an infusion center. Office space as well as personnel provided. Location: 4370 Auburn Blvd., Sacramento....Click here for more information.
THE LEADER IN CORRECTIONAL HEALTHCARE HAS AN IMMEDIATE OPENING FOR A PHYSICIAN To work at the Ventura County Jail and Juvenile Hall. 32 hours per week. Salary up to $195,000 per year. Includes shared call. Responsibilities include: provision of patient care, supervision of FNP/PAs, and monitoring the quality of medical care. Specialty in Internal Medicine, Family Practice or Emergency Medicine preferred....Click here for more information.
INTERNAL MEDICINE: FAMILY PRACTICE PHYSICIAN North County Health Services, a Joint Commission accredited, federally qualified community health center, celebrating 35 years of services, and serving more than 60,000 patients in multiple locations in North San Diego County has opportunities for BC/BE physicians. Compensation includes attractive base, call and incentive bonuses, and great benefit programs, including PTO, holidays, malpractice, reimbursement for CMEs (expense and time), and licensure. Joining NCHS is an opportunity to make a difference in the lives of patients who are under-insured or do not have insurance without having overhead expense, management concerns, as well as work-life balanced hours... .Click here for more information.
FLEXIBLE SCHEDULING OPPORTUNITIES, including weekends. Provide physician services in an interesting and dynamic environment. Competitive compensation as an independent contractor....Click here for more information.
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1. CMA Sponsors Bill to Stop Unfair Health Insurance Cancellation
Last week, Assemblymember Hector De La Torre introduced a CMA-sponsored bill (AB 2) that will prevent insurance companies from unfairly rescinding patients’ health insurance. Last year, this same legislation (AB 1945) passed with bipartisan support through the Senate and Assembly, only to be vetoed by Governor Schwarzenegger, leaving Californians exposed to this insidious practice.
Thousands of Californians have had their health insurance policies unfairly cancelled by insurance companies after they got sick. This bill would require that insurers be subject to an independent automatic external review before rescinding coverage. The bill also requires the Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) to jointly establish standard information and health history questions to be used on applications.
Several major California health insurance companies have announced their support for external review of their decisions to rescind or cancel policies, although their trade association opposed AB 1945. Since then, DMHC has restored coverage for 1,092 Kaiser Permanente consumers and 85 Health Net consumers due to unfair rescissions.
In 2007, CMA sponsored and won passage of AB 1324, which prohibits health insurers from denying payment for treatment that they have already approved.
2. It’s Time to Make Medicare Participation Decisions for 2009
It is the time of year again when physicians must make decisions about their Medicare participation. Physicians who wish to change their participation status for 2009 must do so by December 31.
In July, CMA helped overturn the president’s veto of a bill to prevent the scheduled 15 percent Medicare physician payments cuts. Physicians will instead receive a 1.1 percent increase in 2009, with bonuses of up to 2 percent for participating in the quality reporting program and an additional 2 percent for e-prescribing.
Physicians have three choices regarding Medicare: be a participating provider; be a nonparticipating provider; or opt out of Medicare entirely.
Contact: CMA’s Reimbursement Help Line, 888/401-5911.
3. CMA Supports Regulations to Reduce Diesel Emissions
As a participating member of the Health Network for Clean Air, CMA has signed on to a letter encouraging the California Air Resources Board (CARB) to implement proposed regulations to reduce emissions from diesel vehicles.
The regulations would require existing heavy-duty diesel vehicles to be upgraded or replaced to comply with specified particulate matter and oxides of nitrogen emission standards. These harmful pollutants are associated with increased emergency room and doctor’s office visits and contribute greatly to health disparities in communities along the goods movement chain. CARB staff estimates that the implementation of these regulations will reduce premature deaths by roughly 3,300 between 2010 and 2025.
CMA has extensive policy supporting greater regulation to reduce the emission of air pollutants, including a resolution passed at this year’s House of Delegates (715-08) that calls on CMA to “support efforts to significantly reduce the amount of particulate pollution from diesel sources.”
CMA members will testify about the public health impacts of poor air quality at public hearings on these regulations scheduled for December 11 and 12 in Sacramento.
If you are interested in participating, please contact Delilah Clay at dclay@cmanet.org or 916/551-2568.
4. Superior Court Upholds DMHC “Balance Billing” Regulation
On December 2, the Sacramento Superior Court finalized its order in the CMA-led lawsuit seeking to invalidate the Department of Managed Health Care’s “balance billing” regulation. Consistent with its preliminary ruling, the court determined that the regulation is valid, but only insofar as it seeks to define balance billing as an unfair billing pattern. The court did not address whether DMHC can enforce the regulation against providers, despite DMHC’s public assertions that this regulation “prohibits” balance billing. Despite the lack of clarity from the court on this point, DMHC has indicated that it intends to take enforcement actions against providers that “balance bill.”
CMA is considering its options in response to this ruling and will very likely appeal. Once formal judgment is entered, which will likely happen this week, CMA will have 60 days to file an appeal. CMA may seek to expedite the appeals process, which can take more than a year. CMA’s legal team is also actively exploring separate litigation avenues to challenge DMHC’s authority to take any enforcement action based on this regulation.
As part of our efforts on balance billing and other issues related to out-of-network services, CMA will be conducting a survey of physicians in the coming days. This survey will help provide us with the data to support our legislative and legal advocacy efforts. CMA encourages all physicians to keep an eye out for the survey, and to respond if possible.
5. CMA RICO Victory:
HealthNet Sends Contract Addendums to Physicians
Earlier this year, CMA successfully challenged a number of provisions in HealthNet’s standard physician contract that did not comply with the terms of the RICO settlement. The CMA-requested contract addendum was recently approved by regulators and mailed to all physicians with standard HealthNet contracts in California and 6 other states.
HealthNet is one of seven insurance companies that settled CMA’s class action civil racketeering (RICO) lawsuit against for-profit health plans. The settlement agreements required the health insurers to change their business practices to effect transparency and fairness in their relationships with physicians.
Highlights of the new addendum include:
The definition of “medically necessary” has been updated so that it is consistent with the definition agreed to in the settlement.
Contracting physicians are not required to participate in all of Health Net’s products.
HealthNet will provide at least 90 days advance notice of material contract changes, which is even more than the 45 days required by California law.
CMA continues to have concerns with the HealthNet contract that do not fall under the RICO settlement and CMA is working with the insurer to resolve these issues.
Over the last two months, some 20,000 California physicians received letters from the California Physician Performance Initiative (CPPI). These letters contain raw and relative performance scores for physicians on 15 quality measures based on claims data from Medicare and United Health, Blue Cross, and Blue Shield PPOs. The letters do not contain the underlying data.
CMA urges all physicians to request their data from CPPI and verify its accuracy. The deadline to do so has been extended to December 16. Physicians will then have 30 days after they receive the data to submit corrections.
We understand that this may be a time- consuming process, but it is critical for physicians to take the time to verify their data. If you do not raise concerns now, payors will use this data in the future to adjust your reimbursements and change the flow of patients to your practice.
Step by step instructions on obtaining and reviewing your patient data is available at http://www.cmanet.org/cppi.
Contact: CMA Member Help Line, 800/786-4CMA (4262).
7. State Will Take Up Family PACT Issue with New Administrator
As we reported last week in CMA Alert, California is at risk of losing federal funding for its Family PACT Program if it cannot reach an agreement with the Centers for Medicare and Medicaid Services (CMS) officials over eligibility verification for the program.
CMS has already extended the deadline until December 15, and
is likely to
extend the waiver until President Obama takes office, so that the state can take up the matter with the new Administration.
Democratic leaders in the California Congressional Delegation are extremely supportive of the program and have vowed to help convince the new Administration to save it.
8. Member Benefit of the Week: Group Dental Program
Don’t miss the chance to get comprehensive dental coverage for yourself and your family at a reasonable cost. Until December 31, CMA members can enroll in the Group Dental Plan (underwritten by Guardian Life Insurance Company), with or without their employees. Following this open enrollment period, only groups will be able to enroll.
Beginning in January, the 6 month waiting period between cleanings has been eliminated.
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