Advertisement 1. Medicare Condition Critical:
Please Call Your Representatives Today
Congressional negotiations on Medicare are at a crossroads. The situation remains very fluid with potential outcomes for California physicians ranging from good to very bad.
- Payments to physicians may be cut by 10 percent or increased.
- Geographic payment problems may or may not be fixed.
- The reforms might be paid for by equalizing physician rates with Medicare Advantage rates (as CMA advocates) or by mortgaging the debt into future years, leaving physicians facing even greater SGR cuts next year and beyond.
The Senate Democratic and House Democratic leaders are meeting over the next several days to craft a new agreement to stop the payment cuts to physicians and to address the other issues. If they can get an agreement, the vote will likely be next week (the week of December 17).
Your members of Congress need to hear from you on these issues NOW. Please call before Tuesday, December 18, to maximize your impact on this debate. Call AMA’s toll-free grassroots hotline at 800/833-6354 to be patched through to your Representative.
Tell your Representatives that time is running out and urge them to:
- Stop the 10 percent payment cut.
- Provide a payment increase.
- Update the geographic payment localities.
- Fund these reforms by equalizing Medicare Advantage rates with physician rates, not by increasing the physician SGR cuts in future years.
Please also tell them how these cuts will impact their ability to care for senior patients. Make sure that physicians are heard in Congress. Call today!
Also, ask your patients to call AMA’s grassroots patients hotline at 888/434-6200. CMA’s “Help Preserve the Promise of Medicare” posters are available for download. Put one up in your office today.
Click here for more information.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
2. New Law Clearly Prohibits Rescission of Treatment
Authorization After Services Have Been Rendered
A CMA-sponsored law that takes effect January 1 clarifies that under no circumstances are insurers allowed to rescind or modify authorization after services are rendered in good faith. Although existing law already prohibits this activity, physicians and their patients have been increasingly faced with unpaid medical bills for preauthorized services.
This new law (AB 1324) specifically states that authorization cannot be rescinded for any reason, including but not limited to, subsequent rescission, cancellation, or modification of the patients health insurance polcy or subsequent determination by the insurance company that it did not initially make an accurate determination of eligibility.
There will now be no question that the law prohibits retroactive modification of authorization after services have been rendered, even if a patient’s health insurance policy is subsequently cancelled by the insurer.
The CMA ON-CALL system is currently being updated to reflect all new legislation, including A.B. 1324. This new law will be discussed in full in the revised ON-CALL document #0145, “Payment Denial After Treatment Authorization or Verification of Eligibility.” This document will be available on CMA’s website, CMA's website, in January 2008.
Click here for more information.
Contact: CMA’s legal department, 916/551-2033 or legalinfo@cmanet.org.
3.CMA Comments on FDA’s Behind-the-Counter Drug Proposal
The Food and Drug Administration (FDA) is considering a proposal to create a new class of drugs that could be sold by pharmacists behind-the-counter (BTC). These drugs would be sold without a prescription, and could include birth control, cholesterol, and migraine medicines.
CMA recently submitted comments on this proposal and expressed concern that a BTC classification could have the opposite of its intended effect, and actually reduce patient access to important medications. In recent years, it has become common practice for insurers to drop coverage for nonprescription drugs, particularly those that are moved to over-the-counter (OTC) status. This has increased patients’ out-of-pocket costs, thus reducing their access to these drugs.
CMA is also concerned that insurance companies might require patients to try BTC drugs as part of a step therapy program before receiving other prescription medications or worse, before seeing a physician.
“The BTC process will create additional barriers for patients to receive appropriate medical care from physicians,” wrote CMA CEO Joe Dunn in the comments. “It is crucial that patients with multiple chronic conditions receive care from a physician who is capable of managing such complex cases. Pharmacists do not have the appropriate education and training to manage such cases.”
Click here for more information, including a copy of CMA’s comments.
Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.
4. There Is Still Hope for Health Reform in 2007
As Governor Schwarzenegger’s promised “year of health care reform” draws to a close, there is still hope that an accord will be reached before the end of the year.
The Governor and Democratic Assembly Speaker Fabian Nuñez have indicated to CMA that they may release draft language for a new bipartisan proposal this week.
CMA has remained in close contact with both the speaker and the Governor and has learned that the new proposal will not include expand scope of practice for PAs and NPs, as previously proposed by the Governor.
The financing for the $14 billion proposal remains fluid as they try to close a nearly billion dollar revenue shortfall. Increasing state budgetary concerns may also impact the negotiations.
Stay tuned for more information.
Contact: Dustin Corcoran, 916/444-5532 or dcorcoran@cmanet.org.
5. Next Medicare Conference Call on
Quality Reporting Program Is December 19
The Centers for Medicare & Medicaid Services (CMS) is hosting a series of conference calls to help physicians understand Medicare’s Physician Quality Reporting Initiative (PQRI). The next call is Wednesday, December 19, noon to 2 p.m., Pacific time.
CMS experts will discuss the 119 quality measures selected for 2008 reporting. The Q&A format will allow physicians and their staff to have their questions answered by CMS PQRI experts.
Participation is free, but registration is required. Available phone slots fill up quickly, so interested physicians are urged to register as soon as possible. Registration information is available at the PQRI website, http://www.cms.hhs.gov/pqri. Physicians who are unable to participate in these calls can access on-demand audio replays, also at the PQRI website.
Click here for more information.
Contact: Geanelle E. Griffith, 410/786-4466 or geanelle.griffith@cms.hhs.gov.
 6. Download CMA's 'Save Medicare' Poster
CMA has produced “Save Medicare” posters to display in your office or hospital to encourage patients to join the fight to stop the physician payment cuts. High-resolution posters are available in a number of sizes for you to download.
Click here to select a size.
7. Member Benefit of the Week:
Dental Insurance Open Enrollment Now Underway
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 Guardian Dental Plan, with or without their employees. Following this open enrollment period, only groups will be able to enroll.
The Guardian Dental Plan provides up to $2,000 per person of annual benefits for dental care with network providers ($1,500 if you use nonnetwork providers).
A new maximum rollover benefit has been added to the plan, which allows individuals to rollover a portion of their unused annual maximum benefit each year.
Once the open enrollment period closes, you will not be offered the opportunity to join as an individual member until next December. Groups can join throughout the year, subject to normal underwriting and participation requirements.
For more information, please call a Marsh Client Service Representative at 800/842-3761.
Click here for more information on your membership benefits.
Contact: CMA's membership hotline, 800/786-4CMA (4262) or info@cmanet.org.
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