In this week's CMA Alert 1. U.S. House Passes Federal Tort Reform Bill 2. Courts Uphold Noncontracting Physicians' Rights to Health Plan Payment 3. HIPAA Tip: FAQ About OHCAs 4. FDA Seeks Public Comment on Ephedra Labeling 5. Southern California Medicare Claims Denied in Error 6. CMA Convenes 132nd House of Delegates 7. You're Invited to CMA's 2003 Legislative Leadership Day 8. Save the Dates:     IMQ's CME Providers Conference      Pri-Med West     Pri-Med Updates

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1. U.S. House Passes National Tort Reform Bill
The U.S. House of Representative last week passed, by a vote of 229 to 196, a national professional liability reform bill (HR 5), which would cap noneconomic damage awards at $250,000. This is very good news, even though HR 5 contains some provisions that CMA does not support—including its application not only to physicians and other health care providers, but to health plans and pharmaceutical manufacturers. If a state has established (or establishes in the future) its own liability limits, HR 5 defers to state law. California already has a $250,000 cap on noneconomic damages in medical malpractice, but does not cap such damages for health plans and drug companies that lose liablilty lawsuits.

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2. Courts Uphold Noncontracting Physicians' Rights to Health Plan Payment
Two recent Court of Appeal decisions uphold physicians’ rights to recover payment from health plans for medically necessary services, even if they do not have a contract with the health plan or its contracting intermediary. In Coast Plaza Doctors Hospital v. UHP Healthcare (2002) and San Joaquin Community Hospital v. PacifiCare (2003), the courts concluded that where no contract exists and where the patient assigns to the provider his or her right to health plan reimbursement, noncontracting health care providers have a right to seek reimbursement directly from the health plan. The courts also ruled that the Knox-Keene Act does not preclude lawsuits seeking reimbursement based on contract theory and/or the Unfair Competition Law (Business & Professions Code §17200).

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5.  Southern California Medicare Claims Denied in Error
CMA has learned that Medicare claims recently submitted by a large number of Southern California physicians were mistakenly denied because of a computer error. NHIC, California’s Medicare carrier, is aware of the problem and expects to have all the affected claims adjusted by the end of the month. Claims affected were those processed between March 3 and March 6, with the denial code "PR49."

6. CMA Convenes 132nd House of Delegates
Nearly 700 physicians representing geographic communities, ethnicities, and specialties from across the state will convene this weekend at the San Francisco Hilton and Towers for CMA’s 132nd annual House of Delegates. From March 22 to 25, delegates will be considering nearly 200 resolutions, including ones on reforming Medicare, covering the uninsured, equalizing health care for minorities, and combating childhood obesity.

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For previous editions of CMA Alert, visit our news archives .