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Reference Committee D: Resolution 401-03: Pre-Existing Medical
Conditions
Resolution 401-03: Pre-Existing Medical Conditions
RESOLVED: That CMA support legislation that would encourage insurance companies to approve health insurance coverage to those with pre-existing medical conditions through tax advantages and/or other financial incentives. ACTION: Referred for study and report back Resolution 402-03: Single Address For Insurance Billing
RESOLVED: That CMA support the following requirements: (1) that all payers maintain a single mail address for the submission of claims, (2) that this address be clearly printed on enrollees’ insurance cards, (3) that all payers maintain a single electronic address for receipt of claims, and (4) that payers notify physicians in advance of any changes to these addresses; and be it further RESOLVED: That health insurance companies providing health care benefits in California shall immediately enter all claims received from providers into their systems, assign a number to each claim received, and provide this information to the physician who submitted the claim; and be it further RESOLVED: That health plans be responsible for promptly routing claims to subcontracted payers. ACTION: Adopted as amended Resolution 403-03: Claims Experience Data
RESOLVED: That CMA form a coalition with business groups, including Cal-PERS and the Pacific Business Group, to seek a regulatory mandate requiring all health plans and insurance companies to provide access to employers, when requested and in a timely fashion, of two years of pooled employee claims experience data. ACTION: Referred for study and report back Resolution 404a-03: Insurance Verification For Payment Of Laboratory Services
RESOLVED: That laboratories and other providers of outpatient services be responsible for verification of insurance eligibility and authorization for services provided to patients; and be it further RESOLVED: That CMA oppose the imposition of any monetary penalty on a physician who in good faith refers a patient for laboratory or other outpatient services. ACTION: Substitute adopted for combined resolutions
404-03 and 417-03 Resolution 405a-03: Full Disclosure In PPO Contracts
RESOLVED: That CMA support the requirement that all payers who contract with physicians for health care services provide all necessary fee schedules, payment rules, and other information required for physicians to determine their reimbursement for each CPT code and any other service covered by the contract; and be it further RESOLVED: That CMA support the following requirements: (1) that all payers make available a copy of the executed contract to physicians within three business days of the request; (2) that all health plan EOBs contain documentation regarding the precise contract used for determining the reimbursement rate; (3) that once a year, all contracts must be made available for physician review at no cost; (4) that no contract may be changed without the physician's prior written authorization; and (5) that when a contract is terminated pursuant to the terms of the contract, the contract may not be used by any other payer; and be it further ACTION: Substitute adopted for combined resolutions
405-03 and 407-03 Resolution 406-03:
ACTION: Withdrawn Resolution 407-03: Full Disclosure In PPO Contracts
ACTION: See Resolution 405a-03 Resolution 408-03: Eliminate Medicare Reimbursement Caps
RESOLVED: That CMA continue to advocate that the Centers for Medicare and Medicaid Services eliminate all caps on balance billing. ACTION: Adopted as amended Resolution 409-03: Hospital Support For Restoring Medicare Fee Cuts
RESOLVED: That CMA encourage California hospitals and hospital organizations to support CMA and AMA efforts to reverse or ameliorate scheduled cuts in Medicare reimbursement for physician services; and be it further RESOLVED: That CMA assist its members in encouraging local hospitals and hospital organizations to support these efforts. ACTION: Adopted Resolution 410-03: Insurance Compensation When Medicare Rates Are Decreased
RESOLVED: That CMA support legislation that prohibits insurance companies from decreasing their compensation rates for services provided to non-Medicare patients when Medicare rates are decreased; and be it further RESOLVED: That this matter be referred for national action. ACTION: Adopted as amended Resolution 411-03: CMS Pharmaceutical Reimbursement Method
RESOLVED: That pharmaceutical costs be excluded from the Sustainable Growth Rate (SGR) formula; and be it further RESOLVED: That this issue be referred for national action. ACTION: Adopted as amended Resolution 412-03: Provision Of Updated Billing Software By CMS
RESOLVED: That CMA work with the AMA and other professional physician organizations to advocate that CMS provide, free of charge to all licensed physicians who treat Medicare-eligible patients, current updated computer software programs for posting, coding, and electronic claims submission which physicians may, at their option, use; and be it further RESOLVED: That this computer software be updated semiannually and be compatible with all payors, including crossover with Medi-Cal and other secondary plans; and be it further RESOLVED: That local Medicare carriers provide toll-free phone access for electronic claims submission. ACTION: Adopted Resolution 413-03: Worker’s Compensation, Negotiations, State Action Exemption RESOLVED: That CMA consider legislation to create a workers’ compensation board modeled after the Federal Reserve Board that would include representation from leaders in workers’ organizations, business, insurance and medicine; and be it further RESOLVED: That CMA reaffirm its commitment to legislation to create a state action exemption enabling physicians to negotiate rates and contract terms collectively with public and private payors. ACTION: Adopted as amended Resolution 414-03: RBRVS And Worker’s Compensation Fee Schedule
RESOLVED: That CMA oppose introduction of an unmodified RBRVS as the sole template for developing the new Official Medical Fee Schedule (OMFS) by the Administrative Director of the Division of Worker’s Compensation; and be it further RESOLVED: That CMA convene a workgroup of key stakeholders, including Specialty Society Representatives, to identify the necessary resources, develop a work plan, and explore the feasibility of creating a California Relative Value Unit Committee (RUC) to develop a new Workers’ Compensation Official Medical Fee Schedule (OMFS). ACTION: Adopted as amended Resolution 415-03: Revision Of The Emergency Medical Services Fund
RESOLVED: That CMA support a revision to the of the Maddy Emergency Medical Services Fund to permit physicians to bill and receive payment for all services provided during a covered emergency admission, regardless of the date of service relative to the date of admission. Action: Referred for study and report back Resolution 416-03: Reimbursement For Acute Stroke Treatment
RESOLVED: That CMA support review of reimbursement for acute stroke treatment in emergency departments and during acute hospitalization by Medicare, health insurance companies and other third party payors; and be it further RESOLVED: That in cases of malpractice litigation against emergency physicians for failure to treat with tPA, CMA support legal action against Medicare, health insurance company and other third party payors, as they are materially responsible for the lack of adequately trained and experienced staff in such instances; and be it further RESOLVED: That this be referred for national action. ACTION: Referred for study and report back Resolution 417-03: Non-Contracting Laboratory Responsibility
ACTION: See Resolution 404a-03 Resolution 418-03: Teaching Physician Documentation Guidelines
RESOLVED: That CMA support the use of the Center for Medicare and Medicaid Services Teaching Physician Documentation Guidelines in place of the current Medi-Cal guidelines; and be it further RESOLVED: That CMA encourage the Department of Health Services to adopt the CMS Teaching Physician Documentation Guidelines in place of the current Medi-Cal guidelines. ACTION: Adopted as amended Resolution 419a-03: New Medicare Physicians’ Fee Localities
RESOLVED: That CMA request studies from both the Government Accounting Office (GAO) and MedPac to address the appropriateness of the data sources and the methodology employed in establishing and updating the Medical Practice Cost Index; and be it further RESOLVED: That CMA work with our legislators and the AMA to endeavor to remove the budget neutrality language in those sections of the law that relate to the Physician Fee Schedule and to develop a more appropriate formula; and be it further RESOLVED: That CMA create a task force to work with CMS to review the process and methodology used to determine the Medicare Geographic Cost Index for the State of California. ACTION: Substitute adopted Report D-1-03: Fair Vaccine Payment
ACTION: Filed for information Report D-2-03: Medicare Reimbursement For Preventive Care
RECOMMENDATION 1: That the House of Delegates adopt the following substitute for Resolution 403-02: RESOLVED: That CMA support an expansion of Medicare preventive benefits only if the expansion is accompanied by a program funding increase and elimination of all caps on balance billing; and be it further RESOLVED: That CMA provide education to physician members on billing for preventive services in the Medicare program. ACTION: Recommendation adopted as amended and remainder
of report filed for information Report D-3-03: Policy Review
RECOMMENDATION: THAT THE FOLLOWING POLICIES BE ALLOWED TO EXPIRE: Resolutions 204-85, 207a-85, 405a-85, 907-85, 409-86, 219a-87, 209a-88, 910a-88, 301-89 and 1008a-89 ACTION: Recommendation adopted
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