The Department of Managed Health Care will hold two public hearings on newly proposed regulations that would prevent noncontracted physicians from billing patients for emergency services. The hearings are scheduled for Nov. 13 in Sacramento and Nov. 14 in San Diego. Both hearings start at 10 a.m.

Physicians interested in testifying at the Sacramento hearing should contact Francisco Silva at 916/551-2887. Physicians interested in testifying at the San Diego hearing should contact Tom Gehring at 858/565-8597.

DMHC is also accepting written comments until November 30. CMA encourages all members to submit comments on these regulations, which attack the future viability of physician practices. They do not address the key underlying problems of unfair contracts, which result in inadequate physician networks and chronic and pervasive underfunding of emergency care by insurance companies. It is critical that regulators understand the severe economic impact that these regulations would have on physicians and the health care system in general. CMA has prepared sample comments and talking points to help physicians communicate this message.

In addition to prohibiting noncontracted physicians from billing enrollees for emergency services (except for copayments, coinsurance, and deductibles), the new proposal creates a voluntary independent dispute resolution process to resolve payment disputes; requires HMOs in the event of a payment dispute to pay physicians an interim amount of 150 percent of 2007 Medicare rates; and modifies the Gould criteria (the nationally accepted standard for determining fair and reasonable payment for health care services) to include Medicare and contract rates.

• Notice of Rulemaking from DMHC
• Statement of Reasons for Proposed Rulemaking from DMHC
• Additional Details

Contact: Francisco Silva, 916/551-2887 or fsilva@cmanet.org.