Wednesday, January 16, 2019

No on 46

On November 4, 2014, voters will be asked to weigh in on Proposition 46, a costly ballot measure that will make it easier and more profitable for lawyers to sue doctors, community health clinics and hospitals, resulting in billions in increased health care costs annually.

Prop. 46 is being disguised by the trial lawyer sponsors as a measure that will “increase patient safety” but RCMA knows it’s really just about seeking change to a current law that will allow proponents to file more medical lawsuits against health care providers.

If the trial lawyers get their way, medical lawsuits and payouts will skyrocket and someone will have to pay the price.

California’s non partisan Legislative Analyst has taken a close look at Prop. 46 and concluded that it could increase state and local government health care costs by “hundreds of millions of dollars annually.

We know that these increased costs would reduce funding available for vital state and local government services like police, fire, social services, parks, libraries and the list goes on. Really, this is just another example of trial attorneys pulling money directly out of the health care delivery system and our communities to line their own pockets.

As physicians, it is your job to provide care for and protect your patients - but Prop. 46 does just the opposite. Taxpayers across the state will be on the hook for hundreds of millions of dollars in increased state and local government costs each year and could lose critical state and locally provided services that so many count on.

That’s just how Prop. 46 will impact state and local government costs. An independent study estimates that this proposition will increase health care costs across all sectors by almost $10 billion annually. How does that affect patients throughout California? It translates to about $1,000 per year in higher health care costs for a family of four. For many families, that’s the difference between being able to afford groceries or health care each month.

If you haven’t signed up to oppose Prop. 46, please visit and join the coalition today – the price to your patients is too great to risk it.

Prop. 46 was written by trial attorneys for trial attorneys – not for the patients of California who will be forced to pay, plain and simple.

If you haven’t signed a “No On Prop 46 Commitment Card” or pledged to be a coordinator at your hospital, visit and sign up today.

As we forge ahead to Election Day, RCMA asks each of you reading this to take action and get involved in the No on Prop. 46 campaign. To find out more information about the issue and how you can help educate your colleagues, patients and neighbors, visit today.

Meaningful Use Relief

Additional relief for eligible providers participating in the meaningful use program has arrived in two forms – expanded payment adjustment exemptions and extended assistance.

Expanded Exemptions – Providers who are eligible for the Medicare EHR Incentive Program and have been unable to successfully demonstrate meaningful use for either the 2013 or 2014 reporting year due to circumstances beyond their control may apply for a hardship exemption. The deadline to apply is July 1, 2014. An organization whose hardship application is approved would be exempt from payment adjustments which take effect in 2015. CMS is currently accepting applications from both new and returning program participants whose circumstance meets one of the following hardship exemptions:

1.       Lack of infrastructure

2.       New Eligible Professionals

3.       Unforeseen and/or uncontrollable circumstances

4.       Lack of face-to-face interaction

5.       Lack of control over availability of EHR certified technology

6.       2014 EHR Vendor Issues

Visit the CMS Payment Adjustment and Hardship Exemption webpage for downloadable tip sheets that detail the qualifications of each hardship exemption. The webpage also includes a link to the application and further instructions.

Extended Assistance – Eligible professionals may still seek subsidized assistance from CalHIPSO to meet meaningful use in 2014. CalHIPSO is the federally funded regional extension center serving clinicians in all California counties except Orange and LA. CalHIPSO is continuing to provide technical services through December 31, 2014 to both current and new members. However, there is limited availability for new enrollments. Contact CalHIPSO for more information at 510.302.3364 or email organization name, contact info, zip code and NPIs to

CMA 2013 Annual Report

Serving more than 39,000 members, CMA and its staff remain committed to our time-honored mission statement: to promote the science and art of medicine, protection of public health, and the betterment of the medical profession.

Download the 2013 Annual Report to see how CMA supported its mission, including advocacy efforts, member benefits, ways to get involved and more.

Click here to download the 2013 Annual Report.

Governance Reform: CMA envisions a new future for organized medicine

By Steven E. Larson, M.D., MPH, Chair of the CMA Governance Technical Advisory Committee


Change is never easy. But oftentimes is it necessary, and even invigorating. The California Medical Association (CMA) is about to embark on a journey of change that will position our association as a nimble, proactive organization ready to lead the practice of medicine into a brave new world. In 2013, the CMA House of Delegates (HOD) approved a plan to reform the way our association is governed. Will it be easy? No. Will it be worth it? There is not a doubt in my mind.


In a nutshell, the reforms will make CMA more relevant and effective by focusing the association on, and bolstering its resources to address, the critical issues of universal importance to physicians. By doing so, CMA will be better able to protect the interests of its physician members and, even more importantly, guide the future of our profession, not only in California but nationwide.


150 Years of Tradition

For 150 plus years, CMA has been guided by the HOD, which meets once a year to set policies and direct resource allocation. This has led to a sometimes unwieldy 581-member HOD, a Board of Trustees numbering more than 50, a seven-member Executive Committee and hundreds of other members serving as alternate delegates and in various capacities on dozens of councils, committees, sections and mode of practice forums.


Over the years, there have been several task forces assigned to this subject. It wasn't until this year, however, that the abstract discussions about "governance reform" began to produce concrete results.


These discussions resulted in big questions. Does the HOD foster a reactive culture rather than a proactive one? Does it inhibit CMA’s ability to take quick action in a rapidly evolving health care environment?


While these questions were being asked, the HOD was spending most of its time on a growing number of resolutions that struggled to be assigned or implemented because of resource limitations.


The CMA Board of Trustees, realizing that a floundering governing style prevented the organization from quickly acting on issues of universal import to the membership and their patients, created a committee—the Governance Technical Advisory Committee (GTAC)—to look at this issue.


The GTAC confirmed what the executive committee had feared —the association was unable to quickly address universal issues that arose faster than the once-a-year HOD meetings could handle. And, there were other inefficiencies in CMA’s governing bodies and processes.


And there was the cost. An independent study commissioned by CMA (an activity-based costing, or “ABC” study) found that CMA governance is far more resource-intensive than previously thought, accounting for almost one-third of CMA’s operating budget—an allocation that commensurately reduces resources available for advocacy and other member services.


The GTAC began its discussion of how to bring relevance, democracy and cost-effectiveness to governing the association. It became clear to us that the rank and file members want more advocacy, while the delegates and trustees are heavily invested in leadership.


Tackling the Big Issues

A proposal to reform CMA's governing structure, put before the 2013 CMA HOD by the GTAC this past October, proposed that instead of a diffuse focus on many issues, the HOD take on a limited number of big issues—the most important, most pressing matters facing physicians and the practice of medicine.


CMA’s long-standing traditions of democratic participation and representative governance would continue; the difference, as envisioned by the GTAC, is that specific issues that are of concern to a narrow spectrum of the membership would no longer command HOD’s limited time. Rather, the democratically elected Board of Trustees would act on those issues, as it already does on the increasing number of matters referred to the board for action by a House that is aware of its policy-making constraints.


The HOD would continue to set policy on major issues, and its decisions would be informed through a year-round process not constrained by 15-minute limits on debate of recommendations developed in a rushed overnight exercise, as is currently the case. More focused expertise would be brought to bear in a more careful development of recommendations for action. Policy on other issues would realize the same benefits of a more careful and expert deliberative process throughout the year.


We would like to improve the discussion at the House of Delegates to deal with the big issues of the day and to utilize the valuable resources of our delegates for the collective development and direction of important policy matters. We believe this proposal has real potential for a robust discussion around issues that will impact all physicians.


The reforms would also open the discussion to individual members who could continue to bring forth their ideas and proposals through a year-round resolution process provided for in the CMA bylaws. Such proposals would be studied, with recommendations acted on by the board.


A year-round dialog about timely issues should result in well-thought out policy pieces that could be brought to the floor during HOD.


Charting a Course for the Next 150 Years

This year’s discussion and debate at HOD on governance reform has set the stage for the GTAC to make proposals to modify the bylaws to begin the changes needed to set CMA’s course for the next 150 years.


I am optimistic that this will result in an improvement for our entire organization. It will make CMA more effective in reaching the average member and give them a direct voice in policy, bringing broader input into our more difficult decisions.



The full report of the CMA Governance Technical Advisory Committee, as amended by the House of Delegates at its October 2013 meeting in Anaheim, is available for download on the California Medical Association website. To access the report, available to members only, visit and click on the "documents" tab. The report begins on page 12 of the "Actions of the 2013 House of Delegates" document.

Understanding The Covered CA Grace Period

RCMA/CMA has made significant progress through our advocacy efforts to help ensure that physicians are not on the hook for unpaid claims in months two and three of the three month grace period. Instead, coverage will be suspended during those two months. We have prepared an easy to understand fact sheet to help physicians and their staff understand what the grace period means for their practices and their patients.

Download  Understanding the Grace Period for Subsidized Exchange Enrollees FAQ Sheet

Gov. Brown's proposed budget eliminates retroactive Medi-Cal cuts

Governor Jerry Brown this morning announced that the State of California would not be moving forward with retroactive collection of a 10 percent cut to the Medi-Cal program, a win for physicians and patients in California. The announcement came as part of the governor's 2014-2015 fiscal year budget proposal.

"The Governor’s budget demonstrates a clear understanding of the importance that California’s Medicaid (Medi-Cal) program has for the state’s poorest and most vulnerable patients," says Richard Thorp, M.D., president of the California Medical Association (CMA). “After voicing a commitment to expand Medi-Cal eligibility and ensure that the rollout of the Affordable Care Act in California be a success, restoration of the retroactive cut is a huge step in the right direction."

Unfortunately, the budget does not stop the 10 percent cuts moving forward. Although elimination of the retroactive cut is a huge step in the right direction, an additional 10 percent cut will only cement California in the position of having the lowest Medicaid rates in the nation. While this budget will provide some relief to physicians who may have otherwise been forced to stop taking new Medi-Cal patients altogether, it does not go far enough.

CMA is part of an unprecedented coalition of physicians, dentists, health care workers and hospitals that will continue working to stop the cuts. The coalition, called “We Care for California," includes the largest statewide organizations representing physicians, dentists, hospitals and health care workers, as well as health plans, first responders, caregivers and other health providers. CMA and the We Care for California coalition will continue to push for full restoration of the cuts moving forward.

“As the rest of the nation looks to California for an example of health reform success, we simply cannot move forward with a 10 percent prospective cut to the Medi-Cal program while simultaneously adding new patients to the program," says Dr. Thorp. Under the Affordable Care Act, more than 3 million patients are expected to enter Medi-Cal over the course of the next two years.

“CMA and our stakeholder partners will look toward reforms that will result in real access to care so that health reform is more than an empty promise of an insurance card," says Dr. Thorp.

In March of 2011, the California Legislature passed and Governor Jerry Brown signed AB 97, which included a 10 percent reimbursement rate cut for physicians, dentists, pharmacists and other Medi-Cal providers. The cuts were enjoined for two years while the matter was being argued in a CMA-filed lawsuit.

Despite earlier rulings in our favor, a three judge panel of the 9th Circuit Court of Appeals cleared the way for implementation of these rate reductions. CMA requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied.

Even before the cuts, California's Medi-Cal provider payment rates were the lowest in the nation. Low reimbursement rates have forced many of California’s providers to stop seeing Medi-Cal patients. As a result, 56 percent of Medi-Cal patients report difficulty finding a doctor. If these cuts are not stopped, Medi-Cal will become nothing more than a broken promise of access to care.

Five Inadvertent HIPAA Violations by Physicians

Doctors do not plan ahead to violate HIPAA, but in this digital age, they may be doing it because they did not plan ahead. The recent final rule of the HITECH Act outlines that even if the physician is unaware of the violation, they may be fined a civil penalty of $100 - $50,000 per violation. It is time for even the most resistant doctors to pay attention to how they handle protected health information (PHI). Here, we will outline five common ways physicians are breaking HIPAA/HITECH privacy and security rules, and may not even know it.

1)    Texting PHI to members of your care team

It’s a simple scenario: you’ve just left the office, and your nurse texts you that Mr. Smith is having a reaction to the medication you’ve just prescribed. She has included his name and phone number in the text. You may know that texting PHI is not legal, but feel justified because it is a serious medical issue. Perhaps you even believe that deleting the text right away will protect you – and Mr. Smith

In reality, this text message with PHI has just passed from your nurse’s phone, through her phone carrier, to your phone carrier, and then to you – four vulnerable points where this unencrypted message could either be intercepted or breached. In a secure messaging app, this type of message must be encrypted as it passes through all four points of contact. Ideally, both sender and recipient should be verified and have signed a business associate agreement (BAA).

2)    Taking a photo of a patient on your mobile phone

To some this will sound silly, to others, it is as common as verifying a rash with a colleague or following the margins of a cellulitis day by day. Simple enough, but if these photos are viewed by eyes they are not intended for, you may be in violation of your patient’s privacy. It’s important to be aware of where and how patient information and images are stored. Apps that allow you to take a secure photo are just as important as sending the message securely. DocbookMD allows photos to be taken within the secure messaging app itself – never stored on your phone or within your phone’s photo album. Always use this type of feature when taking any photo of a patient or patient information.

3)    Receiving text messages from your answering service

Many physicians believe if they receive a text message from a third party, like an answering service, they are not responsible for any violation of HIPAA – this is simply not true. Many services do send a patient’s name, phone number and chief complaint via SMS text. The answering service may verify it is encrypted on their end, but if PHI pops onto the physician’s screen, it is certainly not secure on their end – and this is where the physician’s responsibility lies. Talk with your answering service today to see how they are protecting you at both ends of the communication.

4)    Allowing your child to borrow your phone that contains PHI

Many folks allow their kids to play with their phones – maybe play games on apps while in the car. If your phone has an app that can access PHI, then you may be guilty of a HIPAA breach if the information is viewed by or sent to someone it is not intended for. The simple fix is to utilize the pin-lock feature on your messaging app – and for double-protection, always password protect your phone!

5)    Not reporting a lost or stolen device that contains PHI

Losing your smartphone or tablet is a pain for many reasons, but did you know that if you have patient information on that device, you could be held responsible for a HIPAA breach If you do not report the loss right away. The ability to remotely disable an app that contains or handles PHI is an absolute must for technology that handles communications in the medical space. Be sure to ask for this feature from any company claiming to help you be HIPAA-compliant in the mobile world. Remember: Being HIPAA – compliant is an active process. A device can claim to be HIPAA secure, but it is a person who must ensure compliance.

New Health Laws 2014

The California Legislature had an active year passing many new laws affecting health care. Below are highlights of the new laws likely to impact physicians next year and beyond. For more details, see "Significant New California Laws of Interest to Physicians for 2014," in the California Medical Association's online resource library at


(CMA Position: Support / Co-Sponsor)
Allows physical therapists to treat patients for 45 days or 12 visits without first seeing a physician. Requires a physical therapist to refer a patient to a physician if the condition is beyond the therapist's scope of practice or if the patient is not progressing, to disclose to the patient any financial interest he or she has in treating the patient, and with the patient's authorization, notify the patient's physician that the physical therapist is treating the patient. Specifies that professional corporations, including medical corporations, are not limited to employing those licensed professionals that are listed in Corporations Code §13401.5.

AB 1308 (Bonilla) – MIDWIFERY
Removes physician supervision over licensed midwives. Specifies conditions of a normal pregnancy and childbirth and requires a licensed midwife to refer clients who do not meet these conditions to a physician for examination. Requires Medical Board to adopt regulations specifying those certain conditions. Authorizes a licensed midwife to directly obtain supplies and devices, obtain and administer drugs and diagnostic tests, order testing, and receive necessary reports consistent with the scope of practice. Requires disclosure to prospective clients of the specific arrangements for referral of complications to a physician and surgeon, and to obtain consent of those disclosures.


Amends existing law that requires notification to individuals whose unencrypted computerized personal information was, or is reasonably believed to have been, acquired by an unauthorized person due to a breach of security of a computerized system or data. Revises certain data elements included within the definition of personal information by adding certain information that would permit access to an online account. Imposes additional requirements on the disclosure of a breach of security of the system or data in situations where the breach involves personal information that would permit access to an online or email account.

Specifies the manner in which a health care service plan or health insurer would be required to maintain confidentiality of information regarding the treatment of an insured, including a requirement to accommodate requests to receive requests for confidential communication of medical information in situations involving sensitive services, including requests by dependents insured under a health insurance policy held by another person, or situations in which disclosure would endanger the individual. Authorizes a health care provider to communicate information regarding benefit cost-sharing arrangements to the health care service plan or health insurer. Prohibits health plans from conditioning enrollment in the plan or eligibility for benefits on the waiver for certain rights provided for in the bill.


(CMA Position: Support)
Authorizes a licensed health care provider, who is permitted by law to prescribe an opioid antagonist and is acting with reasonable care, to prescribe and subsequently dispense or distribute an opioid antagonist for the treatment of an opioid overdose. This is permitted to treat a person at risk of an opioid-related overdose or a specified person in a position to assist a person at risk of an opioid-related overdose. Authorizes these licensed health care providers to issue standing orders for the distribution of an opioid antagonist.

(CMA Position: Support)
Funds the Controlled Substance Utilization Review and Evaluation System (CURES) for the electronic monitoring of the prescribing and dispensing of controlled substances by assessing an annual fee on practitioners authorized to prescribe, order, administer, furnish or dispense controlled substances, non-governmental clinics and non-governmental pharmacies. Establishes the CURES Fund within the State Treasury. Requires the Medical Board to periodically develop and disseminate education materials relating to the assessment of a patient’s risk of abusing or diverting controlled substances and information related to CURES to physicians and general acute care hospitals. Eliminates notarization requirement for application process and requires health care practitioners and pharmacists to apply to obtain approval to access CURES after January 1, 2016. Requires the Department of Justice in conjunction with the Department of Consumer Affairs and relevant licensing boards to develop a streamlined application and approval process to access CURES and enable health care practitioners and pharmacists with access to CURES to delegate their authority to order reports from CURES.


Requires the California Major Risk Medical Insurance Board to provide the California Health Benefit Exchange (Covered California) with specified information to assist in conducting outreach to subscribers to notify them that they may be eligible for coverage through the Exchange or Medi-Cal. Implements various provisions of the Affordable Care Act relating to determining eligibility for the Medi-Cal program. Requires the Department of Health Care Services (DHCS) to authorize individuals to select Medi-Cal managed care plans via the California Healthcare, Enrollment, and Retention System.

Requires the California Health Benefit Exchange (Covered California), by means of selective contracting, to make a bridge plan product available to specified eligible individuals, as a qualified health plan (QHP). Exempts the bridge plan product from certain requirements that apply to QHPs, relating to making the product available and marketing and selling to all individuals equally (guaranteed issue) outside the Exchange and selling products at other levels of coverage. Requires the Department of Health Care Services to include provisions relating to bridge plan products in its contracts with Medi-Cal managed care plans. Requires Covered California to evaluate three years of data from the bridge plan products, as specified.


(CMA Position: Support)
Prohibits a stop-loss insurer from excluding any employee or dependent on the basis of specified actual or expected health status-related factors. Establishes regulatory requirements for stop-loss insurance policies for small employers, including requiring a stop-loss insurer to renew all stop-loss insurance policies at the option of the small employer and prohibiting setting individual attachment point of $40,000 or greater and an aggregate attachment point of the greater of $5,000 times the total number of group members, 120% of expected claims, or $40,000 for a policy year or providing coverage for an employee or his or her dependents. Exempts small employer stop-loss insurance issued prior to September 1, 2013, from these attachment point requirements.

(CMA Position: Support if Amended)
Establishes health insurance market reforms contained in the Affordable Care Act specific to individual purchasers, such as open enrollment, prohibiting insurers from denying coverage based on preexisting conditions, insured claims experience as part of a single risk pool, the use of certain factors in determining individual plan rates, insurance advertising and marketing, small employer enrollment periods and coverage effective date and premium rates, a risk adjustment program, insurance data reporting, and insurer disclosure requirements; and makes conforming changes to small employer health insurance laws resulting from final federal regulations.


Imposes the same licensing and building standards to all primary care clinics, including those that provide abortion services. Grants the Office of Statewide Health Planning and Development emergency regulatory authority to implement these provisions and requires the Department of Public Health to repeal certain regulations relating to abortion services in primary clinics by July 1, 2014.

(CMA Position: Support)
Requires the Occupational Safety and Health Standards Board to adopt a standard for the handling of antineoplastic drugs, primarily cancer drugs, in health care facilities regardless of the setting. Requires the standard to be consistent with and not exceed specific recommendations adopted by the National Institute for Occupational Safety and Health for preventing occupational exposures to those drugs in health care settings.

(CMA Position: Co-Sponsor)
Extends the operative date to January 1, 2017, of existing law that establishes the Maddy Emergency Medical Services Fund, which authorizes each county to establish an emergency medical services fund for reimbursement of costs related to emergency medical services and funding for pediatric trauma centers, and authorizes county boards of supervisors to elect to levy an additional penalty upon fines, penalties and forfeitures collected for criminal offenses. Makes technical, non-substantive changes to the provisions.


SB 94 (Senate Budget and Fiscal Review Committee) – MEDI-CAL: MANAGED CARE: LONG-TERM SERVICES AND SUPPORTS
(CMA Position: Oppose)
Amends existing law regarding the Coordinated Care Initiative (CCI) and separates CCI provisions to allow the mandatory enrollment of Medi-Cal and Medicare beneficiaries (dual eligibles) into Medi-Cal managed care, the integration of long-term supports and services into managed care plans, and the commencement of the In-Home Supportive Services Statewide Public Authority, to proceed separately from the CCI Duals Demonstration Project (now called Cal MediConnect).

(CMA Position: Support)
Increases the number of beneficiaries assigned to the panel of a full-time equivalent primary care physician under a Medi-Cal managed care plan. Requires a health service plan to ensure that there is at least one full-time primary care physician for every 2,000 enrollees. Authorizes the assignment of up to an additional 1,000 enrollees to the primary care physician for every full-time non-physician medical practitioner supervised by that physician. Requires the Medi-Cal program to evaluate the location, hours, and language capabilities of practitioners and adds non-physician medical practitioners (physician assistant or a nurse practitioner) to the definition of a primary care provider.


Higher education budget trailer bill that allocated $15 million dollars to the Regents of the University of California, Riverside School of Medicine.

(CMA Position: Sponsor)
Amends the Steven M. Thompson Physician Corps Program to require the guidelines for the selection and placement of program applicants to include criteria that would give priority consideration to program applicants with experience providing health care services to medically underserved populations or in a medically underserved area. Gives priority to applicants who agree to practice in those areas and serve a medically underserved population, and give priority consideration to applicants from rural communities who agree to practice in a physician owned and operated medical practice. Amends the definition of "practice setting" to include a physician owned and operated medical practice setting that provides primary care located in a medically underserved area.


(CMA Position: Sponsor)
Requires the State Medical Board and the Osteopathic Medical Board of California to develop a process to give priority review status to the application of an applicant who can demonstrate that he or she intends to practice in a medically underserved area or serve in a medical underserved population.

This bill is the sunset extension bill for the Medical Board containing statutory and technical changes to provisions relating to Medical Board review by appropriate legislative committees, issuance of a license to a physician and surgeon who has acquired any part of his or her education from an unrecognized medical school who has held licensure in another state or Canada, reporting an electronic address to the Board, licensed midwives, adverse event reporting, fines for failure to provide health care records by a facility, and Medical Board investigations.

(CMA Position: Support)
Authorizes the Medical Board, in any investigation that involves the death of a patient, to inspect and copy the records of the deceased patient without authorization of the beneficiary or personal representative of the deceased patient or a court order to determine the extent to which the cause of death was the result of the physician and surgeon's violation of the Medical Practice Act, if the board provides a written request to the physician that includes a declaration that the board was unsuccessful in locating or contacting the deceased patient's beneficiary or personal representative after reasonable efforts. Revises definition of unprofessional conduct to include repeated failures by a licensee who is the subject of an investigation, in absence of good cause, to attend and participate in an interview by the board. Clarifies the authority of the administrative law judge to issue an interim order limiting the authority to prescribe, furnish, administer or dispense controlled substances.


AB 446 (Mitchell) – HIV TESTING
(CMA Position: Support)
Requires a medical care provider or a person administering a HIV test to provide a patient with information about risk reduction strategies and information regarding test results. Requires oral or written informed consent as specified for the HIV test except when a person independently requests an HIV test from an HIV counseling and testing site and requires the person administering the test to document the person's independent request for the test. Exempts clinical laboratories from the informed consent requirements. Requires an HIV test to be offered to any patient having blood drawn at a primary care clinic and consents to the test. Authorizes disclosure of HIV test results by secure Internet website posting.


AB 154 (Atkins) – ABORTION
(CMA Position: Support)
Allows nurse practitioners, certified nurse midwives and physician assistants to perform an abortion by medication or aspiration techniques in the first trimester of pregnancy if he or she completes training and validation of clinical competency and is working pursuant to specified standardized procedures that specify the extent of physician supervision, and procedures for transferring patients to the care of a physician or a hospital, obtaining assistance and consultation of the physician and providing emergency care until physician assistance and consultation is available. Deletes references to nonsurgical abortions.

(CMA Position: Support)
Requires that health care service plan and health insurer coverage for the treatment of infertility be offered and, if purchased, provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex or sexual orientation.

(CMA Position: Support if Amended)
Requires the Department of Public Health to include prescribed information regarding environmental health in the California Prenatal Screening Program patient educational information and to post that information on the department’s website. Requires the Department of Public Health to send a notice to all distributors of the patient educational information that informs them of that change and encourages obstetrician-gynecologists and midwives to discuss environmental health with their patients.

Riverside County Medical Association Sponsors Group Long-Term Disability Program

You work to protect your patients…

We work to protect you.


As a physician, you probably know better than anyone else how quickly a disability can strike and not only delay your dreams, but also leave you unable to provide for your family. Whether it is a heart attack, stroke, car accident or fall off a ladder, any of these things can affect your ability to perform your medical specialty.

That’s why the Riverside County Medical Association sponsors a Group Long-Term Disability program underwritten by New York Life Insurance Company:

•  Benefits not tied to a practice, giving you more flexibility with potential career changes

•  Benefit payments that are 100% TAX-FREE — when you pay premiums yourself

•  High monthly benefits up to $10,000

•  Protection in your medical specialty for the first 10 years of disability

With this critical protection, you’ll have one less thing to worry about until your return.

Learn more about this valuable plan today! Call Mercer for free information, including features, costs, eligibility, renewability, limitations and exclusions at 800-842-3761.

Don't Miss Out On Increased Medi-Cal Payments

The California Department of Health Care Services (DHCS) will soon be implementing rate increases for primary care physicians who treat Medi-Cal patients, as authorized under the Affordable Care Act. The increase also applies to services provided by physicians to Medi-Cal managed care patients. In order to see the bump in pay, providers must first attest to their eligibility. According to DHCS, less than half of eligible providers have completed the brief self-attestation process as of September 24. Have You?

For purposes of this regulation, primary care is defined as family medicine, general internal medicine, pediatric medicine or related pediatric subspecialties. Pediatric subspecialists must be recognized by the American Board of Medical Specialties, American Board of Physician Specialties or the American Osteopathic Association to receive the increased fees. If a physician is not board certified, eligibility can be determined by the physician’s billing history. Physicians will qualify if 60 percent of the codes they bill are for evaluation and management codes and vaccine administration codes covered by this rule. Physicians can self-attest to their board certification or billing history.

Although the regulations implementing the pay raise were released by the Centers for Medicare & Medicaid Services (CMS) in November 2012, DHCS is still awaiting approval of its State Plan Amendment, which details California's proposed payment methodology for both fee-for-service and managed care payments. DHCS expects to receive approval soon and plans to implement the increase in late October. Once approved, the increases will be retroactive to January 1, 2013.

The goal of the increase is to recruit more physicians to treat low-income patients who will be newly eligible for health coverage under the ACA. Under the ACA, primary care physicians will see their reimbursement rates raised to Medicare levels in 2013 and 2014. According to CMS, states must also incorporate the increased payment rates into their contracts with managed care plans so that primary care physicians contracting with Medi-Cal managed care plans see the higher rates.

Physicians are encouraged to complete the attestation form, which is available on the Medi-Cal website The attestation form must be completed online (paper copies will not be accepted).

The rate increase applies to evaluation and management codes 99201 through 99499 and vaccine administration codes 90460, 90461 and 90471 – 90474.

For more information on the increase, including which specialties qualify, see CMA’s Medi-Cal Primary Care Physician Rate Increase FAQs or contact RCMA’s Physician Advocate Mitzi Young at or (888) 236-0267.

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