Thursday, January 17, 2019

RCMA/CMA's Advocacy Secures $1 Billion+ for Medi-Cal Providers

In 2016, and with a $1 million investment, the California Medical Association (CMA) led a coalition to take on Big Tobacco to improve access to care through Medi-Cal.

California voters overwhelmingly approved Prop 56, which added a $2 tax on tobacco products and stipulated that funds should increase access by improving provider payments. California's 2018-2019 state budget continues to provide over $1 billion annually to improve provider payments so more Medi-Cal patients can access care when they need it most. Other key investments include graduate medical education (GME) funding increases and school loan repayments.

What Does This Mean For Riverside County Doctors?
This supplemental funding affects both fee-for-service Medi-Cal as well as Medi-Cal Managed Care. Click Here to view a comparison of Prop 56 payments by year as well as how these new reimbursements compare to current Medicare Rates in Riverside County.

RCMA has been informed that Inland Empire Health Plan (IEHP) will be paying FY 2018/2019 at the enhanced rates, including the additional E&M codes, starting July 1, 2018. However, given the lag in encounter data and timing of payments, the first enhanced payments physicians will see this Fall will be 2017/2018 timeframe payments.  The first quarter payment for 2018/2019 will not be until early 2019.  

Look for further communication from IEHP in the next few weeks. Payments will be made directly to IEHP providers based on encounter submissions reflecting the E&M codes shown in the Rate Comparison Chart

For Further Information Please Contact:
Riverside County Medical Assoication
(800) 472-6204

or

Inland Empire Health Plan (IEHP)
(909) 890-2054
 


Opioid Advocacy Update

From the beginning of the opioid epidemic, the California Medical Association (CMA) has been one of the most engaged and determined stakeholders working to strike a balance between patient access to necessary medicine and preventing and addressing abuse.

 

CMA has been a leader in advocating for increased funding, access and availability of preventive services, opioid-use disorder treatment programs and non-opioid therapies, including mental health services and medication-assisted treatment (MAT). We have successfully worked to stop legislation that interferes with the practice of medicine and creates barriers to care, such as government-mandated dosage and duration limits.

 

Over the last few years, the changing landscape surrounding prescribing opioids has been dizzying as payors, legislators, pharmacies and medical boards seek ways to be proactive in addressing the opioid epidemic – sometimes ignoring the actual realities of medical practice and creating barriers to good care. And as you’re aware, California physicians have been engaged in the debate since the beginning, on behalf of our patients and profession.

 

CMA released a white paper, “Opioid Analgesics in California: Relieving Pain, Preventing Misuse, Finding Balance” in 2013. Developed through CMA’s Council on Science and Public Health, it has been the cornerstone of our work to educate physician colleagues, guide the medical board and policymakers, and help health care stakeholders navigate the evolving science related to opioids. At its core is the premise that care must be evidence-based and reflect the individual needs of the patient – ultimately, allowing physicians to make proper care decisions.

 

CMA’s emphasis on these principles has remained constant, including advocacy on opioid-related activities in 2018, which include:

 

Controlled Substance Utilization Review and Evaluation System (CURES): CMA has been working with the state for years to ensure adequate educational and technical support for physicians who will have to check CURES as part of their prescribing workflow, starting on October 2, 2018. CMA has advocated for sustained user outreach and educational efforts by the state that provide clarity of this new law, as well as prioritize the clinician perspective on an ongoing basis following implementation. We will continue to engage as the new requirement to consult CURES is implemented and work with stakeholders to ensure CURES has adequate support.

 

Ensuring Fair Enforcement: The Medical Board of California is examining deaths associated with the use of prescription opioids and is reviewing whether the care and treatment provided by physicians to those individuals met the standard of care. As part of a “routine” review, the board sent letters to physicians who were identified as prescribing opioids in a manner that, after physician review, merited further investigation, and requested that those physicians submit additional information including a summary of the care provided, the patient’s medical records, and any additional materials that would be pertinent to the board’s investigation.

 

CMA has raised concerns about the board’s process and will continue to work with the board to address physician concerns, monitor the board's process to determine whether disciplinary actions are based on the appropriate standard of care, and if the process used to identify physicians subject to these inquiries needs additional transparency or modification. Physicians who are under review may contact CMA (800-786-4262, CMAdocs.org) for information about the disciplinary process and their legal rights.

 

Access to Medication-Assisted Treatment and Overdose Reversal Medications: To help reduce the rates of overdose and stigma associated with opioid-use disorder, CMA sponsored AB 2384 (Arambula), which would have removed barriers to coverage of MAT services and naloxone to ensure that people who face addiction have better access to treatment. Governor Jerry Brown vetoed AB 2384, claiming a need for utilization controls and barriers to patient access of life-saving treatments. In response, CMA issued a statement expressing disappointment and concern, while reiterating our intention to work with the next governor to make this issue a priority in 2019.

 

The federal opioid bill continues to push treatment in the right direction by providing grants to improve access to MAT and codifying the ability for physicians to prescribe MAT for up to 275 patients, which is critical since the current caps are far too limiting and leave many patients on waiting lists for years.

 

Individual Patient Care: At the federal level, CMA successfully fought back against legislation that would have required one-size-fits-all medicine by mandating prescription drug dosage and duration limits.

 

California legislators also sought to statutorily limit dosages and durations of opioid pain relievers through AB 2741 (Burke) and AB 1998 (Rodriguez), using arbitrary and minimal amounts. Both bills were defeated earlier this year.

 

Federal Funding and the Congressional Opioid Crisis Response: Earlier this year, Congress approved $10 billion in new funding for states to address opioid-related education, prevention, treatment and law enforcement issues. The House and Senate reached an agreement on the “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act,” and they will send it to President Donald Trump soon. It is a comprehensive package of more than 300 bills that, among other things, provides grants to states to address prevention and treatment, as well as stop the flow of illicit drugs, such as fentanyl. It also expands the number of Institute for Mental Diseases inpatient Medi-Cal beds available for opioid substance abuse disorder treatment and enhances Medi-Cal patient access to non-opioid options. Medicare coverage for treatment has been expanded, with new Medicare payment and delivery demonstration projects approved for comprehensive management of opioid-use disorder.

 

Unfortunately, the bill package also includes a mandate for physicians to e-prescribe controlled substances for Medicare patients after January 1, 2021. However, it includes many exceptions, and it directs the Centers for Medicare and Medicaid Services to implement additional exceptions. In a major win, the Drug Enforcement Administration (DEA) has been mandated to update its antiquated and burdensome process for e-prescribing. While more than 90 percent of physicians e-prescribe, only 21 percent e-prescribe controlled substances, largely due to the DEA’s burdensome requirements. The state mandate takes effect in 2022.

 

Physician Education on Safe Prescribing and Treatment: Governor Brown recently signed AB 2487 (McCarty), which originally mandated all California physicians to take an eight-hour course required to qualify for a federal waiver to the Drug and Addiction Treatment Act of 2000 in order to allow physicians to prescribe MAT drugs, like buprenorphine, outside of an opioid treatment center.

 

After CMA-led negotiations with the author, the bill was amended to allow physicians who seek to prescribe MAT to fulfill their annual continuing education requirement by completing the DATA-Waivered Physician course along with four additional credit hours on treating substance use disorders. Successful advocacy prevented additional and mandatory continuing education.

 

The road has been long and hard-fought, and California’s comprehensive approach has focused on safe prescribing, naloxone distribution, public education campaigns, local opioid safety coalitions and increasing access to treatment, including MAT.

 

This approach has produced promising results. From 2013-2017, California experienced over a 24 percent decrease in opioid prescriptions, and is only one of five states with a multi-year decrease in prescription opioid overdoses. California is now tied for the lowest per capita opioid prescription rate in the country, while opioid prescribing has decreased for the fifth year in a row.

 

More work remains, as the drugs responsible for these overdose deaths are changing and have been spurred by illicit fentanyl. CMA will continue to work with policymakers, elected officials and health care stakeholders to ensure your voice – and your patients’ voices – are heard.

 

ADDITIONAL RESOURCES:

 

White Papers:

 

Webinars:

 


AB 3087 Defeated

Assembly Bill 3087 (Kalra) has been defeated.  This dangerous legislation would have created a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals and physician practices in California. 

Thousands of physician members contacted their legislators because AB 3087 would have:

  • Decimated California’s health care delivery system.
  • Disrupted care and limited choice for millions of California patients.
  • Caused 175,000 health care workers to lose their jobs.
  • Forced hospitals to close and pushed health care providers into early retirement.
  • Caused a “brain drain” of talented medical students and residents fleeing California for more ideal working conditions.

 


Are You Ready to Check CURES?

Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES.

Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload.
  

On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-to-consult taking full effect on October 2, 2018.

What Physicians Need to Know
Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.

The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed a five-day supply.

Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are:

  • Admitted to a facility for use while on the premises;
  • In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply;
  • As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or
  • Receiving hospice care.

In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician.

CMA Fights for CURES Protections
CMA worked closely with the bill's author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 482, Lara). Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that health care providers sharing the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute.

Save the Date: CURES webinar with DOJ on 8/22
CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Registration will open soon at cmanet.org/events.

For More Information
For more information, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA's online resource library at www.cmadocs.org. Nonmembers can purchase documents for $2 per page.

Additional Resources:
CURES website: oag.ca.gov/cures
CURES FAQ: oag.ca.gov/cures/faqs
Medical Board CURES webpage: mbc.ca.gov/cures
• CMA CURES webpage: cmadocs.org/cures
• CMA Safe Prescribing webpage: cmadocs.org/safe-prescribing

CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement. Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov



Survey: How would the AB 3087 price fixing proposal affect your practice?


Assemblymember Ash Kalra (D-San Jose) last week announced a radical physician rate setting proposal (AB 3087) that would increase patient out-of-pocket costs, create state-sanctioned rationing of health care for all Californians and force physicians out of state or into early retirement.
The RCMA/CMA are asking physicians to answer a few questions about how AB 3087 will impact their practices. The survey is anonymous and the results will help in our legislative efforts to fight this dangerous and irresponsible legislation.
Take the survey now at: www.surveymonkey.com/r/ab3087.
And, if you are among California's physicians that will be forced into early retirement or out of state if AB 3087 passes, we want to tell your story. Drop CMA a line at communications@cmanet.org.

To Take Action Now Visit: www.actnow.io/PriceFixing

For more information about AB 3087 click here.

Significant new California laws of interest to physicians for 2018

The California Legislature had an active year, passing many new laws affecting health care. RCMA/CMA have provided a summary of these changes spanning a number of topics including health care coverage, drug prescribing & dispensing, and public health. Stay up-to-date by downloading the PDF here.


ELECTION NIGHT 2016: One for the history books!

MACRA before and afterOnce again, the California Medical Association took on tough fights and prevailed. We won all of our statewide ballot measure endorsements, including three local initiatives in the Bay area.

Together, we voted to…

  • Invest in Medi-Cal. (Yes on Prop. 56, 55 and 52) • Save lives, reduce smoking rates and prevent thousands of children from starting in the first place. (Yes on Prop. 56)
  • Triple the funding for California's anti-smoking programs. (Yes on Prop. 56)
  • Provide more essential services like medical check-ups, immunizations, prescriptions and dental/vision care for 13 million low-income Californians, including seven million children. (Yes on Prop. 52)
  • Prevent an increase in state prescription drug costs, as well as preserve patient access to medications. (No on Prop. 61)
  •  Protect public health and clarify the role of physicians in controlling and regulating the adult use of cannabis. (Yes on Prop. 64)
  • Reduce sugar intake to prevent diabetes and obesity. (Yes on Measures V (San Francisco), HH (Oakland) and O1 (Albany))
  • Break down barriers and removed outdated bilingual education mandates to better reflect California's diverse society. (Yes on Prop. 58) • Ensure critical infrastructure projects – including hospitals and medical facilities – aren't subject to delays or loss of local control. (No on Prop. 53)
  • Strengthen California's ability to prevent gun violence. (Yes on Prop. 63)

Voters made health care a priority

 In the coming months, we'll work to ensure the new revenue reaches the communities most in need of access to health care and improved services.

Voters sent a clear signal that they are willing to support investments in public health and that they are tired of Sacramento chronically underfunding health care. CMA's alignment with voters further demonstrates our strength and ability to fight for physicians throughout the state and in all modes of practice.

And on the national front – there are more questions than answers, but one thing is clear: we could be facing a major shake-up.

How will the next Congress and Trump's administration handle the Affordable Care Act? Rising drug prices? Health and Human Services secretary? Medicaid expansion? Mega-mergers?

Regardless of what comes next, CMA will continue to keep California's physicians in the driver's seat on health care policy. And we're working ahead to 2018 to ensure the next Governor reflects our values, including the protection of MICRA and investments in public health.

I want to thank each of you for your support and dedication to CMA. Your membership drives this organization to excellence. Together, we stand stronger.

 

Dustin Corcoran
CMA CEO






November 2016 Ballot Initiatives

CMA’s Board of Trustees has approved positions on several ballot measures for the November 2016 election

Prop. 52: California Medi-Cal Hospital Reimbursement Initiative
Position: CMA Supports
Prop. 52 would lock in hospital fees to allow the state to draw down federal health care funds. It would add language to the California Constitution requiring voter approval of changes to the hospital fee program. This will prevent diversion of the funds from the original intended purpose of supporting hospital care to Medi-Cal patients and paying for health care for low-income children.

Prop. 53: California Public Vote on Bonds Initiative
Position: CMA Opposes
Prop. 53 would require voter approval before the state could issue more than $2 billion in public infrastructure bonds that would require an increase in taxes or fees for repayment. This initiative could impact medical care by curtailing the ability of the State of California and local government entities to build or rebuild major infrastructure projects.

Prop. 55: California Children’s Education and Health Care Protection Act of 2016
Position: CMA Supports
Prop. 55 would extend the current income tax rates on the wealthiest two percent of Californians – singles earning more than $250,000 and couples earning more than $500,000 a year – for 12 years. Funding would provide local school districts the money needed to hire teachers and reduce class sizes and improve access to health care services for low-income children so they can stay healthy and thrive.

Prop. 56: California Healthcare, Research and Prevention Tobacco Tax Act of 2016
Position: CMA Supports
Prop. 56 – supported by a broad alliance of physicians, health care advocates, educators and others – would raise California’s tobacco tax, which is currently among the lowest in the country, to $2.87 a pack. Designed as a user fee on cigarettes and other tobacco products, the majority of the money would be used for existing health programs and research into cures for cancer and other illnesses caused by smoking and tobacco products.

Prop. 58: The Language Education Acquisition and Readiness Now (LEARN) Initiative
Position: CMA Supports
Prop. 58 would give local school districts and their academic staff the option of providing bilingual education. California needs a well-prepared and educated health care workforce that reflects our diverse society. Prop. 58 would break down barriers by removing outdated mandates, helping physicians provide the best patient care for all Californians.

Prop. 61: Drug Price Standards Initiative
Position: CMA Opposes
Prop. 61 would prevent certain state agencies from entering into contracts for the purchase of prescription drugs unless the price paid is the same as or lower than the special discounts provided to the U.S. Department of Veterans Affairs. The measure could result in the invalidation of existing agreements between the state and pharmaceutical companies that already provide significant discounts to the state.

Prop. 63: Safety for All Act of 2016
Position: CMA Supports
Prop. 63 would prohibit the possession of large-capacity ammunition magazines and would require most individuals to pass a background check and obtain authorization from the California Department of Justice to purchase ammunition. CMA supports Prop. 63 to ensure our communities are safe and healthy places to live.

Prop. 64: Adult Use of Marijuana Act
Position: CMA Supports
Prop. 64 would regulate and control the cultivation and use of non-medical cannabis. The proposal would generate up to $1 billion in taxes for state and local governments, according to a fiscal analysis of the proposal. CMA believes that the most effective way to protect public health is to tightly control, track and regulate cannabis, as well as comprehensively research and educate the public on its health impacts.



The California End of Life Option Act

On October 5, 2015, California became the fifth state in the nation to allow physicians to prescribe terminally ill patients medication to end their lives. ABX2-15, the "End of Life Option Act," permits terminally ill adult patients with capacity to make medical decisions to be prescribed an aid-in-dying medication if certain conditions are met. (ABX2-15, Stats. 2015, Ch.1; Health & Safety Code §§443 et seq.)

The California Medical Association's Center for Legal Affairs has created an On Call document to explain the requirements under the End of Life Option Act.

Download The California End of Life Option Act

Download CA State Death Certificate Instructions

Additional end-of-life resources can be found at www.cmanet.org/endoflife or www.coalitionccc.org/tools-resources/end-of-life-option-act


2015 Legislative Wrap Up

By Janus L. Norman, CMA Senior Vice President

It is difficult to imagine, but the 2015 legislative year was even more challenging than the 2014 legislative year, which included the diversion of staff resources to defeat Proposition 46. With a third of legislators (40 out of 120) serving freshman terms, the California Medical Association’s (CMA) Government Relations staff spent a considerable amount of time during the first quarter educating new legislators and their staff about the mission and policies of CMA. Through our educational efforts, we successfully stopped the introduction of a number of harmful legislative proposals and shifted focus to the passage of CMA’s sponsored bill package.

School Vaccines
A majority of our resources this year went to the passage of SB 277 (Pan and Allen), our sponsored bill eliminating the personal belief exemption (PBE) for school vaccination requirements. We faced relentlessly vocal opposition from anti-vaccine activists, who were supported by the California Chiropractic Association and the newly founded Public Health Council. As it moved through the Legislature, SB 277 had four hearings in various committees, each of which was flooded by protesters. Our strategy to overcome this deluge was to counteract on the same grassroots level from which we were attacked. CMA engaged with school districts, county boards of supervisors and all levels of local government to strengthen support for the bill. Through these and our more traditional lobbying efforts, we were able to see the bill passed out of the Legislature and sent to the Governor’s desk. Although the Governor had 12 days to pass or veto the measure, he chose to sign SB 277 into law less than 24 hours after he received it. In his signing message, he wrote, “The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.”

SB 277 also garnered tremendous support in the press and from the physician community at large. All through the year, this bill made state and even national headlines. The New York Times, often regarded as the national “newspaper of record,” even editorialized in support of the bill. After SB 277 became law, Senator Richard Pan, M.D., was lauded by TIME magazine as a “hero of vaccine history,” while the Journal of the American Medical Association pointed to SB 277 as a potential catalyst and model for stricter vaccine requirements across the nation. The New England Journal of Medicine chronicled the entire SB 277 story, describing a sea change in the national politics of vaccination. We continue to regularly field calls from allies across the country who are seeking to learn more about what we accomplished and how we did it.

Unfortunately, our time to celebrate the hard-won victory was not long, as we quickly had to turn our attention to new attacks: a referendum to overturn the new law and a recall effort against Dr. Pan for his authorship of it. Through CMA’s political action committee, CALPAC, we will continue to work to defend Dr. Pan and his important law from this spurious attack.

Scope of Practice
Throughout the year, CMA dedicated a vast amount of resources to the successful defeat of several scope-of-practice expansion attempts that were before the Legislature. These measures were: SB 323 (Hernandez), for nurse practitioners; SB 538 (Block), for naturopathic doctors; and SB 622 (Hernandez), for optometrists. Each of the bills claimed to expand the scope of practice for allied health professionals as a means of ameliorating California’s access to care crisis, but, in reality, posed a danger to patients. Through diligent lobbying and with the engagement of our physician members calling and writing their legislators, CMA convinced lawmakers of that truth. Each bill was successfully killed in either a policy or fiscal committee, sending an unequivocal rejection of scope expansions as an answer to access to care issues. Year after year, these expansions are rejected by the Legislature, demonstrating that the physician voice still holds sway at the Capitol.

Scope of practice fights generally play out similarly, except, this year, for one unique experience. An amicable solution was reached on AB 1306 (Burke), relating to certified nurse midwives (CNMs). Negotiations with the CNMs were productive and in time we were able to reach an agreement, moving CMA to a neutral position. Ultimately, however, this bill, too, died in committee.

Physician Aid-in-Dying
Another fruitful negotiation centered on SB 128 (Wolk and Monning), the physician aid-in-dying bill. This controversial measure demanded a lot of attention from CMA. We began the year with a longstanding House of Delegates-established policy of opposition to this subject. It soon became clear, though, that this was no longer the overwhelming stance of the membership that it once was. CMA’s physician leaders began a conversation with our physician members so that we could update our official policy to reflect the new, nuanced views of our members. CMA became the first medical association in the nation to move from opposition to neutrality on physician aid-in-dying. Having received permission from our Council on Legislation and from our Board of Trustees to engage with the bill’s proponents in hopes of reaching solutions, CMA’s lobbyists, in conjunction with CMA’s Center for Legal Affairs, entered exhaustive negotiations. Although CMA had become neutral on the concept of physician aid-in-dying, there were still concerns to be addressed about the bill’s language. Through countless meetings, a final comprehensive solution was reached and CMA officially became neutral on the bill. The crucial amendments that were secured to reach that agreement included the strongest statutory immunity protections for physicians, voluntary participation protections and mental health evaluations. After SB 128 failed in the Assembly Health Committee, its cause was revived through a bill, ABX2 15 (Eggman), in the special session on health care called by the Governor. This bill ultimately retained our negotiated amendments and our neutrality, and was passed by the Legislature on its last day in session. On October 5, the Governor signed the bill into law.

Workers' Comp
The physician aid-in-dying bill was far from our only instance of exhaustive negotiations this year. CMA also took part in extensive discussions regarding AB 1124 (Perea), a bill that would require the Division of Workers’ Compensation to establish a prescription formulary. After several months of diligent negotiations, we reached an agreement with the author’s office that moved our position to neutral. Through negotiations on this bill, CMA solidified its standing as a full stakeholder in workers’ compensation.

CURES
In the final days of the session, while almost all eyes were watching the major political fights, CMA staff went to work with Assemblymember Travis Allen to extend the Controlled Substance Utilization Review and Evaluation System (CURES) registration deadline for all prescribers and furnishers. On Thursday, September 10, CMA and Assemblymember Allen gutted and amended AB 679 to extend the deadline from January 1, 2016, to July 1, 2016. This extension will allow the Department of Justice to roll out its automated registration process and protect doctors from being disciplined by the Medical Board of California during the system roll-out.

In two days, the bill was heard in Senate Business and Professions Committee, on the Senate Floor and on the Assembly Floor. AB 679, as amended on September 10, passed the Legislature without receiving a single “no” vote. The measure also included an urgency clause, meaning the bill goes into effect as soon as it is signed by the Governor.

“Surprise” Billing
Our other focus in the final days was the completion of a year-long fight. AB 533, introduced by the Chair of the Assembly Health Committee, Rob Bonta, initially seemed like a matter of negotiation. We had a good relationship with the author, and we shared his goal of addressing the “surprise billing” problem. Instead, over the course of the year, those negotiations became increasingly hostile until they finally deteriorated to an all-out war.

Going into the last week of the legislative session, AB 533 would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. The bill would have required non-contracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. In addition, the bill would have implemented barriers for PPO patients seeking to access their out-of-network benefits. Overnight, the bill became essentially a health plan-sponsored bill, with the strong support of consumer groups and organized labor.

With myriad resources, the health plans spent tens of thousands of dollars hiring contract lobbying firms to lobby in favor of AB 533. The California Federation of Labor, the California Firefighters and most of organized labor, who were misinformed about the full contents of the bill, also lent their political muscle to the passage of bill, for they believed it would protect patients from exorbitant, unexpected bills. Finally, the California Chamber of Commerce and consumer groups, led by Health Access, also spent their political resources in favor of the bill.

In order to defeat AB 533, it was all hands on deck at CMA and we called upon our Legislative Key Contacts, CMA officers and medical executives, asking them to call their legislators on the last night of session to ask them to vote no on AB 533. CMA was also able to call upon the specialty societies and two of our closest allies to stand in opposition: the California Dental Association and the California Podiatric Medical Association.

After countless hours of lobbying and passionate debate in the halls and on the floors of the State Capitol, CMA and our allies defeated the measure on the floor of the State Assembly. This CMA victory was the final act taken by the Legislature in 2015, solidifying this year as one of the most challenging and one of the most successful.

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