Wednesday, January 16, 2019

Significant New California Laws of Interest to Physicians for 2016

The California Legislature had an active year, passing many new laws affecting health care. In particular, bills making major changes to state immunization requirements and end-of-life options were enacted. There was also a strong focus on new legislation related to allied health professionals, mental health, medical records and privacy, and reproductive issues.

CMA’s annual publication, New Health Laws, contains a list of the most significant health laws of interest to physicians for the year 2016.

Download New Health Laws


House Landslide Vote to Pass SGR

Today, RCMA/CMA congratulates the U.S. House of Representatives for passing monumental Medicare reform and the Children’s Health Insurance Program (CHIP) extension, and urgently asks their colleagues in the Senate to do the same before spring recess. The 392-37 vote clearly shows that now is the time to make Medicare reform a reality.

The legislation, H.R. 2, known as the “The Medicare and CHIP Reauthorization Act,” will reform the broken Medicare sustainable growth rate (SGR) physician payment system and extend the expiring Children’s Health Insurance Program. Both of these important reforms will help to improve access to doctors in California for five million seniors on Medicare, one million military families on TriCare and the nearly one million uninsured children currently covered by CHIP.

“It is imperative that the House AND the Senate act before the 21 percent SGR Medicare payment cut takes effect on March 31,” said Luther Cobb, M.D., CMA president. “A drastic cut to physician payments will result in decreased access to care for some of our country’s most vulnerable patients. It’s crucial to the success of our health care delivery system that the bill passes before Congress goes home.”

The SGR legislation is nearly identical to the bipartisan, bicameral Medicare physician payment reform package that three Congressional committees unanimously approved in the last Congress and more than 750 state and national physician organizations, including CMA, supported.

There are more than 1,000 new Medicare enrollees every day in California, yet many physicians are no longer accepting new Medicare patients.

“California desperately needs payment reform to improve access to physicians because Medicare influences all public and private health insurance,” added Dr. Cobb. “Patients are experiencing access to care problems all across the state and H.R. 2 will help alleviate some of that.”

With the new bipartisan agreement between House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) on how to fund the SGR fix, CMA is calling on Congress to immediately pass this monumental, fiscally responsible legislative achievement that will lead to meaningful improvements in our health care system.

The Ultimate Measure - CMA's 2014 Legislative Wrap Up

By Janus L. Norman, CMA Senior Vice President

For more than 150 years, the California Medical Association has upheld the banner for practicing physicians. Year after year, the state medical society has partnered with the local medical societies to diligently strive to ensure the care and well-being of patients and to protect public health by working for the betterment of the profession. In years of prosperity, the challenge of carrying out this duty is restrained. In years of controversy, the same duty is laborious. This year was full of controversies.

The fight to defend the Medical Injury Compensation Reform Act (MICRA) may have ended with a ballot box victory in November, but the threat of a statewide ballot measure loomed heavily from the onset of the 2014 Legislative Session. The leader of Senate, President Pro Tempore Darrell Steinberg, introduced Senate Bill 1429 as vehicle to execute the strong-arm strategy of the plaintiffs bar attorneys to eliminate MICRA’s cap on non-economic damages. Tremendous political pressure and immature bullying tactics were employed in an attempt to force CMA to the bargaining table, but the association held fast to its principle of working to create an economic environment that allows physicians in all specialties the ability to practice throughout California. Rejecting the false choices presented by opponents of MICRA and choosing to make our case before the people of California, CMA united its political allies to ensure Senate Bill 1429 never received a hearing, leaving the trial attorneys' Proposition 46 ballot measure the only available avenue for overturning MICRA.

Senator Mark DeSaulnier’s Senate Bill 1258 contained another component of Proposition 46: the requirement for Schedule V controlled substance prescriptions to be reported to the Controlled Substance Utilization, Review and Evaluation (CURES) database. The bill also would have required the electronic prescribing of controlled substances, expanded government access to CURES and dictated the quantity of controlled substances allowed to be prescribed. Like the mandatory checking of CURES inserted into Prop. 46, SB 1258 was touted as a bill to address prescription drug abuse. However, the impact would have been to legislate the practice of medicine, undermine the patient/physician relationship and reduce patient access to care. CMA was instrumental in killing the bill, which was held in the Senate Appropriations Committee. The committee's action prevented passage of bad policy and also extinguished Bob Pack’s ability to use the bill as a platform from which to campaign against CMA in the months leading up to the November vote on Prop. 46.

Senate Bill 492, authored by Senator Ed Hernandez, sought to expand to scope of practice of optometrists to include surgical procedures and primary care services. Senator Hernandez, a practicing optometrist and Chair of the powerful Senate Health Committee, worked feverously toward the passage of Senate Bill 492, which passed out of the Senate in 2013 and was resting in the Assembly. Utilizing his great influence and charm, Senator Hernandez, along with the Optometric Association, battled with CMA, the California Academy of Eye Physicians and Surgeons, the California Academy of Family Physicians and the California Society of Plastic Surgeons to win the votes of the members of State Assembly. Hundreds of CMA members made phone calls and wrote emails and letters outlining the flaws within Senate Bill 492 and urging legislators to vote no on the measure. As the coordinated statewide effort moved forward, members of the Assembly began to acknowledge the harm that would have resulted from irresponsibly expanding the scope of optometrists to perform surgeries and provide primary care services by publicly committing to stand with the physician community in opposition to Senate Bill 492. With a majority of the members poised to oppose the measure, Senator Hernandez and the optometrists agreed to drop the bill and allow it die quietly on the Assembly Floor.

California’s physician shortage is consistently utilized as an argument for expansion the scope of allied health professionals. To combat this argument and the increase access to quality care, CMA has prioritized improving our state’s physician workforce by increasing the number of residency slots for medical school graduates. Studies have indicated that where a physician completes his or her residency is a primary indicator of where the physician will practice. CMA pushed the state to make an initial investment in its future medical workforce. The 2014-15 Budget Act signed by Governor Brown included $7 million to support primary care residency slots through the state’s Song-Brown program. Of that $7 million, $4 million will be prioritized to residency programs that wish to expand and train additional residents in internal medicine, pediatrics, obstetrics-gynecology and family medicine.

The 2014-15 state budget also provided significant resources to physicians. Specifically, the budget includes $3.7 million to draw down $37.5 million in federal funds for technical assistance to Medi-Cal providers on implementing and achieving meaningful use of electronic health records (EHRs). The 10 percent contribution from the state will allow an additional estimated 7,500 Medi-Cal providers to participate in the Medi-Cal meaningful use incentive program and receive the necessary training from the existing technical assistance infrastructure. In addition, CMA convinced the Governor to forgive the retroactive Medi-Cal cuts contained in AB 97 (Chapter 3, Statutes of 2011), which reduced Medi-Cal provider cuts by 10 percent.

For the last several years, CMA led the effort to seek an injunction to invalidate and stop the implementation of the 10 percent Medi-Cal cuts, arguing that this reduction would threaten the ability of physicians to continue to treat Medi-Cal beneficiaries and would create significant gaps in access to care for this population. The legal process ran its course when the U.S. Supreme Court declined to hear our appeal. CMA was, however, able to convince Governor Brown to not attempt to retroactively collect the portion of the cuts during the period of time the injunction was in place. As a result, physicians will be able to retain $218 million in Medi-Cal payments.

During the last months of the 2014 legislative session, CMA learned of the imminent closure of Doctors Medical Center in Contra Costa County. Doctors Medical Center (DMC) is the area’s main medical facility, serving over 250,000 patients in west Contra Costa County, including the city of Richmond and surrounding areas. Even though over 80 percent of its patient population is insured through Medi-Cal or Medicare, low reimbursement rates prevent DMC from creating a business model that would allow for sustained financial viability. CMA sponsored Senate Bill 833 (Hancock) to appropriate $3 million from the Major Risk Medical Insurance Fund to DMC to provide bridge funding to secure additional avenues of finance and create a new and viable business model for the facility going forward.

CMA sponsored and strongly supported additional legislation that addresses the daily challenges faced by physicians and raised public awareness surrounding critical health care issues. Assembly Bill 1755, authored by Assembly Member Jimmy Gomez and co-sponsored by CMA and Planned Parenthood Affiliates of California, was signed by Governor Jerry Brown. The bill will improve California’s notice requirement specific to breaches of medical information in order to reduce administrative burdens on providers and health facilities, while also ensuring accurate notification to patients, thereby allowing health care providers to put those resources back into patient care.

CMA, joined by various patient advocacy groups, worked with the Legislature and Governor to secure the enactment of Senate Bill 964 (Hernandez), which required Medi-Cal managed plans and insurers offering individual plans through Covered California to provide annual reports to the California Department of Managed Health Care (DMHC) about the adequacy of their provider networks and to make the reports available online.

Our successful advocacy did not come without sacrifices. As CMA battled in the Assembly to defeat Senate Bill 492, Senator Hernandez, Chair of Senate Health, held two CMA sponsored bills hostage in the Senate: Assembly Bill 2400 (Ridley-Thomas), which reintroduced an important discussion in the Legislature about the contracting relationship between physicians and health care plans and health care insurers, and Assembly Bill 1771 (Pérez), which would have ensured physician reimbursement for non-face-to-face patient management services to help increase patient access to care. Ultimately, CMA stood strong in the midst of controversy and held to its core principle of ensuring the safety of patients, and as a result both measures were held in the Senate. However, CMA was able to convincingly make the policy argument for both measures and to secure bipartisan support for the underling policy, for which we will be advocating again in the near future.

In its first year, the “My CMA Idea” contest produced one of the most hotly debated topics of the year: the negative impact of sugary drinks. CMA co-sponsored SB 1000 (Monning), which would have required warning labels on sugary drinks. A strategy to help educate consumers about the risks associated with consuming sugary drinks, the bill was the first of its kind in the country. It generated unprecedented media attention, including coverage by international media outlets. Twenty-four California papers editorialized in support of the bill. Scholastic News magazine, a teaching tool distributed throughout the country, included stories on the bill in a way that encouraged classroom debate on the issue. SB 1000 was even referenced in the nationally syndicated cartoon strip “Drabble.”

SB 1000 faced a tough political environment from the outset, with the soda industry pulling out all the stops to defeat it. Though the bill died in the Assembly Health Committee, the campaign supporting the bill showed CMA’s strong commitment to reducing obesity, our willingness to pursue innovative public health policy and – most importantly – helped educate people about the risks associated with consuming sugary drinks.

As Martin Luther King, Jr. famously said, “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.” In 2014, I am proud to say, CMA measured up!

For more details on the major bills that CMA followed this year, visit

Proposition 46 isn't the CURE(S)

On November 4, voters will be asked to weigh in on Proposition 46, a costly and deceptive measure funded and sponsored almost exclusively by trial lawyers. In addition to raising health care costs and reducing access to quality medical care, Prop. 46 could put patient prescription drug history at risk of being hacked and would force physicians and pharmacist to use an unworkable database.

The Controlled Utilization Review and Evaluation System, or CURES, is a statewide, government-run database that allows physicians to know which medications patients are taking. In concept, it could be a helpful tool in ensuring that patients don’t “doctor shop” – or visit several doctors to get multiple prescriptions for controlled substances.

Though the database already exists, it is underfunded, understaffed and technologically incapable of handling the massively increased demands this ballot measure will place on it. In its current form, the CURES database is plagued with system errors and major deficiencies. The state staffer in charge of CURES recently testified that the database is “not sufficient enough to carry out the mission that we need.” To see excerpts of his testimony, click here.

In fact, in evaluating Prop. 46 the independent, non partisan Legislative Analyst noted, “Currently CURES does not have sufficient capacity to handle the higher level of use that is expected to occur when providers are required to register beginning in 2016.”

While a potentially useful database, CURES simply isn’t able to handle what’s being asked of it. The health care community helped to pass SB 809, which will increase funding for the database and update the technology along with adding funds for more staff; unfortunately upgrades won’t be ready until the middle of 2015, at the earliest.

Despite all of this, Prop. 46 includes a provision that would mandate physicians and pharmacists check the CURES database before prescribing Schedule II or III drugs – a list of medications that is far too long for this newsletter. This “CURES mandate flaw” puts physicians in the untenable position of either breaking their professional oath to give patients the best possible care or breaking the law.

What’s more, the CURES mandate comes without any increased security to ensure that the database is up and running efficiently, effectively and safely before legally making health care professionals check it.

That’s a risky gamble in these days of massive data breaches.

Many of you reading this know firsthand the difficulties of the CURES database and have yourselves tried to use it to improve and advance patient safety. You then also know how unlikely it is that the CURES mandate will work. 

In the few weeks left between now and Election Day, RCMA cannot stress enough how important it is to spread the word about the dangers of Prop. 46.

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.

Legislative Alert: Urge Legislators to Oppose Bill that would Require Medical Board Investigations for Prescription Drug Deaths

On June 26, the Assembly Business and Professions Committee will be considering a bill that would require a coroner to file a report with the medical board when a controlled substance is found to be a contributing factor in a death.

While well-intentioned, SB 62 simplifies a very complicated issue to the potential detriment of patients. CMA is urging physicians to contact their assembly members today and ask them to oppose this flawed bill.

Click "take action" below to quickly and easily contact your legislator via CMA's grassroots action center.

 Call (877) 362-8455 to be connected with your legislator

Take Action

I Made the Call!


SB 62 (Price) would expand provisions to require a coroner to file a report with the Medical Board of California when he or she determines that a Schedule II, III, or IV drug was a contributing factor in a death.

Senator Price's stated assumption that a coroner’s report connects the dots between overdose deaths and so-called physician over-prescribing is fundamentally flawed.

This bill is a response to growing concern about prescription drug abuse, an issue that is of great concern to CMA and physicians across the state. However, the statistics show that the vast majority of people who abuse prescription drugs acquire them from friends and family (often without their knowledge) or from sources other than the prescriber. There are also many circumstances in which individuals with legitimate prescriptions for controlled substances might die, including non-compliance with prescriber's orders or mixing the drugs with other substances like illicit drugs or alcohol.

As currently written, this bill would make it increasingly more difficult for patients being treated for pain to get appropriate treatment, as physicians will become less likely to prescribe controlled substances for fear of a medical board investigation.
CMA has requested an amendment to the bill that would require the medical board to notify a physician when a report with his/her name is received. This amendment would help provide some balance by providing physicians the opportunity to seek ongoing education on opioid prescribing or identify fraudulent activity being done in their name, but the author has refused to accept it.

We ask that you and your colleagues
call, fax or email your legislators
TODAY and ask for a NO vote on this bill

The bill is expected to be heard in the Assembly Business and Professions Committee this week.

Phone calls and office visits are most effective, but faxes and emails are important too. If you choose to fax or email your legislators, we strongly encourage that you personalize the letter (provided below), which will greatly increase its impact.

If you are logged into the CMA website, your legislators should automatically be displayed. If not, you can click here to locate your legislators by zip code.

Talking points, a sample email, and background information are below.

Talking Points

  • As a physician, I am very concerned about the growth in prescription drug abuse and want to be a partner in addressing it, but SB 62 is an approach that will have significant unintended consequences.
  •  The reports being required under SB 62 will make physicians less likely to prescribe drugs on Schedule II, III, and IV for fear of investigation even in instances when the care is appropriate. Doing so will impact patient’s ability to get appropriate pain management.
  • There are many circumstances in which a person with a legitimate prescription for a controlled substance may die, including the patient being non-compliant with the prescriber’s orders or mixing the drugs with other substances like illicit drugs or alcohol.
  • Patients being treated for pain may also have comorbities that could result in death. None of these instances reflect inappropriate practice by a physician and yet all of them could be reported to the Medical Board for investigation under SB 62.
  • Further, the vast majority of people (70%) who use drugs for non-medical purposes did not get it from a prescriber, but from other sources.
  •  The risk of negatively impacting patient care must be balanced with the potential benefit. Given all the extenuating factors that exist in assessing overdoses related to controlled substances, SB 62 is not balanced.
  • CMA has requested an amendment to the bill that would require the medical board to notify a physician when a report with his/her name is received. This amendment would help provide some balance by providing physicians an opportunity to seek ongoing education on opioid prescribing or identify fraudulent activity being done in their name, but the author has refused to accept it.
  •  I urge Assembly-member ____________ to vote no on SB 62 unless the requested amendment is taken.


Legislation To Repeal SGR Unveiled

The Energy and Commerce Committee Republicans unveiled draft legislation that would repeal the sustainable growth rate (SGR) formula and replace it with a new system for determining Medicare physician payments. Building off a framework released this spring; the legislation would eliminate the SGR and replace it with a modified fee-for-service system with an emphasis on improving quality and outcomes through performance measures, while also providing means for physicians to participate in alternative payment models.

Funding UCR School of Medicine

California’s Senate and Assembly have unanimously approved identical bills appropriating $15,000,000 annually from the General Fund to the Regents of the University of California for allocation to the School of Medicine at UC Riverside. The Inland Empire has the lowest ratio of primary care physicians and specialists of any region in the state. The Council on Graduate Medical Education, a federally funded and authorized group that assesses the physician workforce and reports to federal policymakers, recommends a minimum of 60 to 80 primary care physicians and 85 to 105 specialists per 100,00 people. Sadly, the physician and specialist ratio in the Inland Empire is barely half of that recommended number. The UC Riverside School of Medicine is a critical factor in addressing this need, and consistent state funding is needed for the school to maintain its accreditation.

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