Wednesday, January 16, 2019

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.


AMA Letter to Congress on AHCA

Earlier today, the AMA sent a letter to Congress in opposition to the American Health Care Act (H.R. 1628), which is scheduled for a vote on the House floor tomorrow.

Modifications made to the bill following consideration by the committees of jurisdiction did not address the AMA’s chief concerns, which were expressed to Congress in previous correspondence. More specifically, the bill that will be considered on the House floor will not preserve recent gains in health insurance coverage, nor will it make meaningful and affordable coverage more available to low and moderate income Americans. Changes proposed to the Medicaid program will reduce federal support and erode the health care safety net, and Medicaid enrollees will be denied access to covered services provided by certain qualified health care providers.

Prospects for a successful floor vote in the House are uncertain. If the bill does pass, the Senate intends to consider it next week and will very likely make changes due to both parliamentary issues and policy concerns.

RCMA will keep your apprised of developments.

Read AMA Letter To Congress


AMA Statement on the Future of Health Care Reform

Download AMA Vision on Health Reform

“The AMA House of Delegates, reflecting more than 170 state and specialty medical societies from across the country, today reaffirmed its commitment to health care reform that improves access to care for all patients.

“Using a comprehensive policy framework that has been refined over the past two decades, the AMA will actively engage the incoming Trump Administration and Congress in discussions on the future direction of health care. The AMA remains committed to improving health insurance coverage so that patients receive timely, high quality care, preventive services, medications and other necessary treatments. 

“A core principle is that any new reform proposal should not cause individuals currently covered to become uninsured. We will also advance recommendations to support the delivery of high quality patient care.  Policymakers have a notable opportunity to also reduce excessive regulatory burdens that diminish physicians’ time devoted to patient care and increase costs.

“Health care reform is a journey involving many complex issues and challenges, and the AMA is committed to working with federal and state policymakers to advance reforms to improve the health of the nation.”

Andrew W. Gurman, M.D.
President, American Medical Association


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






It's Finally Over! The Medicare SGR is Dead!

LAST NIGHT THE SENATE APPROVED H.R. 2: THE MEDICARE SGR REFORM AND THE CHILDREN’S HEALTH INSURANCE REAUTHORIZATION ACT WHICH REPEALS MEDICARE’S SUSTAINABLE GROWTH RATE FORMULA, HOURS BEFORE DOUBLE-DIGIT PAYMENT CUTS TO PHYSICIANS WERE SET TO TAKE EFFECT. THE BILL HAS BEEN SENT TO THE WHITE HOUSE WHERE PRESIDENT OBAMA IS EXPECTED TO SIGN IT INTO LAW.

After a decade of battling, the U.S. Senate, in a whopping vote of 92-8, passed H.R. 2, the monumental, bipartisan Medicare SGR Payment Reform and Children’s Health Insurance Program (CHIP) Reauthorization Act. Both California Senators Feinstein and Boxer voted in the affirmative. Two weeks earlier, the U.S. House of Representatives adopted the legislation in a landslide vote of 392-37. This was a rare, bipartisan achievement in a deeply divided Congress. RCMA, CMA, AMA and more than 780 state and national physician organizations supported the bill. In 2013, the policy was jointly developed on a bipartisan basis by the three House and Senate health committees. This year, U.S. House of Representatives Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) are credited with negotiating the final budget offsets to fund the SGR bill.

RCMA/CMA extends a sincere thank you to all physicians for the extraordinary campaign this last decade to end the SGR. We have kept up the fight these last two years to hold Congress’ feet to the fire to develop a comprehensive bill to reform Medicare physician payments. The unity within organized medicine finally put this over the finish line. Moreover, 52 out of 54 Members of the California Congressional delegation voted to support physicians. This is an incredible achievement in one of the most dysfunctional Congresses in history.

PLEASE BE SURE TO CONTACT YOUR REPRESENTATIVE AND
THE CALIFORNIA SENATORS TO THANK THEM FOR THEIR SUPPORT!

While H.R. 2 is far from perfect, it represents a significant improvement over the current Medicare program which mandates penalties up to 13% in the coming years with no opportunities for payment updates or bonuses. This bill consolidates the burdensome reporting programs and reinstates significant bonus payments. By repealing the SGR and providing annual updates, it provides stability to physician practices that allows for longer term planning. Significantly, it allows physicians to design new payment systems that work for physicians and patients instead of government bureaucrats. And it mandates physician involvement in defining and developing quality measures. Moreover, once the costly SGR is repealed, it will be much easier for physicians to work with Congress to make improvements to the payment system (such as increasing the annual update) at a lesser cost. The enormous cost of the SGR has been a barrier to making any improvements.

Note that Medicare should begin processing claims today for services provided in April at the rates that were effective before the 21 percent cut was scheduled to take effect. Under the provisions of H.R. 2, the fee schedule conversion factor will be increased by 0.5 percent on July 1, 2015, and by another 0.5 percent on January 1, 2016.

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.


CMA Launches Exchange Resource Center

In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the individual and small group health insurance markets and, beginning in 2014, will provide health insurance to much of the nation's uninsured. Under the ACA, two-thirds of California's uninsured may be may be eligible to purchase coverage through the health benefit exchange. The exchange's goal is to begin open enrollment on October 1, 2013 – with coverage beginning on January 1, 2014.

To help educate physicians about the exchange and ensure that they are aware of important issues related to exchange plan contracting, the California Medical Association (CMA) has developed a resource page where physicians can find all of CMA's exchange-related news and resources.

The new exchange resource center can be found at www.cmanet.org/exchange.

For more information about California's Health Exchange, contact RCMA’s physician advocate Mitzi Young at (888) 236-0267 or myoung@cmanet.org.

 


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.


Covered California Update

Covered California, the state agency implementing the Affordable Care Act (ACA), has announced participating health insurers and proposed premiums for the state's exchange.  13 commercial health plans were selected to offer products on the exchange, including California's three largest insurance providers, Kaiser Permanente, Anthem Blue Cross and Blue Shield of California. One major concern for contracting physicians is a loophole in the ACA that could see physicians left to foot the bill for services provided to patients who haven't paid their insurance premiums. The law allows for a three month "grace period" for non-payment of premiums, but only requires insurers to pay the claims through the first month of non-payment. The final version of the exchange model contract included a provision that requires 15 days advance notice to physicians when a patient has entered the second month of the grace period, but still leaves the burden of 60 days worth of unpaid claims on the physician and the patient.

For more information about Covered California, please contact your RCMA Physician Advocate Mitzi Young at myoung@cmanet.org or (888) 236-0267.


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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