San Francisco Medical Society Blog

What Providers Need to Know about EHR Audits

Wed, 10 Apr 2013 13:59:47 GMT

All eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) attesting to receive an incentive payment for either the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program may be subject to an audit.

Pre- and Post-Payment Audits

CMS and its contractor, Figliozzi and Company, perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers who are participating in the EHR Incentive Programs. States perform audits on Medicaid providers participating in the Medicaid EHR Incentive Program.

In addition to the post-payment audits that have been conducted since 2012, CMS began pre-payment audits this year, starting with attestations submitted during and after January 2013.

New Resources to Prepare for Audits

For those providers selected for pre-payment or post-payment audits, CMS and its contractor will request supporting documentation to validate submitted attestation data. To help providers prepare for a potential audit, CMS created the new Supporting Documentation for Audits Fact Sheet. The fact sheet and a sample audit request letter for both EPs and eligible hospitals are also available on the Educational Resources page of the EHR Incentive Programs website.

Additional Information About the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Click here for additional resources from CMS regarding audit information and guidance.

Questions or request for more information? Please contact the CMS San Francisco Regional Office at (415) 744-3658 or rosfofm@cms.hhs.gov.

Feds Allows States to Cut Medicaid Pay, Files Brief in CMA Court Battle

Fri, 08 Mar 2013 12:59:51 GMT

The U.S. Department of Justice filed a brief last Friday before the Ninth Circuit Court of Appeals arguing states can cut Medicaid (Medi-Cal in California) providers’ reimbursement as long as it does not harm access to care.

Earlier this year, SFMS/CMA have requested an en banc review from the Ninth Circuit as part of an effort to stop the State of California from implementing a 10% cut to Medi-Cal provider reimbursement rates.

In December 2012, a three judge panel of the Ninth Circuit ruled that the state could move forward with the rate cuts, passed by the Legislature in the spring of 2011, despite an earlier district court ruling that found that the cuts would irreparably harm the millions of patients who rely on Medi-Cal for health care. CMA and the other plaintiffs in the case are requesting a rehearing from the full Ninth Circuit Court of Appeals.

The justice department's brief urged the court to uphold the cuts and insisted that the Centers for Medicare and Medicaid Services (CMS) is not required to disapprove the plan amendments because they were motivated by “budgetary reasons.”

"It is entirely appropriate for a state to review its Medicaid plan to determine whether it can continue to satisfy its statutory obligations at lower payment rates," the justice department wrote in the brief.

CMA and the other plaintiffs in the case—California Dental Association, California Pharmacists Association , National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response—argue that reducing payments in the Medi-Cal system will force providers out of the program at a time when millions of new patients will be diverted into the Medi-Cal system.

If the state moves forward with these cuts, access to care will be devastated, not only for the existing Medi-Cal patients, but also the 900,000 kids moving from the Healthy Families program into Medi-Cal in 2013 and the millions of patients that will be newly eligible for Medi-Cal under the Affordable Care Act in 2014.

Brown Highlights Budget, Health Care in State of the State Address

Fri, 25 Jan 2013 11:06:42 GMT

Governor Jerry Brown promoted his fiscal year 2013-2014 budget proposal and discussed several state health care initiatives in In his State of the State address yesterday.

Budget Comments

Earlier this month, Brown released his budget plan. He said that if implemented, the proposal would leave the state with a budget surplus of $851 million. The plan projects $98.5 billion in revenue and transfers, and it estimates $97.7 billion in spending.

Brown's plan includes an expansion of Medi-Cal to individuals with incomes up to 138% of the federal poverty level. The expansion—included in the Affordable Care Act—is expected to add up to 1.5 million newly eligible adults to the program.

The budget plan also includes a 4.9% funding increase for In-Home Supportive Services—with an assumption that the state will implement a 20% reduction in IHSS service hours in November—and a $142 million funding increase for Cal-WORKs, the state's welfare-to-work program

In addition, the budget proposal allocates $1.6 billion for a court-appointed federal overseer to manage continued improvements in the state's prison health care system.

Health Care Comments

Discussing the Medi-Cal expansion, Brown called the initiative "incredibly complex" and said it will "test our ingenuity" and "will not be achieved overnight." He said, "Given the costs involved, great prudence should guide every step of the way."

Brown also said that the state must develop "the right relationship with the counties" to successfully implement the expansion.

Brown also called for a special session of the Legislature beginning next week that will focus on implementing ACA provisions.

Source: California Healthline, January 25, 2013.

California’s Dual Eligibles Initiative Under National Spotlight

Thu, 06 Dec 2012 12:33:45 GMT

Patient advocates across the nation are closely watching California’s transition of beneficiaries eligible for both Medicare and Medi-Cal from traditional fee-for-service plans to managed care plans.

The California initiative is in its second year. State officials seek to transfer so-called dual eligibles to managed care plans to improve their health care services and reduce costs.

The state has estimated that the initiative will save $663 million next year and that it will yield additional savings in subsequent years. Federal officials have begun implementing a similar national effort under a provision in the Affordable Care Act.

Howard Kahn—CEO of L.A. Care, the largest public health plan in the U.S. with one million members in Los Angeles County—said the California initiative allows health plans to organize all of the care that dual eligibles receive and curb unnecessary treatments. However, some patient advocates who have followed the California initiative wonder if the federal demonstration project will put patients at too great a risk.

A report released by the California HealthCare Foundation in August 2012 determined several problems with the transition, such as:

A short timeline that allotted the state only seven months between federal approval and when enrollment began;
Privacy rules that prevent some health plans from receiving complete patient records;
Transfer guidance that confuses certain patients about whether their preferred physicians participate in various managed care plans; and,
An appeals process that patients seeking exemption from the program find onerous.

According to Kaiser Health News, California's initiative has caused some patients to leave trusted physicians and others to start receiving generic drugs that they say are ineffective.

In addition, health experts have expressed concern that insurers participating in the initiative have little experience overseeing the long-term home care needs of certain dual eligible patients.

Source: California Healthline, December 6, 2012.

Medi-Cal Requiring Physician Re-enrollment

Fri, 09 Nov 2012 11:51:53 GMT

The California Department of Health Care Services (DHCS) will soon be notifying physicians that they must re-enroll in Medi-Cal as one of the provisions of the Affordable Care Act (ACA). The ACA requires every state Medicaid program (Medi-Cal in California) to revalidate provider enrollment information at least every five years beginning January 2, 2013.

DHCS is currently working to identify an initial list of all physicians and other providers who will be required to revalidate. Notices of revalidation will be mailed beginning the second week of January 2013. Notices will be sent to business location on file with DHCS. Each notice will include information on which application(s) must be completed. Anyone receiving a notice must complete and return the requested form(s) and required attachments within 35 working days of the date of the notice. Failure to do so may result in payment delays.

Physicians, who have revalidated, updated, or submitted new applications to the Medicare program within the last 12 months (January 1 through December 31, 2012) will not be required to revalidate at this time. However, your Medicare enrollment information must match the information on file with the Medi-Cal program. If the information does not match, you will receive notice from DHCS requiring you to revalidate.

SFMS/CMA will be hosting two live webinar training courses with representatives from DHCS to walk attendees through the Medi-Cal enrollment process for both individual providers and groups. Also to be discussed will be program requirements and how to avoid common mistakes that can lead to delays, denials and exclusion from the Medi-Cal program. These extended-length webinars are free to members, and will be held November 15, 2012, and January 16, 2013, from 12:15 to 1:45 pm.

Click here for more information or to register for the complimentary webinar(s).

Safety-Net Hospitals Face Funding Cuts on Two Federal Fronts

Tue, 07 Aug 2012 14:58:03 GMT

Representatives of California’s safety-net hospitals say the devil is in the details concerning the federal government’s plans to reduce funding for hospitals caring for a disproportionate share of low-income patients.

The Affordable Care Act will reduce by at least half the amount of Medicaid money set aside to help safety-net hospitals provide uncompensated care for patients with no insurance and no cash. Hospitals serving a high percentage of uninsured, low-income patients—or disproportionate share hospitals—are reimbursed at a higher rate by Medicaid. 21 California public hospitals receive approximately $1.1 billion a year in DSH funding.

The reductions make sense, hospital officials agree, because more people will become paying customers under ACA. But exactly how those reductions are made will be critical, according to representatives of California's safety-net hospitals.

“While we do expect that many patients currently seen in public hospital systems will gain coverage through the expansion of Medi-Cal and the exchange, recent estimates suggest that roughly three million people in California will remain uninsured even after full implementation of reform,” said Erica Murray, senior vice president of the California Association of Public Hospitals and Health Systems (CAPH).

CAPH represents 19 public hospitals and systems—including University of California teaching hospitals—in 15 counties where more than 81% of the state's residents live. The CAPH network is the principal fabric of the state’s safety net.

DSH cutbacks begin relatively modestly with about $500 million in national reductions in 2014. Reductions increase each year growing to expected cuts of $5.6 billion in 2019 and $4 billion in 2020.

Medicare Changes Could Also Hit Safety-Net Hospitals

In addition to Medicaid funding cuts, changes in the way Medicare reimburses hospitals—through what is known as "value-based purchasing"—could affect safety-net hospitals. Beginning in October, Medicare will adjust hospital reimbursements to reflect hospitals' performance in a number of clinical and patient satisfaction areas. A recent study published in the Archives of Internal Medicine suggested safety net hospitals often do not score well in patient satisfaction and could suffer financially as a result.

In an op-ed piece accompanying the Archives of Internal Medicine report, Katherine Neuhausen, a Los Angeles physician, and Mitchell Katz, director of the Los Angeles County Department of Health Services, warned that the double whammy of DSH cuts and Medicare payment changes could push some safety-net hospitals into insolvency.

Their editorial on Medicare value-based purchasing said, in part: "Safety-net hospitals that are already drained by the DSH reductions are likely to lose additional funds under this program, leaving them without any capital to launch initiatives to improve quality and patient experience. Over time, VBP could worsen the disparities between prosperous non-SNHs (safety net hospitals) and struggling SNHs. It would be a tragedy if the combined stressors of the DSH cuts and VBP trigger the closures of SNHs."

Source: California Healthline, August 6, 2012.

Supreme Court Concludes Hearings on Federal Health Reform Law Case

Wed, 04 Apr 2012 14:23:16 GMT

The U.S. Supreme Court concluded three days of oral arguments in the lawsuit challenging the federal health reform law yesterday.

Wednesday’s hearings consisted of a morning session on the severability of the law’s individual mandate and an afternoon session on the overhaul’s Medicaid expansion.

Audio and written transcripts of the morning session and the afternoon session are available from the Supreme Court’s website.

Wednesday’s afternoon session ended more than six hours of oral arguments over three days. The high court is expected to release its decision in late June (Bloomberg, 3/28).

Severability of Individual Mandate
In the morning session of Wednesday’s arguments, some of the justices seemed open to allowing the remainder of the overhaul to stand even if the individual mandate is deemed unconstitutional. Some observers noted that the justices’openness to allowing other provisions to stand could indicate that they have accepted that the individual mandate will be struck down.

According to AP, three liberal justices—Rth Bader Ginsburg, Elena Kagan,and Sonia Sotomayor—asked questions that intimated they believe the law can stand without the minimum coverage requirement. Meanwhile, Chief Justice John Roberts and Justice Antonin Scalia—both conservatives—also asked questions that suggest they were leaning the same way. Roberts noted that the law includes measures—such as a provision related to Native American health care—that are unrelated to the individual mandate.

Uncertainty Among Justices
While most of the justices seemed opposed to eliminating the entire law, they also “were clearly worried about the consequences if they pull out pieces of the law and that throws the rest of the health care system into chaos” (Gerstein/Budoff Brown, Politico, 3/28).

Ginsburg said that if portions of the overhaul needed to be changed as a result of the high court’s decision, “Congress can take care of it” rather than the courts. Kagan noted that it would represent a “revolution” for the court to guess which provisions Congress would have approved without the individual mandate.

Scalia said it is “totally unrealistic” for the court to comb through the 2,700 pages in the health reform law. “My approach would be to say that if you take the heart of the statute”—referring to the individual mandate—“the statute’s gone.”

Justice Anthony Kennedy, a likely swing vote, said it would be “more extreme” for the court to attempt to piece together the remaining parts of the overhaul. If they were to do that, “we would have a new regime that Congress did not order.”

Implications for California
The Kaiser Family Foundation has estimated that California could receive an additional $45 billion to $55 billion in federal funds between 2014 and 2019 if the reform law is upheld.

A friend of the court brief filed by California Attorney General Kamala Harris and attorneys general in 11 other states estimates that the law’s Medicaid expansion could extend health care to 11.2 million U.S. residents, including 1.9 million Californians.

Supreme Court Sends Medicaid Case Back to Court of Appeals

Wed, 22 Feb 2012 10:31:41 GMT

Today, in a majority decision, the United States Supreme Court refused to reverse the Ninth Circuit Court of Appeals decision in Douglas v. Independent Living Center of Southern California ("Independent Living Center"). That court has previously sided with physicians and other providers, agreeing that interested parties should have the ability to sue in order to block cuts to California’s Medicaid program, Medi-Cal.

The case will now return to the Ninth Circuit Court of Appeals. The federal Medicaid Act requires that government insured and privately insured patients have equal access to medical care. If the state and federal government continue to cut funding to these programs, physicians will be forced to stop taking new patients, meaning that access to care will be greatly impacted.

“This is a win for physicians and their patients in California,” said James T. Hay, MD, President of the California Medical Association (CMA). “The lower court has previously ruled that interested parties indeed have the right to sue the state and federal government if the federal Medicaid Act is being violated. They will have the opportunity to decide that once again.”

The Supreme Court’s decision will have huge implications for the more than 10 million patients who are currently enrolled in California’s Medicaid program.

“The state cannot continue to propose sweeping cuts to programs for California’s poorest and most vulnerable patients,” Dr. Hay added. “Our hope is that they get the message loud and clear with the U.S. Supreme Court’s decision today.”

Through Medi-Cal, physicians, dentists, pharmacists, adult day health care providers, clinics and hospitals provide health care services to low-income seniors, families, children and people with disabilities. By providing these primary and preventive care services, the state ensures these Californians have access to health care, while at the same time saving money by lowering the chances they will be forced to seek more costly health care, such as emergency rooms or hospital admissions. CMA is a party in the case.

CMS EHR Information Center Updates

Thu, 09 Feb 2012 11:17:24 GMT

CMS has recently updated previously-posted FAQs and added new FAQs on several incentive program topics, including reporting periods and incentive payments. Answers to common questions about disbursing 2011 incentive payments, reporting periods, determining Medicaid patient volume are now posted on the site.

The Electronic Health Record (EHR) Information Center Interactive Voice Response (IVR) system has also been enhanced to provide users with an increased number of options and services to make accessing and reviewing data easier than ever before.

For eligible professionals, eligible hospitals, or critical access hospitals (CAHs), the revised functionality vastly improves the efficiency in obtaining desired information, while also offering a more varied amount of information and options for callers. Providers can now obtain information through an extensive IVR Self-Service option. Included in this option is a reinforced privacy protection module that requires your individual National Provider Identifier (NPI), the last five digits of your Tax Identification Number (TIN), and your EHR registration ID. Once accepted, this newly enhanced Self-Service tool allows you to:

Obtain registration status
Acquire attestation status
Review payment information
Check progress towards meeting the $24,000 threshold amount

Users may access these new options by dialing (888) 734-6433, pressing 3 for Self-Service, and entering the authentication elements. These options will be available on the IVR effective February 16, 2012.

EHR Information Center Hours of Operation: 7:30am-6:30pm CT, Monday through Friday, except federal holidays. Please note that General Information and Self-Service options may be reached via IVR 24 hours a day, except during periods of planned system maintenance or upgrades.

HHS Publishes New Medicaid Quality Measures

Tue, 10 Jan 2012 11:48:33 GMT

HHS has issued a final notice containing an initial set of 26 quality measures (PDF) that will be used to determine the quality of care that adult Medicaid patients are receiving in each state. The Affordable Care Act (ACA) required HHS to publish a core set of health quality measures for Medicaid-eligible adults by January 1, 2012. Additionally, the law mandates that HHS must develop a standardized quality reporting format by January 1, 2013, and also publish any changes to the measures on an annual basis. After numerous meetings with representatives from the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality, HHS pinpointed 51 quality measures. But after it received comments that 51 was too many, it narrowed the list to 26. The final list, which was published in the Federal Register last week, includes quality care measures in six areas: prevention and health promotion, management of acute conditions, management of chronic conditions, family experiences of care, care coordination, and availability of care. Click here to view the full list of quality measures, p. 14-16.

Medicaid Prompt-Pay Bill Introduced

Tue, 13 Dec 2011 09:47:23 GMT

Reps. Brian Bilbray (R-Calif.) and Anna Eshoo (D-Calif.) have introduced legislation that would require the Medicaid program to reimburse all providers—including nursing facilities, hospitals and community health centers—in a more timely manner. The bill, known as the Fair Pay to Medicaid Providers Act (PDF), would extend to these healthcare providers a provision that requires Medicaid to reimburse 90% of claims to physicians in 30 days and the remainder within 90 days, according to Eshoo’s office. “This is a common-sense bill directed to patients,” Eshoo said in a news release. “Our health care professionals and facilities deserve to be reimbursed in a predictable and consistent timeframe in order to provide optimal care to those in need. We must ensure that our communities’ most vulnerable citizens do not face a disruption in healthcare services, and our bipartisan bill helps to make sure their care is not held up by red tape and bureaucracy.” The bill has been referred to the House Energy and Commerce Committee. Source: Modern HealthCare, December 12, 2011

Congressional Super Committee Fails to Reach Agreement

Mon, 21 Nov 2011 14:45:40 GMT

Today, the Joint Congressional Committee on Deficit Reduction (otherwise known as the Super Committee) declared defeat and will not reach agreement on a package to reduce spending by $1.5 trillion. A statement from the panel's co-chairs said that “after months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee's deadline.”

What does this mean for physicians?

The law now requires across-the-board spending cuts—called sequestration—that will begin January 1, 2013. Many members of Congress may try to undo the sequestration deal because the military takes 50% of the cuts. However, both Republican and Democratic Congressional leaders have reiterated their support for the original deal that requires sequestration. Therefore, on January 1, 2013 next year, Medicare will reduce physician payments by 2% because of the sequestration agreement. The entire Medicare program will take a 2% cut, including GME, Medicare Advantage, and other programs within Medicare. The Medicaid program is protected from cuts under the sequestration agreement.

What about 2012?

There will not be a complete repeal of the Medicare SGR payment formula this year. The 27.4% Medicare SGR payment cut still looms on January 1, 2012. Now that the Super Committee agreement has gone down, Congress will turn their attention to several significant issues that they must address before the end of the year, including extending Unemployment Insurance funding, extending the Alternative Minimum Tax (AMT), extending the payroll tax cut and eliminating the 27.4% Medicare physician payment cut before January 1, 2012. The good news is that there are several large issues that Congress must address before the end of the year and the leaders have listed the Medicare physician payment cut as a major priority.

What you can do to help

Please keep calling, writing, and meeting with your local legislators. It is imperative that we stop the 27% cut BEFORE January 1, 2012. Use the AMA Grassroots Hotline at (800) 833-6354; plug in your zip code and it will automatically connect you to your Representative/Senator.

Medi-Cal EHR Incentive Program Enrollment Starts on December 15, 2011

Fri, 18 Nov 2011 10:50:13 GMT

The American Recovery and Reinvestment Act of 2009 established the Electronic Health Record (EHR) Incentive Program for Medicaid and Medicare providers. Beginning in 2011, eligible Medi-Cal professionals and hospitals will be able to receive incentive payments to assist in purchasing, installing, and using electronic health records in their practices. Effective 11/15/2011, California has opened registration for groups and clinics. Group/clinic representatives can register their group/clinic(s) in the State Level Registry. Provider registration is scheduled to begin on 12/15/2011.

Program Eligibility for Professionals

Professionals must not be hospital-based (may not perform 90 percent or more of their services in a hospital inpatient or emergency room setting) and must meet at least one of the following criteria:

Have a minimum 30 percent Medicaid patient volume
Have a minimum 20 percent Medicaid patient volume if they are a pediatrician
Practice predominantly in a FQHC or RHC and have a minimum 30 percent patient volume attributable to needy individuals

Providers can review the EHR Incentive Programs: Medicaid Eligible Professional page on the CMS website for more information. Click here to learn more about this incentive program or consider registering for the November 30, 2011 complimentary webinar hosted by SFMS/CMA. Register at www.cmanet.org/events.

California Legislators Split on Federal Budget Cuts

Tue, 15 Nov 2011 12:01:54 GMT

When a bipartisan mix of 100 House members urged the deficit-reduction supercommittee to search for cuts in federal spending, including entitlements, the California delegation didn't show much enthusiasm. Only six of the delegation's 53 members signed a letter to the Joint Select Committee on Deficit Reduction: Reps. Mike Thompson, Adam Schiff, Dennis Cardoza, Jim Costa, John Garamendi, and Devin Nunes. Reaction has highlighted a split in how these programs are viewed: Protecting Medicare and Social Security is far more urgent with many lawmakers than standing guard over Medicaid. Though he didn't mention Medicaid specifically, Rep. Sam Farr (D-Carmel), looks elsewhere before cutting social programs. "Before we look to slashing Social Security and Medicare, we have to look at cutting defense spending and closing tax loopholes that assure that corporations and the wealthiest 1 percent pay their fair share." One of those who didn't sign the letter to the supercommittee, Rep. Mary Bono Mack (R-Palm Springs), said she is concerned about federal spending but wants to protect programs Americans depend on. "The Congresswoman does not support any cuts to Social Security and Medicare benefits at this time, but Medicaid is certainly one area that should be looked at because of widespread waste, fraud and abuse which has occurred in the past," said her spokesman, Ken Johnson. Medicaid is the federal-state health care program for the poor, especially women and children and elderly in nursing homes. Medi-Cal, California's version of Medicaid, has 7.4 million users. Still, Bono Mack is far from the only California member to leave out Medicaid when stressing which programs to protect. Sen. Barbara Boxer (D-Rancho Mirage) wants a "balanced approach between cuts and revenues" when it comes to deficit reduction, spokesman Zachary Coile said. "She opposes efforts to slash Medicare and Social Security benefits for our seniors, but supports strengthening those very successful programs so that they continue to benefit future generations." Boxer's spokesman, too, said nothing of Medicaid. Source: The Californian, November 14, 2011.

Supreme Court To Hear Challenge To Health Law

Mon, 14 Nov 2011 12:09:15 GMT

By agreeing today to hear challenges to President Obama's 2010 health care law, the Supreme Court set the stage for a decision—probably in late June and in the midst of the presidential campaign—that could be among its most important in decades. The case, which will probably be argued in March, is especially momentous because it not only will determine the fate of President Obama's biggest legislative achievement, but also will cast important light on the Supreme Court’s future course under Chief Justice John Roberts on issues of federal government power. The central issue is whether Congress exceeded its constitutional powers to regulate interstate commerce and to levy taxes when it adopted the so-called "individual mandate" at the heart of the health care law. That provision would require millions of people starting in 2014 to buy commercial health insurance policies or pay financial penalties for failing to do so. The court also agreed to decide a challenge to the Affordable Care Act's provision essentially requiring states greatly to expand their Medicaid spending. The court made clear that if it decides to strike down the individual mandate or Medicaid provision, it will also decide which of the 975-page law's hundreds of other provisions should go down too, by divining whether Congress would have wanted some or all of them to be effective even without the voided provision or provisions. Finally, the court agreed to decide whether the litigation surrounding the individual mandate must be deferred until 2015 because of the 1867 "Anti-Injunction Act," which bars courts from striking down tax laws before they take effect. A decision in June—or before—would help make the future of health care law a central issue in the 2012 presidential campaign. Source: Kaiser Health News, November 14, 2011.

Medicare Provider Revalidation List Now Online

Fri, 11 Nov 2011 13:18:07 GMT

The Centers for Medicare & Medicaid Services (CMS) has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing contains the name and national provider identifier (NPI) of each provider sent a letter, as well as the date the letter was sent. Click here to view the full listing (Revalidation Phase 1). Please note there are two sheets included in this Excel workbook. CMS will be updating this list in the download section of the Medicare Provider Supplier Enrollment Revalidation page on a monthly basis. If you are listed and have not received the request, please contact Palmetto GBA Provider Contact Center at (866) 932-3901.

Update: Supreme Court to Decide if Doctors Can Sue States Over Medicaid

Mon, 03 Oct 2011 12:06:23 GMT

Justices will hear arguments today regarding California's plan to cut Medicaid payments to doctors, hospitals, and other medical providers in an effort to address the state's budget issues. There was no consensus apparent among the justices Monday. Experts say the case has national implications because its central issue involves states' rights to regulate their Medicaid programs. Click here for background information about Douglas v. Independent Living Center of Southern California, et al., where CMA is a named party in the case. See an update of the case at http://www.washingtonpost.com/politics/health-care/first-monday-in-october-marks-start-of-new-supreme-court-term-justices-hear-to-medicaid-case/2011/10/03/gIQAVm2FHL_story.html

Supreme Court to Hear Oral Arguments in Douglas v. Independent Living Center of Southern California, et al.

Wed, 28 Sep 2011 16:04:29 GMT

This case will determine whether or not patients and providers can legally advocate for themselves

On October 3, 2011 the U.S. Supreme Court will hear oral arguments in the Douglas v. Independent Living Center of Southern California ("Independent Living Center") case. The Supreme Court’s ruling could have huge implications for the more than 10 million patients in California that are currently enrolled in California’s Medicaid program, as well as for the physicians that voluntarily treat those patients. The California Medical Association (CMA) is a party in the case. The issue addressed by Douglas v. Independent Living Center is whether or not Medicaid recipients and providers can sue a state for failing to pay the rates required by the Medicaid Act, which states that government insured and privately insured patients have equal access to medical care. As the Supreme Court hears the case, a number of state plan amendments (SPAs) submitted by the State of California sit with the Centers for Medicaid and Medicare Services (CMS). The SPAs each propose significant cuts to California’s Medicaid program, Medi-Cal. The SPAs would, among other things, cut physician reimbursement, limit the number of times a patient can see a physician per year, and implement mandatory patient co-pays. “The state plan amendments submitted by California to CMS would severely reduce Medi-Cal patients' access to medical care,” Francisco Silva, CMA General Counsel and Vice President said. “The proposed cuts would mean that a primary care physician would only be reimbursed $11 for a Medi-Cal patient visit. Physicians have to pay their staffs and keep their doors open, and these rates would just not allow for them to do that and accept Medi-Cal Patients.” Medi-Cal provides essential health care services to the poorest and most vulnerable Californians. Through Medi-Cal, physicians, dentists, pharmacists, adult day health care providers, clinics, and hospitals provide health care services to low-income seniors, families, children, and people with disabilities. By providing these primary and preventive care services, the state ensures these Californians have access to health care, while at the same time saving money by lowering the chances they will be forced to seek more costly health care, such as emergency rooms or hospital admissions. “The issue before the U.S. Supreme Court is crucial to the future of how patient advocacy will unfold,” said Theodore Mazer, MD. “If patients can’t fight for themselves, and as physicians, we can’t either--then who is left to stand up for the group of people that needs our help the most?” Mazer, a San Diego otolaryngologist treated Medi-Cal enrollees for over 20 years until the state began seeking reimbursement cuts. 18 months ago, he stopped accepting new Medi-Cal patients. He is an individual party in the lawsuit. “It’s unfortunate that the State has made us choose between accepting new Medi-Cal patients and keeping our practices viable,” Mazer added. In 2008, a coalition of health care providers including CMA sued the state of California to stop a 10% cut in Medi-Cal reimbursements. A federal appeals court ruled that Medi-Cal providers have standing to challenge the state’s rate cut and upheld the merits of the 2008 preliminary injunction that forced the state to immediately reverse the cut. The U.S. Supreme is considering this case and others with respect to whether providers and patients have legal standing to enforce the federal Medicaid law. A number of amicus briefs have been filed in support of respondents in the case, including:

Reports Detail State-By-State Impacts of Proposed Medicaid Cuts

Wed, 14 Sep 2011 15:04:56 GMT

Cutting Medicaid could leave hundreds of thousands of people across the country facing life-threatening illnesses on their own, patient advocates said today. The advocacy group Families USA partnered with the American Cancer Society, the American Diabetes Association, and the American Lung Association to determine how many people with cancer, heart disease, stroke, diabetes, and chronic lung disease depend on Medicaid. Reports from four major states—California, New York, Texas and Illinois—were released today, with more to come in the next few weeks. The reports come as the deficit supercommittee considers ways to shrink the deficit by $1.5 trillion, including massive cuts to health care entitlements like Medicare and Medicaid. “Cuts to Medicaid would pose a specific and dangerous threat to hundreds of thousands of [people] who depend on the program for regular treatment for such medical conditions as cancer, diabetes, chronic lung disease, heart disease and stroke,” the groups said in a joint statement. “Without Medicaid, many of these seriously ill [people] would no longer be able to fill essential prescriptions, keep up with key screenings or see a doctor if their condition worsens or recurs.” Click here to view the California report.