Transition of the Medicare Administrative Contract from Palmetto GBA to Noridian is scheduled for September 16, 2013 (Part B). To help physicians understand what is changing, Noridian is offering a series of Implementation 101 and EDI Support Services web-based workshops. Noridian is also holding in person “Meet and Greet” workshops at the following Bay Area location on July 18-20:
South San Francisco, CA 94080
Specific times and registration information are available on the Noridian website.
Other programs will be added as they progress through the transition. SFMS/CMA encourages physicians to join the Noridian mailing list to stay apprised of changes.
The California Legislature passed a $234-billion budget on Friday that will reduce Medi-Cal payments to physicians and other providers by 10%. The cuts were originally passed as part of the 2011-2012 budget, but were held up in court as the SFMS/CMA and other plaintiffs filed suit to stop the draconian cuts.
In January 2013, a three judge panel of the 9th Circuit court ruled that the state could move forward with the rate cuts, 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. SFMS/CMA and the other plaintiffs in the case had requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied.
Although the state is in a much better financial situation than it was in 2011 when the cuts were first passed, the 2013-2014 budget includes roughly $1 billion in Medi-Cal provider rate cuts annually.
On Saturday, the California Legislature passed legislation (AB X1-1) that would expand Medi-Cal to more than 1.4 million state residents under the Affordable Care Act. The irony of slashing rates while promising coverage to more than a million new patients has not gone unnoticed. If the state moves forward with the cuts, particularly at a time when millions of new patients will be eligible for the program, access to care will be decimated in our state, undermining the success of federal health reform.
The budget does restore dental and mental health benefits under the Medi-Cal program.
The final agreement includes $206 million to improve mental health services, including $142 million in one-time general fund money; $51 million in non-general fund money in the coming fiscal year and about $150 million the following fiscal year to boost grants for CalWORKS, California's welfare-to-work program; and $16.9 million in general fund money in the coming fiscal year and $77 million the following fiscal year to help partially restore Denti-Cal (Medi-Cal dental program) benefits for adults.
Even before the cuts, California’s Medi-Cal provider payment rates are some of the lowest in the nation. Low reimbursement rates have driven many of California’s providers from the program. As a result, 56% of Medi-Cal patients report difficulty finding a doctor. If these cuts are not stopped, Medi-Cal will become nothing more than a broken promise of access to care.
“What good does it do our communities if they have health care coverage, but cannot get in to see a doctor?" said Senator Ricardo Lara, author of SB 640, one of two CMA-sponsored bills (along with AB 900, authored by Assemblyman Luis Alejo) that will stop the Medi-Cal cuts. “If we want healthy communities we need to provide access to quality and preventative care.”
CMA has joined an unprecedented coalition of physicians, dentists, health care workers and hospitals that will continue working to stop the cuts. The coalition, called “We Care for California," includes the largest statewide organizations representing physicians, dentists, hospitals and health care workers, as well as health plans, first responders, caregivers and other health providers.
CMA and the We Care for California coalition will aggressively push for a solution to the provider cut before the end of session.
SFMS/CMA, along with the California Dental Association, the California Hospital Association, and the American Medical Association, filed an amicus brief with the California Court of Appeal defending the constitutionality of our state’s landmark Medical Injury Compensation Reform Act (MICRA), which allows non-economic damage awards up to $250,000. This case is just the latest in many legal challenges to MICRA that have been funded by trial lawyer groups from across the country.
In this case, Rashidi v. Moser, M.D., the jury awarded the plaintiff $125,000 in economic damages and $1,325,000 in non-economic (subjective pain and suffering) damages. The judge reduced the non-economic damages portion of the award to $250,000, in accordance with MICRA. The plaintiff appealed, asserting that MICRA’s cap on non-economic damages (Cal. Civ. Code Sec. 3333.2) violates California's constitutional guarantees of trial by jury, separation of powers and equal protection of the laws.
Contrary to the plaintiff’s arguments that MICRA’s non-economic damages cap “irrationally singles out the victims of medical malpractice for unfair treatment,” the cap is fairly and evenly applied. MICRA’s non-economic damages cap applies uniformly to any patient in California who is injured by medical malpractice. And every Californian benefits from the access to care that MICRA fosters.
The arguments the plaintiff asserts in this case have already been flatly rejected by the California Supreme Court. As the supreme court has explained, the Legislature clearly had a reasonable basis for drawing a distinction between economic and non-economic damages, providing that the desired cost savings should be obtained only by limiting the recovery of non-economic damages. MICRA reflects a strong public policy to contain the costs of malpractice insurance by controlling or redistributing liability for damages, maximizing the availability of medical services to meet the state’s health care needs.
Today, MICRA is working to keep premium rates in California low and stable, while states without liability reform are seeing dramatically higher premiums. Because of MICRA, California has a system that is affordable, compensates patients for their full medical and economic losses, and promotes patient safety and improved patient care.
MICRA allows patients with substantiated medical negligence claims to receive the following forms of compensation:
MICRA also includes a sliding pay scale to control attorney contingency fees, ensuring that more money goes to patients, not lawyers. MICRA’s $250,000 cap on non-economic damages has proven to be an effective way of limiting meritless lawsuits and keeping health care costs lower, but has been targeted by the trial lawyers because it restricts the amount of money they can collect in attorney’s fees.
Several California counties, including San Francisco, were listed among the 50 healthiest counties for children in the U.S., according to an analysis by U.S. News & World Report.
The rankings were developed with help from the University of Wisconsin Population Health Institute, which analyzes U.S. health data as part of its County Health Rankings and Roadmaps program.
Researchers evaluated 1,200 of the nation's 3,143 counties. The rankings highlighted counties with lower rates of:
Eleven California counties were listed among the nation's 50 healthiest counties for children, including:
Source: California Healthline, June 11, 2013.
This month's San Francisco Medicine focuses on Pediatric and Adolescent Safety. Highlights include list of free summer activities available to kids, ergonomics in the age of computers and video games, prevention tips for summer and team sports, clinicians' guide for dealing with bullying, and many more!
Reports began circulating that legislative leadership—the Speaker and Senate Pro Tem—had come to agreement on the major pieces of a budget ‘deal’ with Governor Brown. SFMS/CMA has been working to uncover the details and determine the main pieces of relevance to physicians.
To our knowledge, the deal does not include a fix for the rate cuts. Right before the public announcement of a deal, CMA was joined by the Calfiornia Hospital Association and SEIU-UHW in a meeting with Senate President Pro Tem Darrell Steinberg. In discussing the rate cuts, the Pro Tem committed to going to the Governor with the Speaker and securing a delay in implementing the AB 97 cuts until January 1, 2014 at the earliest, in order to allow time for a late summer/August legislative proposal to secure more funding in the Medi-Cal system through the state paying a higher rate for the expansion population (that rate increase being entirely federally funded for three years). We are anticipating receipt of a written agreement to delay within the next couple days.
There isn't much information about what form the managed care organization (MCO) tax would take in the ‘deal’. The health plan community still doesn’t know what form the MCO takes in the deal and if they’re opposed or not. They want CMA’s support in ‘dividing the question’ and only having one year (2012-13) of MCO, at only the MCO rate to fund finally paying the Healthy Families plans. They do not want to discuss the higher sales tax rate and where that funding stream should go until after the first of July, when they see their rates for next year.
We haven’t heard much yet about the county funding scheme, but have heard many rumors about a variety of potentially problematic proposals being included in the arrangement, potentially including an extension of the Low Income Health Programs/LIHPs as well as a potential renegotiation of the 2010 Medi-Cal 1115 Waiver, which doesn’t expire until 2015. The contents of the county funding arrangement will likely impact CMA’s positioning on the remainder of the budget items impacting physicians due to its pivotal role in the restructuring and expansion of the Medi-Cal system in preparation for health reform implementation in 2014.
The conference committee adopted action to appropriate $15 million to UCR. Their action seemed to have included the money but instead of appropriating additional funds, it was taken out of the existing UC appropriation.
The bicameral Budget Conference Committee finished their work just before 9:30 pm on June 10. Of note, the Pro Tem’s Mental Health Wellness package was approved ($142.5 million), and the DP-SNF facilities did not have their rates restored from the 2008/09 level instituted in AB 97 to the current year level, as originally proposed in the Senate Budget Subcommittee #3 on Health and Human Services.
More details should be emerging about the contents of the full deal in the coming days. SFMS/CMA will continue to keep you apprised of the situation as we receive updated information.