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Legislative Update:  January 6, 2016


Uncertainty Abounds Regarding the Future of the ACA

While Congressional Republicans are publically taking steps to repeal the Affordable Care Act (ACA) by the end of the month, privately there are significant disagreements about what type of system would replace it and when it would take effect. Concerns regarding how insurers will react to uncertainty in the market, the number of people who could lose their insurance and the effect a repeal could have on the national budget are some of the main issues being discussed. Many are pushing for a transition plan taking place over several years. Senate Majority Whip John Cornyn (R-Texas) has said the period could be two years or longer. CAFP’s Legislative Affairs Committee is currently reviewing the provisions of the ACA to determine which sections must be protected and continued in any new health system reform proposal and which the California legislature should consider for duplication at the state level. A full rundown of the many different possibilities, questions and options facing Congress can be found here.


Join CAFP’s Health Care Reform Fight

Are you concerned about how the recent election affects you and your patients? Do you want to take action but don’t know how? Join CAFP and family physicians from across the state in a week of action beginning March 4! The first step is to register for CAFP’s All Member Advocacy Meeting March 4-5, followed by Family Medicine Lobby Day on March 6, at The Citizen Hotel in Sacramento. Be sure to reserve your room at The Citizen Hotel soon to get the CAFP rate of $169 plus tax per night.  


When you attend the CAFP All Member Advocacy Meeting, you will:

Learn about health care policies being proposed at the state and federal level
Receive insider advice on how to inform legislators and influence policy decisions
Learn tricks and tips for honing your message
Network with like-minded colleagues from your community and around the state
Engage in face-to-face dialogue with legislators about issues affecting family medicine


Learning effective ways to advocate on behalf of family medicine and patients is more important than ever as our country is confronted with the unprecedented potential for change. Be sure to register today!


Reproductive Health Survey is Not Mandatory

This information is intended to assist you, but it is not a legal opinion. The Federal Health and Human Services Agency’s Office of the Inspector General (OIG) recently sent out a survey to clinics inquiring as to which reproductive health services offered are performed with and without federal funds. Some clinics, Federally Qualified Health Clinics in particular, have decided to suspend services because of what the survey might imply or signal. The California Primary Care Association has indicated that responding to the survey is not required by federal law because, at a minimum, it does not contain mandated information such as an Office of Management and Budget (OMB) control number. It is your decision whether to fill it out or not. If you have questions or concerns, CAFP suggests you contact your compliance officer or legal counsel for advice on how to proceed.

Residents are NOT Required to Participate in MACRA

Some CAFP members have recently inquired whether third-year residents must participate in MACRA, the new Medicare payment and reporting law. Under MACRA, physicians will need to use the new Quality Payment Program website and choose one of two different payment pathways: Advanced Alternative Payment Models (APMs) or the Merit-Based Incentive Payment System (MIPS). Residents, regardless of their year, are not considered eligible. Therefore, their first year after graduation from residency would be considered their first year as a Medicare-enrolled provider should they choose to enroll, and only then would be subject to MIPS. As an example, Dr. Smith is a PGY-3 resident, has an NPI number but still sees patients (and bills) under the supervision of her attending physician. Dr. Smith graduates from residency in June 2017 and enrolls in Medicare as an independently practicing physician with PCP Medical Group in September 2017. As such, Dr. Smiths' first year being subject to the MIPS payment adjustment would be performance year 2018/payment year 2020. Be sure to check out CAFP’s MACRA Playbook or email CAFP’s Director of Health Policy, Conrad Amenta, if you have any questions.

Save the Date for the 2017 Coding Teleconference

The “Strategies for Coding and Reimbursement: 2017 CPT Updates” teleconference with coding and practice management expert Mary Jean Sage is scheduled for Tuesday, January 31, 2017 from 12:15 pm to 1:45 pm. Register today to ensure you and your staff understand the new, edited and deleted CPT codes and rules for 2017 and get fair payment for the care you provide. Learning objectives for the event are:

Enhance understanding of changes to CPT codes, including additions, deletions and edits;
Improve practice documentation of visits and procedures;
Discuss MACRA and related shifts towards value-based care; and
Improve documentation of medical decision-making.


Also available is CAFP’s coding monograph update with brand new content for 2017. Registration is at a low price of $49 for CAFP members and $79 for nonmembers. Additionally, all participants will receive 1.5 hours of CME credit. Sign up online today or contact Sonia Kantak at 415-345-8667 for more information.