Legislative News
Read the latest legislative news from CAFP
December 22, 2011
December 16, 2011
December 9, 2011
December 2, 2011
November 18, 2011
November 10, 2011
October 28, 2011
October 7, 2011
September 30, 2011
Congress Fails to Avert the Near-30 Percent Medicare Payment Cut – TAKE ACTION NOW!
In less than two months, the Sustainable Growth Rate (SGR) formula that sets Medicare physician payment will reduce the Medicare payment rate by nearly 30percent. Attempts to delay the cut have been caught up in political grandstanding, threatening your practices and access to care for millions of seniors. We must ensure that EVERYONE in Congress knows the hardship created by this political game of chicken. Our legislators need to put aside partisan politics and repeal the SGR. Your national and state Academies have been working hard to pressure Congress to do the right thing, BUT WE NEED YOUR HELP.
HOW YOU CAN TAKE ACTION
Please contact your Representative and Senators immediately. Urge them to:
- Demand a positive, stable Medicare payment rate for at least three years;
- Ensure at least a three percent positive payment differential for primary care compared to other specialties to begin to address the imbalance in our health care delivery system that drives up costs; and
- End patients’ health insecurity by averting the draconian Medicare physician pay cut and establishing a permanent change to the Medicare payment formula. No other sector of the business community is routinely subjected to this variability and uncertainty
Find the contact information for your Representatives here: http://house.gov/representatives/find/.
You Senators’ contact information is:
Barbara Boxer – 202-224-3553
Dianne Feinstein – 202-224-3841
For more information on the SGR and how your Academy has been fighting for you, please go here: http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20111220housesgraction.html.
State Revenues Fall Short; Governor Announces Trigger Cuts
The state must cut nearly $1 billion from education, public safety and health and social services as part of a set of “trigger cuts” created by last year’s budget agreement and the resulting shortage of state funds. The Department of Finance estimates that the state will fall $2.2 billion short of the projected revenue needed to avoid the cuts. These measures serve as a precursor to what will most likely be an austere 2012-13 budget that the Governor will propose in early January and will undoubtedly affect your practice and patients. The nonpartisan Legislative Analyst’s office is projecting a $13 billion shortfall next year.
The mid-year cuts include:
- $529 million from the UC/Cal State systems, community colleges and K-12 schools.
- $102 million from public safety services.
- $100 million from developmental disability services.
- $100 million from In-Home Supportive Services (IHSS).
- $15.9 million from local libraries.
- $8.6 million in Medi-Cal managed care provider payment cuts and increased co-pays.
In-depth budget calculations can be found here: http://www.dof.ca.gov/documents/2012_Rev_Forecast_Determination.pdf
Will “Dual Eligible” Demonstration Project Affect Your Patients?
This week, CAFP participated in a Department of Health Care Services (DHCS) stakeholder meeting concerning consumer protections for patients who are eligible for both Medicare and Medi-Cal, also known as Dual Eligibles. Many of the stakeholders in attendance raised concerns about beneficiary control and choice in their treatment options. Consumer groups stressed their desire for medical home services, including improved communication and accessibility, seamless transition and care continuity, network adequacy and person-centered care. DHCS is holding meetings throughout the state to receive input on a new Dual Eligible Demonstration Project intended to better coordinate beneficiary care and save costs. Follow this link to learn more: http://www.dhcs.ca.gov/provgovpart/Pages/DualIntegrationDemonstration.aspx
After Residency Visit, Rep. Thompson to Co-Author Federal GME Bill
Representative Mike Thompson (D – Napa) has agreed to co-author a graduate medical education (GME) bill after touring the Santa Rosa Family Medicine Residency Program (SRFMRP) in September. During the tour, Rep. Thompson discussed GME funding strategies and the pilot project legislation with SRFMRP Program Director Jeff Haney, MD and CAFP Associate Director of Health Care Workforce Policy Callie Langton. The pilot would help determine the effectiveness of reallocating funds for physician-training programs, including directly funding programs such as the SRFMRP, thereby ensuring funds are spent on family medicine. The “Primary Care Workforce Access Improvement Act of 2011”, HR 3667, is sponsored by AAFP and the Council of Academic Family Medicine, has bipartisan support (co-authored by Representative Cathy McMorris Rodgers (R-WA)) and requires no new funding streams. To learn more, follow this link: http://mcmorris.house.gov/index.cfm?sectionid=96§iontree=25,96&itemid=2016
CAFP Meets with Senator Simitian to Discuss Dense Breast Bill
The Academy met this week with Senator Joe Simitian (D – Palo Alto) as part of a larger coalition (led by the California Medical Association and American Congress of Obstetricians and Gynecologists) that continues to raise concerns regarding a bill he introduced last session. The bill would require that mammography-results letters indicate if a woman has highly dense breasts and, if so, inform her that mammography may not be able to pick up small and state that additional screening might be necessary. Despite the concerns raised previously and at the meeting, the Senator intends to move forward with similar legislation next year. A nearly identical bill by the Senator was vetoed last year by Governor Jerry Brown. While CAFP believes a patient has the right to know about her breast type, there is concern that the way in which patients are informed under this bill changes the standard of medical care. Please click the following link to see the current language of the bill, including the exact wording of the notice the patient would receive: http://leginfo.ca.gov/pub/11-12/bill/sen/sb_0151-0200/sb_173_bill_20110815_amended_asm_v94.html
Register for CAFP's Congress of Delegates and Advocacy Day!
CAFP will be providing multiple in-depth legislative trainings at the 2012 Congress of Delegates (March 3-5) at the Citizen Hotel in downtown Sacramento. You don’t need to be a delegate to participate in the trainings – just email us and let us know that you are interested in attending the March 4 legislative trainings. After the training sessions, join us for our Family Medicine Lobby Day the next morning where you and dozens of your colleagues will head over to the Capitol to meet with legislators and put your new knowledge into action. This is a unique opportunity to let your lawmakers know the importance of family medicine and what they can do to advance family medicine practices and the health of your patients. Join us and let family physicians' collective voice be heard in the halls of the State Capitol in Sacramento.
Congress of Delegates: March 3-4
Key Contact Trainings: March 4
Family Medicine Lobby Day: March 5
To read more about the Congress, please go here: http://www.familydocs.org/about-cafp/leadership/congress-delegates.php
Insurance Commissioner Jones Meets with CAFP, HEART
CAFP participated in a meeting on Wednesday with the newly formed HEART coalition to discuss ways in which the group can best deliver their message to California’s Health Exchange Board. HEART is a statewide alliance of California health care stakeholders committed to the success of California’s Health Benefits Exchange. HEART’s goals are to optimize patient outcomes, reduce growth in health care costs, and drive continuous quality improvement through a properly designed “smart” Health Benefits Exchange that promotes robust market competition among health plans, enables consumers to make informed decisions, and assures that consumers have access to team-based, coordinated care (like the care found in a medical home). Insurance Commissioner Dave Jones was a special guest at the meeting and spoke about the importance of what the coalition is doing and the value of team-based care.
ACTION REQUESTED – Help CAFP to Support Medi-Cal Payment Lawsuit
As you may know, CAFP is part of a coalition led by the CMA that is suing to stop the recently-approved 10 percent Medi-Cal provider payment rate cuts. As part of that effort, CAFP and the coalition are gathering declarations from physicians who are willing to discuss how these cuts will hurt their practices, patients and communities. These declarations are very important in bolstering our case. Because pediatric, FQHC and rural clinic services are exempt from the cuts, the declarations must come from physicians who participate in fee-for-service Medi-Cal for adult patients. These cuts are detrimental to patients' health and will greatly limit their access to care. We must do what we can to prevent them.
If you can participate in a declaration or know any family physicians who could, please contact us AS SOON AS POSSIBLE. Thank you.
ACTION REQUESTED – Help CAFP to Support Medi-Cal Payment Lawsuit
As you may know, CAFP is part of a coalition led by the CMA that is suing to stop the recently-approved 10 percent Medi-Cal provider payment rate cuts. As part of that effort, CAFP and the coalition are gathering declarations from physicians who are willing to discuss how these cuts will hurt their practices, patients and communities. These declarations are very important in bolstering our case. Because pediatric, FQHC and rural clinic services are exempt from the cuts, the declarations must come from physicians who participate in fee-for-service Medi-Cal for adult patients. These cuts are detrimental to patients' health and will greatly limit their access to care. We must do what we can to prevent them.
If you can participate in a declaration or know any family physicians who could, please contact us AS SOON AS POSSIBLE. Thank you.
ACTION REQUESTED – Act Now to Avert 27.4% Medicare Payment Cut
With Congress’ Deficit Joint Select “Super” Committee having failed to agree on the more than$1.5 trillion in spending cuts and deficit reductions needed to stave off an across-the-board cut in federal spending, the last opportunity to avert an early 30 percent cut to Medicare payment is for Congress to act before the end of the year. Follow this link to find out how you can tell Congress to fix the Sustainable Growth Rate (SGR) formula and prevent this disastrous cut to Medicare: http://www.aafp.org/online/en/home/policy/grassroots/fam-med-matters/sgr-take-action.html
Health Benefits Exchange Meets at CAFP Offices
At the behest of California Health Benefits Exchange (HBEX) Executive Director Peter Lee, CAFP hosted a recent meeting of the Exchange Advisory Committee on Eligibility and Enrollment. Representing the Academy at the meeting was CAFP member and Medical Director for the San Francisco Health Plan, Kelly Pfeifer, MD. Representing CAFP at other HBEX meetings around the state this month will be CAFP District VI Board member Adriana Padilla, MD, and Marianne McKennett, MD. Starting in 2014, the California HBEX will make it easier for individuals and small businesses to buy health insurance on the private market by making information about health plans available in an easy-to-understand format, including:
- a website that provides standardized comparison information on plan benefit plans/options;
- a calculator for applicants to compare costs across plan options;
- a web-based eligibility portal to help link individuals to health coverage options available to them; and
- a toll-free consumer assistance hotline.
To read more about the HBEX, please go to: http://www.healthexchange.ca.gov/Pages/Default.aspx
CAFP Becomes Founding Member of HEART Coalition
In March 2011, CAFP was approached by the CEO of America’s Agenda (a group of national labor unions, businesses, health care providers, and government leaders advocating for universal health care coverage) to become a founding member of a California coalition called HEART (Healthcare Exchange Advocacy and Responsibility Team). HEART is a statewide alliance of California health care stakeholders committed to the success of California’s Health Benefits Exchange. HEART’s goals are to optimize patient outcomes, reduce growth in health care costs, and drive continuous quality improvement through a properly designed “smart” Health Benefits Exchange that promotes robust market competition among health plans, enables consumers to make informed decisions, and assures that consumers have access to team-based, coordinated care (like the care found in a medical home). The CAFP Board recently approved of HEART’s Mission Statement and Policy Principles, adding CAFP to the other founding organizations.
Chronic Care the Focus of Coalition Meeting
As a founding member of the California Chronic Care Coalition, CAFP met this week with Secretary of the California Health and Human Services Agency and Chair of the California Health Benefit Exchange Board, Diana Dooley; HBEX Chief Operations Officer, David Maxwell-Jolly, Director of the California Department of Health Care Services Toby Douglas, and Director of the California Dept. of Public Health (and CAFP member) Ron Chapman, MD. The purpose of the meeting was to discuss statewide pilots for those with chronic conditions, including the upcoming dual eligible demonstration project, and the need for more integrated management services for people with chronic conditions. CAFP and the CCCC have advocated for the role the patient centered medical home can play in improving quality of care. To read more about the CCCC, please go to: http://www.chroniccareca.org/
Former LAC Committee Member Appointed to CARB
CAFP member Alex Sherriffs, MD was recently appointed to the governing board for both the San Joaquin Valley Air Pollution Control District and the California Air Resources Board (CARB). He is a former member of CAFP’s Legislative Affairs Committee, a yearly FP-PAC contributor, and a past president of the Fresno-Madera Medical Society. He is also CAFP’s member of the month. Congratulations Dr. Sherriffs! http://www.familydocs.org/member-of-the-month/alex-sherriffs-md.php
CAFP to Support CMA Lawsuit
CAFP’s Board of Directors voted unanimously to provide financial support for a coalition lawsuit led by the California Medical Association (CMA) challenging CMS’s recent approval of California’s 10 percent Medi-Cal provider rate cuts, retroactive to June 1. The State has agreed to forestall the cuts until two similar cases are heard on December 19. We will apprise you of details, following Monday’s filing. In the meantime, please go to: http://www.businesswire.com/news/home/20111003006540/en/California-Pharmacists-Association-California-Medical-Association-Files
More Bad Budget News
The Legislative Analyst’s Office (LAO) is recommending that policymakers address a projected $12.8 billion state budget gap between now and the regular 2012-2013 budget process. The 2011-12 budget package assumed a total of $88.5billion of General Fund revenues and transfers. The budget also contained two tiers of trigger cuts that would take effect if 2011-12 revenues dipped below the amount assumed in the budget package: Tier 1 Cuts include, among others, a reduction in funding for developmental services, In-Home Supportive Services (IHSS), and “Extending Medi-Cal provider cuts and copayments to all managed care plans.” The Tier 2 cuts are listed only as “Prop. 98 reductions” but they include education related cuts. LAO’s recommendations include all of Tier 1 cuts and some of Tier 2 cuts. For more information, please go to: http://www.lao.ca.gov/reports/2011/bud/fiscal_outlook/fiscal_outlook_2011.pdf
CURES Program Threatened
California’s Controlled Substance Utilization Review and Evaluation System (CURES), proven effective in battling doctor-shopping prescription drug addict activities, will be among the $70 million cuts made by the Department of Justice, the Attorney General’s office announced last week. Governor Brown warned earlier this year that programs such as CURES could be on the chopping block if lawmakers insisted on solving the state’s gaping budget deficit without extending previous taxes. CAFP and the California Society for Addiction Medicine have teamed up to explore possible solutions to the pending cut. For more information, please go to: http://abclocal.go.com/kfsn/story?section=news/politics&id=8426062
New PCMH Bill Co-Sponsor
The California Medical Association has signed on as a co-sponsor of Senate Bill 393 (Hernandez) that will provide a definition of the Patient Centered Medical Home (PCMH) under California law. In addition to CAFP and CMA, the bill’s other co-sponsors include: the California Chapters of the American Academy of Pediatrics, California Academy of Physician Assistants, California Association for Nurse Practitioners, California Primary Care Association, California Psychiatric Association, Osteopathic Physicians and Surgeons of California and the American College of Physicians, California. Thank you CMA! For more information about SB 393, go to: http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0351-0400/sb_393_bill_20110531_amended_sen_v98.html
CAFP Board Appoints Ashby Wolfe, MD, MPP, MPH to Chair LAC
Ashby Wolfe, MD, was appointed by the CAFP Board on Saturday to succeed Taejoon Ahn, MD, MPH as the Chair of CAFP’s Legislative Affairs Committee. Dr. Wolfe had extensive experience as a legislative policy advocate at her residency program and in her policy work with CAFP on issues ranging from the Medical Injury Compensation Reform Act (MICRA) to health care reform. She accompanied CAFP staff member Leah Newkirk to a meeting in San Francisco with a representative of the Centers for Medicare and Medicaid Services (CMS) about the impact of the state’s proposed cuts to Medi-Cal payments to physicians and spoke knowledgeably (since she is a former CMS staff member). She organized a Health Policy and Advocacy Committee (HealthPAC) at UC Davis to provide a forum for medical students, residents and faculty from multiple departments to discuss active health policy issues that affect the health and well‐being of their patients. Her two additional degrees – Masters of Public Health and Masters of Public Policy – will be put to good use in helping her advocate for family physicians and their patients. For more information about Dr. Wolfe, please go to: http://www.familydocs.org/member-of-the-month/ashby-wolfe-md-mpp-mph.php
CAFP Meets with DHCS on Health Home Option
CAFP past presidents Carla Kakutani and Bo Greaves, and Executive Vice President Susan Hogeland met by phone with leaders and consultants from the California Department of Health Care Services (DHCS) on Tuesday to discuss how the state intends to move forward on the Affordable Care Act’s (ACA) “Section 2703” Health Home Option. While this was just the first of many meetings on the topic, the ultimate disposition of DHCS on Health Homes may have far reaching implications for the future of California’s patient centered medical homes (PCMH) and pending CAFP co-sponsored legislation, SB 393 (Hernandez).
Consistent with Section 2703 of the Patient Protection and Affordable Care Act of 2010, CMS has provided states with an option to amend their state plan (SPA) to include enhanced funding (a 90-10 state-federal match rather than the current 50-50 for two years) as incentives for the creation of health homes for Medi-Cal beneficiaries with chronic conditions. For its approval by CMS, the SPA must encourage a person-centered system of care focusing on improved outcomes and better services and value for children and adult beneficiaries (including dual eligibles, if requested) of the Medicaid program with a mental health condition, a “substance use disorder,” asthma, diabetes, heart disease or obesity.
During the hour-long phone call between DHCS, its consultants and CAFP, DHCS indicated its current plan is to identify services providers already offer in health homes in order to draw down the 90 percent federal match for the state in a “revenue neutral” fashion (meaning no additional incentives will be provided for participating providers or provider organizations), rather than spur growth of the PCMH model through incentives. Given the state’s current fiscal bind, this should come as no surprise. CAFP will advocate for the value of health home incentives for cost savings, improved quality and improved network availability. For a more detailed description of program criteria, please go to: http://www.chcs.org/usr_doc/Health_Homes_FAQs_101211.pdf
CAFP Well-Represented at AAFP State Legislative Conference
FP-PAC Chair Carla Kakutani presided over AAFP’s State Legislative Conference this past weekend in Salt Lake City in her new capacity as Chair of the AAFP’s Commission on Governmental Advocacy. Representing CAFP in her new capacity as LAC Chair was Ashby Wolfe, MD. Drs. Kakutani and Wolfe say the take-away messages from the meeting were: 1) many other states are wrestling with the same Medicaid problems that we are in California, but are addressing them in a more “holistic” fashion, i.e., realizing that PCMH contributes to efficiencies, not cost; 2) California seems to be more aggressive in its implementation of the Patient Protection and Affordable Care Act (PPACA) than other states (particularly as it intends to implement the Health Benefit Exchange provision); and 3) humane end-of-life care and palliative care are re-emerging in the “patient-centeredness” policy debate.
Feds Approve California’s 10 Percent Medi-Cal Payment Cut – TAKE ACTION NOW!
Yesterday, the Department of Health Care Services (DHCS) announced that the federal Centers for Medicare & Medicaid Services (CMS) had approved of the 10 percent ($623 million) Medi-Cal provider payment cut currently prevented by a federal court injunction.
YOUR ACTION IS NEEDED IMMEDIATELY!
DHCS is continuing its discussions with CMS to obtain approval of other pending proposed budget reductions, including instituting a soft cap of seven visits for physicians and clinics, and requiring beneficiary copayments on most Medi-Cal-covered services.
Call your state and federal legislators THIS WEEK and let them know the effect this cut and the other proposed changes will have on your patients and your practice. You can find the contact information of your state representatives here: http://192.234.213.69/amapsearch/framepage.asp
You can find the contact information of your Congressional representative here: http://house.gov/htbin/findrep?ZIP=
Please use these talking points (http://www.familydocs.org/files/11ADV_TalkingPoints-PreventStatePlanAmendments10-28-11.pdf) on your call and please let CAFP know who you have contacted by emailing us.
Background
Until yesterday, more than $1.7 billion in Medi-Cal cuts were not permitted unless approved by the federal government, including the 10 percent Medi-Cal provider rate cut, a “soft cap” seven visit limitation to physicians and clinics, and increased co-pays and premiums for Medi-Cal and Healthy Families patients. The state needs CMS approval of State Plan Amendments to make the co-payment and soft-cap changes.
Three proposals, however, have been approved by CMS:
- A 10 percent cut to provider payment on a number of outpatient services, including physicians, clinics, optometrists, therapists, laboratories, dental, durable medical equipment and pharmacy.
- A 10 percent cut to provider payment for freestanding nursing and adult subacute facilities.
- A 10 percent cut to provider payment and a rate freeze for distinct part/nursing facility-B services.
The approved cuts are retroactive to June 1, 2011 and vary between five and ten percent. CAFP issued an immediate press release denouncing this move by CMS and the continued efforts of DHCS to push costs onto the very beneficiaries who cannot afford care and on those who provide that care. In the release, CAFP President Carol Havens, MD stated, “We are disappointed and disillusioned by CMS’s approval of the state’s disastrous plan to reduce payments. While DHCS leaders claim that they have developed a “unique monitoring plan” that will collect data to ensure that access to care is not compromised as the reductions are implemented, patients and providers from every region in California know that access to care for Medi-Cal patients has long been in jeopardy because so many physicians simply cannot afford to provide this care. Even without this cut, California’s Medicaid payments are among the lowest in the nation.”
On August 4, CAFP member Kara Odom Walker, MD, MPH, MSHS represented CAFP in high-level meetings with the Administrator of CMS, Donald Berwick, MD, MPP, the Director of the Center for Medicaid and State Operations, Cindy Mann, and several other key CMS staff, as well as with the staffs of numerous members of the California delegation, urging them to halt state cuts to the Medi-Cal Program. CAFP was there as part of a CMA-organized coalition of patients and providers, known as the Alliance for Patient Care, advocating against major cuts to Medi-Cal contained in the 2011-12 California state budget. During the meetings, Dr. Odom Walker relayed how difficult it was for Medi-Cal patients to obtain health care and the likelihood of that worsening should the cuts take effect. CAFP has long asserted that providers will no longer be able to participate in the Medi-Cal program if it is continually decimated by short-sighted state efforts to reduce costs. In addition to these advocacy efforts with government agencies in Sacramento and Washington, CAFP continues to support litigation that has so far prevented the Medi-Cal cuts from being implemented. This litigation is still pending in the Supreme Court, but a decision is expected before spring 2012.
Though it has yet to be released, DHCS’s framework for monitoring access to the Medi-Cal health care system includes such factors as the state’s population demographics and health composition, national and state economic and political influences, realized beneficiary access to health care services and health care outcomes. DHCS selected 23 measures identified in three areas (beneficiary measures, provider availability and service use and outcomes) of a Medicaid and CHIP Payment and Access Commission’s report to Congress. The services analyzed included physician/clinic services, pharmacy, durable medical equipment, transportation, various long-term care services by facility type and other outpatient services. Based upon the analyses, DHCS concluded there were some areas where an additional 10 percent payment reduction was not advisable: DHCS is not moving forward with a 10 percent reduction to physician/clinic services for children, home health services, or distinct part subacute facilities.
DHCS claims they will be implementing a “unique monitoring plan that will collect data to ensure that access to care is not compromised as the reductions are implemented.” CAFP will participate in a stakeholder meeting next week to learn more about DHCS’s plan and voice our strong opposition to these measures that only serve to hurt the move vulnerable Californians.
Big Win for FPs as Governor Signs 15 of 16 CAFP-Supported Bills
On Sunday, Governor Jerry Brown took final action on the hundreds of bills that made it through the legislative session. In a resounding victory for family physicians and their patients, the Governor signed 15 of 16 CAFP-supported bills. Highlights include legislation to improve maternity coverage, facilitate prior authorization of prescription drugs, and bills implementing health care reform. In addition, all CAFP-opposed bills we're vetoed by the Governor, including bills for which the Academy took an "Express Concern" position. Thank you to all of the Key Contacts who supported CAFP's advocacy efforts throughout the year. A big “thank you” also goes out to the many stakeholders and health care groups that worked tirelessly to see these bills passed. We look forward to another successful year in 2012!
CAFP-Supported Bills Signed by the Governor
AB 210 (Hernández) – CAFP position: Support
This new law will ensure maternity benefits will be covered in all group health plans.
AB 415 (Logue) – CAFP position: Support
Authored by the Vice Chair of the Assembly Health Committee, Dan Logue (R - Chico), this new law will update and clarify current telehealth law.
AB 581 (John A. Pérez) CAFP position: Support
This new law will create the California Healthy Food Financing Initiative (CHFFI), the CHFFI fund and the CHFFI Council, for the purpose of expanding access to healthy foods in underserved communities.
AB 1296 (Bonilla) – CAFP position: Support
This new law will enact the Health Care Eligibility, Enrollment, and Retention Act, which requires the California Health and Human Services Agency to establish a standardized single application form and related renewal procedures for public health programs.
AJR 10 (Brownley) – CAFP position: Support
This resolution memorializes the Legislature's support for the school-based health center program authorized by the federal Patient Protection and Affordable Care Act, an appropriation by the United States Congress to fund this program, policies that include school-based health centers as a partner in creating a medical home for all children, and the inclusion of school-based health centers in the reauthorization of the federal Elementary and Secondary Education Act.
AJR 13 (Lara) – CAFP position: Support
This resolution urges the President and the Congress of the United States to continue to provide resources to increase the supply of physicians in California and to consider solutions that would increase the number of graduate medical education residency positions.
SB 41 (Yee) – CAFP position: Support
This new law will increase access to, and counseling for, the use and safe disposal of hypodermic needles and syringes by extending an exchange pilot program.
SB 51 (Alquist) – CAFP position: Support
This new law will give enforcement authority to the state to fully implement the medical loss ratio provisions (premiums dollars spent on patient care versus profits/administration) of the Patient Protection and Affordable Care Act (PPACA) and related regulations. By implementing broader protections to California consumers by conforming state law to federal health care reform, this bill helps make vital health care dollars more available for the actual care of Californians.
SB 222 (Evans) – CAFP position: Support
This new law will ensure maternity benefits are covered in all individual health plans.
SB 299 (Evans) – CAFP position: Support
This new law will prohibit an employer from eliminating or refusing to pay for health care coverage while an employee takes pregnancy or childbirth leave under a group health plan.
SB 543 (Steinberg) – CAFP position: Support
This new law will restrict the PT Board from disciplining physical therapists based solely on their employment in a medical, podiatric, or chiropractic corporation for one year, and allows time to develop a more comprehensive solution to this ambiguity in existing law while protect the jobs of thousands of physical therapists who currently work in medical corporations. Recently, the California Office of Legislative Counsel released a legal opinion arguing that physical therapists (PTs) cannot be employed by any professional corporation except those owned by PTs or naturopathic doctors. This ruling would have essentially changed the professional relationship physicians have held with PTs for years and punish those who do not end that relationship.
SB 614 (Kehoe D) – CAFP position: Support
This new law allowed a pupil in grades 7 through 12 to conditionally attend school for up to 30 calendar days beyond the pupils first day of attendance for the 2011-12 school year if that pupil had not been fully immunized with all pertussis boosters appropriate for the pupil's age. Dozens of school districts reported that pupil compliance with the original July 1, 2011 pertussis immunization deadline was alarmingly low. This law was an effort to balance public health concerns with cost concerns while still maintaining a deadline for immunization.
SB 746 (Lieu) – CAFP position: Support
This new law will make California the first state to prohibit persons less than 18 years of age from using ultraviolet tanning devices in tanning salons. This law will help to combat the rise in Melanoma, the deadliest form of skin cancer.
SB 866 (Hernandez) – CAFP position: Support
This new law directs the Departments of Insurance and Managed Health Care and stakeholders to jointly develop a standardized prior authorization form for prescription drugs by July 2012. It specifies that the form cannot exceed two pages and must be electronically available and transmittable. It requires health plans and insurers to use the standardized form for all prior authorization requests by January 2013. It also specifies that if a plan or insurer does not use the form, or fails to respond within two business days (previous law required a response in five business days), the prior authorization is deemed approved. Under current law, a health plan must have a clinical reason for denying a claim. If a prior authorization is denied, a patient or physician can still file a grievance through the Department of Managed Health Care, which has the ability to overturn the decision.
SB 946 (Steinberg) – CAFP position: Support
This new law requires health insurance plans to provide coverage for behavioral health treatment for individuals with autism.
Bills Vetoed by the Governor
SB 747 (Kehoe) – CAFP Position: Oppose
This bill would have required health care providers to take continuing medical education (CME) on cultural competency, sensitivity, and best practices for providing adequate care to lesbian, gay, bisexual and transgender (LGBT) persons. While CAFP appreciated the intent of the bill (to help address health concerns specific to the LGBT population), we oppose attempts to require CME through legislative mandate.
SB 791 (Simitian) – CAFP Position: Express Concern
This bill had the laudable goal of giving women more control over their health by providing information to those found to have highly dense breasts. The bill required that mammography-results letters inform these women that mammography may not be able to pick up small abnormalities in highly dense breasts and that additional screening might be necessary. Mammography is not a perfect screening tool for women at ANY level of breast density; nor is an ultrasound or MRI. Screening tests, by their nature, are a balance of cost, risk and benefit. As patient advocates, family physicians believe in a patient’s right to know about her breast type, but the data was not clear that additional benefits would be be gained by this bill. It is clear that this bill would unnecessarily increase costs, patients’ health concerns and the time spent by primary care physicians with their patients explaining the meaning of this notice.
Governor Signs Four CAFP Priority Bills as Sunday’s Deadline Looms
Family physicians across the state were pleased to see Governor Jerry Brown sign four CAFP-supported bills this week. Three of the four signed bills will improve maternity coverage. Senate Bill 220 (Evans) and AB 210 (Hernandez) require that every health insurance policy provides coverage for maternity services. SB 299 (Evans) prohibits employers from refusing to maintain and pay for coverage under group health plans for women who take maternity leave. Thank you to all the CAFP Key Contacts who let the Governor know how important these bills are for mothers and families.
The Governor also signed SB 543 (Steinberg) which prohibits the Physical Therapy Board from disciplining physical therapists (PTs) based solely on their employment in a medical, podiatric or chiropractic corporation for one year. The bill allows time to develop a more comprehensive solution to an ambiguity in existing PT employment law while protecting the jobs of thousands of physical therapists who currently work in medical corporations.
CAFP Staff Gives Presentation at UC Davis FM Town Hall
CAFP Director of Government Relations, Tom Riley, addressed a packed house at the UC Davis Family Medicine Town Hall meeting earlier this week. Riley discussed the recent compromise on the federal debt ceiling, looming changes within Medi-Cal, and the state’s ongoing fiscal crisis. Riley said that the combined effect of these will be a “new reality” in California health care for the poor. Mr. Riley described the role that family medicine residents must play, beyond that of clinician, to be advocates for smart change and pledged CAFP’s continued support in helping them make their voices heard.
Institute of Medicine Releases Recs for Essential Health Benefits
The National Academy of Science’s Institute of Medicine (IOM), an independent board that advises the government on health policy, released its nearly 300 page report recommending the criteria and methods the Department of Health and Human Services (HHS) should use in developing the policies offered to individuals and small businesses on the health insurance exchanges created under the Affordable Care Act. Roughly 26 million Americans will get coverage through the new exchanges by 2016, according to the Congressional Budget Office. While the report lays out general guidelines and priorities, it leaves the task of identifying specific benefits to HHS (which are expected to be announced in 2012). Early analyses of the report’s recommendations show a bias towards affordability over more robust and comprehensive benefits. According to the report, the Essential Health Benefits (which can also be thought of as the minimum level of coverage than any health insurance plan is allowed to provide), must be “affordable, maximize the number of people with insurance, protect the most vulnerable individuals, promote better care, ensure stewardship of limited financial resources by focusing on high value services of proven effectiveness, promote shared responsibility for improving our health, and address the medical concerns of greatest importance to us all.” Please go here to read more: http://iom.edu/Reports/2011/Essential-Health-Benefits-Balancing-Coverage-and-Cost.aspx
Rep. Thompson Visits Santa Rosa FMRP, Discusses Possible Pilot
Representative Mike Thompson (D – Napa) toured the Santa Rosa Family Medicine Residency Program (SRFMRP) at the behest of CAFP Wednesday morning and discussed graduate medical education (GME) funding strategies. Representative Thompson is a member of the Health Subcommittee of the powerful House Ways and Means Committee. CAFP, along with the American Academy of Family Physicians and Society of Teachers of Family Medicine, is encouraging Representative Thompson to support legislation creating pilot projects to study the effectiveness of changing the way physician-training programs are funded, including sending funds directly to programs such as the SRFMRP.
CAFP Works to Protect FPs, Patients Under Proposed Visit Cap
CAFP participated this week in a stakeholder meeting with the Department of Health Care Services (DHCS) to provide input regarding how the state intends to implement the proposed “soft cap” on the number of visits a Medi-Cal patient can make to clinics and physicians. CAFP advocated our strong opposition to the concept in general, and urged DHCS to make the process by which physicians may grant exemptions to the “soft” seven-visit cap as easy as possible. CAFP stressed that this new policy will have a chilling effect on providers accepting Medi-Cal patients who are new to them or their system and, combined with the two other proposals passed this year (to reduce Medi-Cal provider rates by 10 percent and increase co-pays), will drive many physicians out of the Medi-Cal provider network at precisely the time when more are needed in preparation for federal health care reform implementation.
Physician Exceptions to the Cap
The limit is called a “soft cap” because the law allows exemptions to the cap. The cap can be exempted if a physician certifies that a lack of treatment will result in emergency department or inpatient admission, a disruption in ongoing medical therapy, or that the visit is part of the assessment and form completion for seeking or receiving in-home supportive services (IHSS). There are also exceptions for specific populations: Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program patients under age 21, pregnant women, recipients of specialized mental health plans, and long-term care recipients in skilled nursing facilities. Medi-Cal managed care organization payments will simply be reduced in lieu of the cap.
Background
As part of the 2010-2011 state budget, legislators approved limiting the number of visits that a Medi-Cal beneficiary may make to a clinic or physician to seven per year. Physicians who treat Medi-Cal patients exceeding the seven “non-exempt” visits within the fiscal year will not be paid for those services. Because this cap is not currently allowed under California’s Medicaid agreement with the federal government, the state applied for a State Plan Amendment (SPA) in July (which is separate from the SPA request for the 10 percent reduction in Medi-Cal payment rates and increased mandatory co-pays). The Centers for Medicare and Medicaid Services (CMS) must approve, deny or request modification to the SPA within 90 days. If approved, the new law is likely to be implemented in January of 2012.
Despite DHCS’s intent to be as minimally disruptive as possible, the Department has not yet established a “counting system” to allow providers to know how many non-exempt visits a Medi-Cal patient has made. CAFP argued that a provider will be accepting unknown financial risk each time he or she sees a Medi-Cal patient. DHCS believes that because most patients will be covered by some form of exemption, this will not be a problem. CAFP expressed concern, however, about the administrative nightmare this would create, and explained that the burden is placed entirely on physicians and office staff to know that they must request an exemption and do so properly each time.
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