Read the latest legislative news from CAFP

July 16, 2010   
July 9, 2010
July 2, 2010
June 25, 2010 
June 18, 2010 
June 10, 2010
June 4, 2010  
May 28, 2010  
May 21, 2010
May 7, 2010
April 30, 2010
April 23, 2010
April 16, 2010
April 2, 2010
March 26, 2010
March 12, 2010
March 4, 2010
February 26, 2010
February 19, 2010
February 12, 2010
February 5, 2010
February 1, 2010
January 22, 2010

 

 

July 16, 2010

Final Rule on "Meaningful Use" of HIT Released

This past Tuesday, the Centers for Medicare and Medicaid Services (CMS) announced the release of the final rule defining how health care providers can demonstrate "meaningful use" of electronic health records (EHRs) to qualify for federal incentive payments under the American Recovery and Reinvestment Act of 2009 (ARRA). This final rule governs what providers must do with their EHRs to be considered meaningful users in 2011 and 2012, the first two years of this multiyear incentive program; subsequent rules will govern later phases. In addition to CMS's announcement, the Office of the National Coordinator for Health Information Technology (ONC) issued its final rule which identifies the standards and certification criteria for EHR vendors to comply with, which will enable physicians to choose from systems that are capable of performing the functions required to meet meaningful use.

CMS received extensive input from the health care community on the original proposal published last January; more than 2,000 comments were submitted, including comments from CAFP and AAFP. CMS reviewed the comments and made significant, generally positive changes to the regulations, including changes that allow physicians greater flexibility in meeting and reporting certain objectives. CMS also reduced certain requirements that CAFP and others deemed particularly onerous.

In the coming weeks, CAFP will comprehensively analyze the meaningful use rule and post the results of this analysis on our website.

 

July 9, 2010

CAFP Amends Sponsored Bills on PCMH and Vaccinations
CAFP's sponsored Patient Centered Medical Home (PCMH) bill, AB 1542 (Jones), and our co-sponsored bill to ensure adequate vaccination payment, AB 2093 (M. Pérez), passed out of the Senate Health Committee last week, but not without amendments. In order to garner sufficient votes from the Committee and overcome concerns that AB 1542's definition could limit the ability of California PCMH practices to qualify for federal health care reform funding opportunities and Medicaid Section 1115 Waiver dollars, CAFP agreed to amendments to exempt those two specific cases. CAFP will also be working to better sync our PCMH definition with that proposed PCMH definition contained in the Medicaid Waiver bill, SB 208 (Steinberg). To read a committee analysis of SB 208, please click here: http://leginfo.ca.gov/pub/09-10/bill/sen/sb_0201-0250/sb_208_cfa_20100628_123605_asm_comm.html

For AB 2093, CAFP and fellow co-sponsors (the California Medical Association and the California chapter of the American Academy of Pediatrics) took amendments that, in our opinion, weakened the bill significantly, but will greatly enhance its chances of becoming law. Prior to last week's hearing, AB 2093 would have set health plan payment to physicians for the acquisition of child vaccines at the "private sector cost per dose, as published on the most current Pediatric Vaccine Price List of the federal Centers for Disease Control and Prevention (CDC)". The author and sponsors initially resisted amendments that would, instead, be silent on the minimum level at which plans must pay physicians for acquiring vaccines. However, when it became apparent that the bill would only leave the committee once it was silent on the issue of acquisition costs, all agreed to accept the amendments. The bill continues to require that plans pay physicians for cost of administration which includes "physician time, clinical staff time, and office staff time, as well as other practice expenses associated with providing the immunization such as storage, insurance, supplies, and medical equipment" at a minimum.

In the absence of language specifying the minimum a plan must pay a physician for acquisition costs, the bill reverts to existing law which specifies that a health plan must pay a physician or physician group for immunizations that are not part of a current contract at the lowest of the following three rates: 1) the physician's actual acquisition cost; 2) the "average wholesale price" as published in the Drug Topics Red Book; or, 3) the lowest acquisition cost through sources made available to the physician by the health plan.  CAFP believes the increase in the administration payment that remains in the bill will help physicians substantially in getting closer to full reimbursement of their associated costs for providing vaccinations.

 

July 2, 2010

Your Advocacy Helped CAFP Bills Pass Key Committee Hearing
Thank you to the many Key Contacts and CAFP leaders who reached out to legislators over the past week urging support of CAFP's sponsored bill, AB 1542 (Jones), and CAFP's co-sponsored bill, AB 2093 (M. Pérez). Both bills received sufficient votes to pass out of the Senate Health Committee on Wednesday. The Academy would like to especially thank CAFP past president Dr. Eric Ramos, for his thoughtful testimony in support of our Medical Home bill (AB 1542). AB 2093, our co-sponsored bill with CMA and AAP that would ensure adequate payment for the purchasing, storing, and administering of vaccinations, will now be heard in the Senate Appropriations Committee. AB 1542, our bill to define the Patient Centered Medical Home, will next be heard in the Senate Business, Professions, and Economic Development Committee. Significant amendments in both bills were required to ensure their passage out of committee. We will present the updated amendments contained in each bill in next week's Legislative Update.

In addition, SB 1050 (Yee), a CAFP high priority Support bill that would revise the membership of the Osteopathic Medical Board of California (OMBC) and the Naturopathic Medicine Committee (and restore the autonomy of each), passed out of the Assembly Appropriations Committee with unanimous support. This bill alleviates the confusion caused by last year's budget action that combined the two governing boards by removing the two newly appointed naturopathic doctors from the OMBC, replacing them with public members, and allowing the Naturopathic Medical Committee to be independent and appoint its own executive officer. For an analysis of that bill, please go to: http://leginfo.ca.gov/pub/09-10/bill/sen/sb_1001-1050/sb_1050_cfa_20100629_155451_asm_comm.html

 

Democratic Leaders Reach Consensus on Budget Proposal
Several days into the new fiscal year, California is without a budget. With legislators going back to home districts for summer recess, we may not have a budget any time soon. This means potentially deeper cuts, IOUs, more state employee pay cuts (pending the outcome of legal challenges) and delayed payment for services if the state runs out of cash before it solves its budget impasse. If there is good budget news this week, it may be found in the fact that the Democratic leaders, Senate President Pro Tem Darrell Steinberg and Assembly Speaker John A. Pérez, announced that they were combining their budget proposals (as detailed in previous Legislative Updates). Their joint proposal calls for:

• A $1 billion fee on companies that extract oil from California (CA is the only oil producing state not to charge an oil severance fee).
• A delay on the $2 billion corporate tax loopholes that are currently slated take effect 2011.
• Prevent cuts to Medi-Cal, In-Home Supportive Services, and CalWORKS (California's welfare-to-work program).
• Maintain education funding.
• Borrow future oil tax revenues to provide funding for job development, public safety, and welfare functions they would move to local governments and counties.

Despite Republican demands that the budget include no new revenue, Democratic leaders may propose extending the tax increases on vehicles and income passed in 2008 that are due to expire next year.

 

July 6 Deadline Temporarily Delayed for PECOS Enrollment

The Centers for Medicare & Medicaid Services (CMS) announced this week that it will, for the time being, not implement changes that would automatically reject claims made by physicians and eligible professionals who have not yet enrolled in the Provider Enrollment Chain and Ownership System (PECOS). While the interim final rule issued in May will be effective July 6, 2010, CMS will not implement automatic rejections of claims submitted by providers that have attempted to enroll in PECOS. In the May rule, CMA announced that physicians who enrolled in Medicare before 2003 or who have not updated/revalidated their enrollment information since then are considered to not have a current Medicare enrollment record and are at risk of being dropped by their Medicare carriers on July 6. If physicians want to continue to order or refer items or services for Medicare beneficiaries, they must enroll in PECOS.  While more than 800,000 physicians and eligible professionals have enrolled and have approved applications in PECOS, some providers have encountered problems. CMS announced that it is working with providers to address concerns about the enrollment process. 

July 6 is also the deadline for physicians to begin maintaining documentation on referrals to "programs at high risk of waste and abuse," such as durable medical equipment, prosthetics, orthotics and supply programs, as well as home health services. Physicians can update their info by completing a CMS-855I form, and mailing it (along with any supporting documentation) to their Medicare carrier or Part A/Part B Medicare administrative contractor. To ensure that your application is received and processed in a timely fashion, follow up is essential. To learn more about the physician revalidation process, consult the Medicare Program Integrity Manual.

CMS is undergoing this process to comply with certain provisions in the Patient Protection and Affordable Care Act in an effort to prevent fraud in Medicare by ensuring that only eligible/identifiable providers and suppliers can order and refer covered items and services to Medicare beneficiaries.

 

Broad Coalition Unsuccessful in Pushing State to Seek PCMH Money

The Department of Health and Human Services and Centers for Medicare & Medicaid Services recently invited states to apply for participation in a Multi-payer Advanced Primary Care Practice Demonstration initiative. Essentially this would have meant significant amounts of money for California to pilot patient centered medical home projects in which Medicare would join with Medicaid and private insurers in state-based efforts to improve the delivery of primary care and lower health care costs. CAFP jumped at the opportunity and spearheaded a coalition of stakeholders including the California Chronic Care Coalition, California Association of Physician Groups, the Latino Coalition for a Healthy California, County and city of Fresno, labor organizations, and the California organizations representing RNs, NPs, PAs, OBGYNs, osteopathic physicians, and psychiatrists.

Despite our collective best efforts and several conference calls with senior officials in the Schwarzenegger administration, the state indicated that they would not submit a letter of intent to the federal government because of their belief that doing so would raise hopes about the prospects of this program moving forward. They also indicated that even if the project did move forward, they would not have the staff capacity to support it. CAFP hopes to maintain the coalition and work together on future medical home projects.

 

June 25, 2010

House End 21.3 Percent Medicare Payment Cut, CMS Releases Important Claims Info
The US House of Representatives voted yesterday afternoon to retroactively repeal the 21.3 percent Medicare physician pay cut and retroactively provide a 2.2 percent increase through November 30, 2010. The Senate approved the $6.5 billion bill last Friday, but the House hoped that if they delayed their vote, they could put pressure on the Senate to finally pass a jobs and economic relief bill (which also included funding to help states pay for their Medicaid programs). When the Senate democrats were unable to garner Republican support for that, the House immediately acted on the Medicare bill.

Last Monday, the Center for Medicare and Medicaid Services instructed its Medicare contractors to start processing claims for physician payments at a 21.3 percent reduction after Congress failed to pass legislation blocking the payment reduction. The 21.3 percent payment reduction was supposed to take effect on June 1, but CMS told its contractors to hold off processing claims for the first 17 days of June in the hopes a solution would be reached. With no solution, CMS was forced by law to instruct its contractors to start processing claims at the reduced 21.3 percent rate starting today, June 18.

CMS released a statement directing Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1 and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors' claims processing systems. CMS expects to begin processing claims at the new rates no later than July 1. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual. CMS also said that claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Affected physicians who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment, according to CMS. Submitted charges on claims cannot be altered without a request from the physician. Physicians should not re-submit claims already submitted to their Medicare contractor.

Despite the temporary reprieve, physician groups across the country (including AAFP and AMA) expressed their outrage at Congress for continuing to play games with physician payment, and ultimately, Medicare patients' access to health services. The groups once again called on Congress to develop a permanent solution to Medicare's flawed Sustainable Growth Rate physician payment formula.

 

June 18, 2010

Medicare's 21.3 Percent Payment Cut Starts Today
The Center for Medicare and Medicaid Services has instructed its Medicare contractors to start processing claims for physician payments at a 21.3 percent reduction after Congress failed to pass legislation blocking a Medicare payment reduction that took effect as called for by the sustainable growth rate formula. The 21.3 percent payment reduction technically took effect on June 1, but CMS told its contractors to hold off processing claims for the first 17 days of June to avoid having to pay physicians at the greatly reduced rate, particularly as it was likely Congress would act to stop the reduction a few days later. Although the Senate did reach an agreement on a payment patch on June 18, CMS was forced by law to instruct its contractors to start processing claims at the reduced 21.3 percent rate starting today, June 18. The Senate measure would provide a 2.2 percent increase in the Medicare payment rate until Nov. 30. However, it requires House approval before it can take effect, and the House cannot take it up until next week.

 

PCMH Stakeholders Discuss CAFP's AB 1542
Assemblymember Dave Jones, author of CAFP's sponsored bill to define the Patient Centered Medical Home (AB 1542), convened a meeting with more than 10 stakeholder organizations (many of which represent dozens of affiliate organizations) to discuss amendments to the bill. Representatives for groups such as the CA Association of Public Hospitals and Health Systems, the American Congress of Obstetricians and Gynecologists, the CA Association for Nurse Practitioners, the Osteopathic Physicians and Surgeons of CA, and the CA Chronic Care Coalition were present. For its part, CAFP let the fellow stakeholders know that all input was appreciated and we would do our best to incorporate their concerns while remaining true to the Joint Principles of the PCMH, as created by the four primary care physician specialties in 2007, and supported by the CMA. If the groups can reach agreement, the bill will be heard in the Senate Health Committee on June 30.

 

Cognitive Coalition Holds Call Regarding Scope of Practice
Late last week, the Cognitive Coalition (the CA primary care physician organizations representing the Pediatricians, Family Physicians, Internists, and Psychiatrists) met by phone to discuss concerns regarding recently passed regulations that alter the scope of practice for providers working in licensed health facilities. The regulations, enacted in April, have the potential to enable non-physicians to assume independent control over a patient's care within hospital settings without the supervision of a physician. The Coalition's efforts, led by the California Psychiatric Association, are focused on gathering information about possible options to correct the new law, and learn what other physician organizations may be doing to counteract it.

 

Santa Rosa FP Residents to Advocate for Patients at the Capitol
This coming Monday, six residents from the UCSF Santa Rosa Family Medicine Residency program will head to the Capitol to meet with their legislators to promote access to healthy foods, the patient centered medical home (AB 1542 Jones), and CAFP's cosponsored bill that would require health plans to pay physicians at a rate equal to or greater than the actual cost of acquiring a vaccine plus the cost of administration (AB 2093 M. Perez). The group will meet up with CAFP Director of Government Relations, Tom Riley, and testify on priority bills in legislative committees.

 

June 10, 2010

CAFP/IBM Hold PCMH Briefing at the Capitol
CAFP and the staffs for the Assembly and Senate Health Committees hosted an informational briefing and discussion delivered by medical home expert Paul Grundy, MD, IBM's Director of Global Healthcare Transformation. Dr. Grundy addressed a group of more than 40 stakeholder representatives and committee staff, including those representing such organizations as Health Access, GlaxoSmithKline, California Association of Public Hospitals, Health Net, Planned Parenthood Affiliates of California, Western Center on Law and Poverty and the California Medical Association. Dr. Grundy provided valuable information on the beneficial outcomes the medical home model has delivered in other states and countries, and answered a wide array of questions during his two-hour presentation.

 

CA and Other States Look to FMAP Extension Budget Support, CAFP Continues to Fight for SGR Fix
As part of the stimulus funds passed last year (also known as the American Recovery and Reinvestment Act), the federal government augmented the amount of matching funds it gave to states in their Medicaid programs. More than half of the states are pushing for that augmentation to be extended for an additional six months in order to help address the dire fiscal situations that state Medicaid programs are facing in this economy. Medicaid enrollment continues to grow because more individuals continue to become Medicaid-eligible as their wages drop or are eliminated. Because the enhanced Medicaid match has been included in various pieces of legislation that have passed both houses, many states have assumed receipt of these funds in their 2011-12 budget and appropriation measures. The National Conference of State Legislatures and many individual Governors are calling for the extension to be included in the same legislation (HR 4213) that provides a temporary fix to physician Medicare payment. As you recall, the House of Representatives passed the bill before the Memorial Day weeklong holiday, but the Senate was not able to take up the bill until after the Memorial Day break. There is still no resolution on the 21 percent Medicare pay that went into effect on June 1. CMS has said it will hold claims for at least ten business days after June 1 (which would end on the 14th. CAFP is, once again, urging Congress to pass the temporary measure and then permanently address the flawed sustainable growth rate (SGR) formula that threatens physician Medicare payment. We ask that you support this effort by contacting Senators Boxer (202-224-3553) and Feinstein (202-224-3841).

 

June 4, 2010

CAFP Provides Input at Health Care Workforce Roundtable

New CAFP Associate Director of Health Care Workforce Policy Callie Langton, MPA represented family medicine at a health care reform workforce meeting jointly sponsored by the Health and Human Services Agency, the Labor and Workforce Development Agency, the Office of Statewide Health Planning and Development, and the California Workforce Investment Board. The event, which was held last week in Sacramento, brought together approximately 100 stakeholders from across the state to being discussions on the development and implementation of a health care workforce strategic plan in California. CAFP has co-sponsored legislation in the past (most recently AB 2375, authored by Assemblymember Hernandez) to create such a strategic plan, with the goal of promoting the primary care physician workforce. The Academy believes the development and implementation of this plan will be an important tool in beginning to address California's primary care health workforce crisis in a more comprehensive manner. 

 

CMS Issues New Enrollment, Ordering, Referring, and Documentation Requirements Effective July 6

The Centers for Medicare and Medicaid Services (CMS) recently published an interim final rule that significantly changes provisions governing enrollment, ordering, referring, and documentation under Medicare. Among other things, these provisions require that physicians be enrolled in the Provider Enrollment Chain and Ownership System (PECOS) by July 6, 2010.

The change to the previously reported January 3, 2011 date given by CMS is a result of the policy changes in health care reform legislation signed into law in March. CMS's new rule states that it will require Medicare contractors to reject claims for some products and services are ordered or referred if the legal names and national provider identifiers (NPIs) are not on the claim, or if the providers do not have an approved enrollment record in PECOS. This will affect items and services including durable medical equipment, prosthetics, orthotics, and supplies; home health items or services; and laboratory, imaging, and specialist services. CMS is considering extending this provision to prescribed Part B drugs within the next year. 

To read all of the new requirements, please go here: www.familydocs.org/files/CMS_New_Rule.pdf 

 

CAFP Co-Sponsored Bill Passes Out of the Assembly, and 13 Others

CAFP's co-sponsored bill (with CMA and AAP) AB 2093 (M. Perez), had overwhelming support this week, passing out of the Assembly on a 73-1 vote. The bill would require health plans to pay physicians at a rate equal to or greater than the actual cost of acquiring a vaccine plus the cost of administration. Also making passing out of the Assembly were 13 other CAFP supported bills, including but not limited to:

AB 1600 (Beall) - expands mental health care coverage to include the diagnosis and treatment of a mental illnesses and disorders recognized by the Diagnostic and Statistical Manual IV.

AB 1825 (De La Torre) - requires health insurance policies to provide coverage for maternity services.

AB 2470 (De La Torre) - protects patients from unfair insurance company practices such as rescinding coverage for spurious reasons when a patient requires care. To do this, the bill requires the state to establish standard information and health history questions to be used by health care service plans and insurers for their individual health care coverage application forms. This bill would also require all plans and insurers to complete medical underwriting prior to issuing a health care service plan contract or insurance policy.

AB 2477 (Jones) and SB 771 (Alquist) - fend off attempts to require Medi-Cal beneficiaries to undergo semi-annual or quarterly eligibility determination. Semi-annual renewal requirements were passed as part of previous budget agreements and have been shown to be more of a hindrance to access than an effective cost-saving measure. As part of the American Recovery and Reinvestment Act, semi-annual reporting requirements were removed in order to draw down federal funds. This reprieve, however, will end in 2011.

SB 220 (Yee) - requires health care service plan contracts and health insurance policies that provide outpatient prescription drug benefits to also provide coverage for tobacco cessation services and would impose limits on copayments for those services.

SB 1050 (Yee) - revises the membership of the Osteopathic Medical Board of California to remove two naturopathic doctor members, and instead includes two additional public members; revises the membership of the Naturopathic Medicine Committee to require five members to be naturopathic doctors, two members to be physicians and surgeons, and two public members; and clarifies that oversight of California naturopathic doctors shall be solely the responsibility of Naturopathic Medicine Committee (i.e., not the Osteopathic Medical Board of Ca). As part of the July 2009 Budget package, the Osteopathic Medical Board of California (OMBC) was changed in structure and composition by combining it with the Bureau of Naturopathic Medicine (BNM). 

SB 1233 (Oropeza) - prevents the elimination of a program that keeps the home addresses of reproductive health care providers, employees and patients confidential in public records. 

 

CAFP Makes Final Budget Push in Conference Committee

As budget activity heads into the final stretch, the Academy has urged lawmakers to protect important health care programs. The final decision on the state budget is likely to be heavily influenced by party leaders in both houses, but the foundation of it is set in budget hearings, the final series of which are Conference Committee hearings. This committee is comprised of select Senators and Assemblymembers who resolve any differences between the two houses' budget proposals. The Academy weighed-in on four specific differences in the two houses' proposals: opposing a proposed cut of at least 12% to the payment physicians receive for administering drugs in their practices; opposing cuts to Rural Health Clinic program funding and the Expanded Access to Primary Care program; supporting the reinstitution of funds that the Governor vetoed in last year's budget from Maternal and Child Health programs; and supporting reinstituting funds for mental health services for special education students. 

May 28, 2010

CAFP Scores Key Legislative Wins
Five of CAFP's top priority bills passed out of the Assembly Appropriations Committee today, no small feat considering the dire fiscal condition the state is facing. Topping the list of bills moving to the Assembly floor for vote is CAFP's co-sponsored bill (with CMA and AAP) AB 2093 (M. Perez), that would require health plans to pay physicians at a rate equal to or greater than the actual cost of acquiring a vaccine plus the cost of administration. Also making it out of committee were four other CAFP supported bills:

AB 1600 (Beall) - would expand mental health care coverage to include the diagnosis and treatment of a mental illnesses and disorders recognized by the Diagnostic and Statistical Manual IV.

AB 1825 (De La Torre) - would require health insurance policies to provide coverage for maternity services.

AB 2470 (De La Torre) - would protect patients from unfair insurance company practices such as rescinding coverage for spurious reasons when a patient requires care. To do this, the bill requires the state to establish standard information and health history questions to be used by health care service plans and insurers for their individual health care coverage application forms. This bill would also require all plans and insurers to complete medical underwriting prior to issuing a health care service plan contract or insurance policy.

AB 2477 (Jones) - would fend off attempts to require Medi-Cal beneficiaries to undergo semi-annual or quarterly eligibility determination. Semi-annual renewal requirements were passed as part of previous budget agreements and have been shown to be more of a hindrance to access than an effective cost-saving measure. As part of the American Recovery and Reinvestment Act, semi-annual reporting requirements were removed in order to draw down federal funds. This reprieve, however, will end in 2011.

 

Cut to Payment for Physician Administered Drugs Held Up in Committee

CAFP and the CMA were successful this week in putting up a road block to the Governor's budget proposal to enact a 12 percent reimbursement reduction for physician administered drugs. Thanks to CAFP member input to our Legislative Update and Academy in Action e-newsletter, we were able to provide compelling arguments as to why this cut would greatly harm patients and physicians participating in Medi-Cal. The proposal will now move to a conference committee where the Academy hopes to keep up the pressure to remove it from future budget discussions.

 

CAFP Calls on Senate to Immediately Fix Medicare Payment

This week, CAFP joined AAFP in once again urging Congress to permanently address the flawed sustainable growth rate (SGR) formula that threatens physician Medicare payment, and asks that you support this effort by contacting Senators Boxer (202-224-3553) and Feinstein (202-224-3841). Physicians face a 21 percent reduction in the Medicare payment rate on June 1 as part of the continuous cycle of payment cuts called for by the SGR formula. A temporary fix has been proposed within a larger funding bill, HR 4213, in the hopes that a more long term solution can be reached later. While the Academy is disappointed that Congress has not provided a permanent solution to the threat posed by the SGR, we urge the Senate to approve HR 4213 as quickly as possible, and continue to advocate for a permanent solution.

HR 4213 would create a 2.2 percent Medicare physician payment increase beginning June 1, followed by a 1 percent increase for 2011. Under this proposal, if a permanent fix is not reached by 2012, the payment formula would revert back to the SGR and physicians would face a 33 percent cut. The House of Representatives passed the bill today. Senate Majority Leader Harry Reid (D - Nevada) said the Senate will not be able to take up the bill until after the Memorial Day break. This means that the 21 percent pay cut will go into effect on Tuesday, but a retroactive fix is likely. It is important that family physicians hold on to their Medicare claims until June 14 to avoid the lower payment rate should the Senate pass the bill before then.

 

Legislative Leaders Propose Cuts and Taxes to Balance Budget

Senate and Assembly Democrats unveiled their budget plans this week to address the $17.9 billion budget gap facing California through 2011. Their proposals were a response to the Governor's May Revise (detailed in last week's Legislative Update), which relied solely on cuts and borrowing to make up the deficit. CAFP spearheaded a coalition of more than 15 other organizations in early March calling for a more balanced approach to solving the fiscal crisis, and was pleased to see that many of our coalition's solutions were included in the leadership's proposals. It is estimated that the Governor's proposal would eliminate 430,000 jobs and cost the state more than $5 billion in lost federal funds.

In the Senate proposal, $4.9 billion in taxes and other revenues would be used to avoid the elimination of health and welfare programs. This would be accomplished through delaying corporate tax breaks, extending the 0.25 percent personal income tax surcharge from last year, and prolonging the reduced tax credit for dependents. The rest of the revenue would be raised by increasing the vehicle license fee (which historically has been set at 2 percent), from 1.15 percent to 1.5 percent for two years, and increasing the state alcohol tax (which has not been increased since 1991) to match inflation, adding 1 to 2 cents to the cost of a drink.

Assembly Democrats proposed a more complicated plan, structured around an attempt to avoid the legislative mandate that any increase in taxes requires the support of 2/3rds of each legislative house. Their proposal would borrow $8.7 billion in bonds from the California Beverage Recycling Fund, which collects deposits on bottles, cans and other recyclable containers (and is often underfunded because of past raids during bad budget years). In order to backfill the money, the proposal calls for an oil severance fee that would raise roughly $1 billion a year. CAFP has consistently called on the legislature to adopt this fee to bring California in line with every other oil producing state in the country. The Assembly Speaker, John Pérez (D - Los Angeles), argues that the oil severance fee does not need a 2/3rds vote because it would be offset by an equal decrease in sales tax. The state would lower its sales tax by one-quarter cent but receive the equivalent amount of money in oil tax dollars, therefore creating a neutral net tax increase. In the overall picture, this move would raise money because local governments could then raise their sales tax by one-quarter cent to maintain the status quo, and pass that money on to local schools. The state would then reduce its payment to local schools by that amount and keep that money in the General Fund. The rest of the money in the Assembly proposal would come from a $500 million loan from the Disability Insurance Fund and by suspending previously enacted tax loopholes for large businesses.

The proposals are similar to many recommendations made by the nonpartisan Legislative Analyst's Office, which urged state leaders to raise revenues in addition to making cuts. The Governor reacted poorly to the two proposals, saying that pension and budget reform must be included in the budget for him to sign it (even though neither reform would save state money in this or next year's budget).

 

CAFP Takes Advocacy Training Program to LA

Last weekend, CAFP staff and consultants held the first in a series of advocacy training programs for interested family physicians to provide helpful tips and guidelines for legislative and media advocacy. The session was held at the USC Medical Center building in Los Angeles. In attendance among the other 17 attendees was newly seated CAFP President Jack Chou, MD. Dr. Chou has held multiple meetings with legislators and will be featured throughout the year in numerous news publications. CAFP will be holding these trainings throughout the state in the coming year, and hopes you will be able to participate in this valuable program.

 

May 21, 2010

CAFP, Contra Costa FP Testify in Support of Tax on Sugar Sweetened Beverages
Last week, CAFP member Jeremy Fish and CAFP staffer Adam Francis testified in support of SB 1210 (Florez), which would enact an excise tax of one cent per teaspoon of added caloric sweetener in a bottled beverage or concentrate. The money raised would go toward funding for statewide childhood obesity prevention activities and programs. Dr. Fish explained that California is facing a health crisis in part due to the overconsumption of sugar-sweetened beverages, and a shortage of obesity prevention programs, family physicians and other primary care providers who can care for patients when they develop obesity, heart disease, cancer and other diseases clearly linked to consumption of sugar sweetened beverages. Dr. Fish also stressed that, in the same way that tobacco taxes have reduced cigarette smoking dramatically in California, this bill takes a first step toward accomplishing that goal with sugar sweetened beverages, and would help to diminish the human and economic costs of obesity.

 

Governor's May Revise: Welfare and Home Services Must Go
Governor Schwarzenegger revised his January budget proposal with a list of new measures to address a $17.9 billion budget gap ($7.7 billion gap to address between now and July 2010, and $10.2 billion for July 2010 to July 2011) and provide a $1.2 billion reserve. Hopes of a recovering economy shrinking the budget deficit were dashed following the April 15 tax deadline when personal income tax revenue did not meet the state's projections ($1.3 billion short), and the administration received only half of the federal aid money they had hoped to secure. Democrats continue to say they want "everything on the table" in negotiations, including increased revenue measures. Republican leaders and the Governor say the topic of taxes is a non-starter. The largest cuts in the Governor's proposal come at the expense of CalWORKS (California's welfare to work program) which would be eliminated, and an almost $650 million reduction in funding for the In Home Support Services program.

While the Governor has proposed decreasing General Fund expenditures on Health and Human services by almost $800 million, roughly $750 million would come from a long shot hope that his administration could convince the federal government to allow him to cut programs below federally mandated minimum levels. Because this request has been rejected by federal lawmakers for the past three years, some believe such cuts are unlikely. Nevertheless, CAFP testified against such cuts during State Assembly Budget deliberations on Thursday and will continue to vigorously oppose any attempts to cut these vital programs.

CAFP also opposes the following of the Governor's proposals to limit utilization and increase cost sharing:

• Eliminate certain over-the-counter drugs and nutritional supplements.
• Establish a maximum annual benefit dollar cap on hearing aids ($1,510) durable medical equipment at ($1,604) incontinence supplies ($1,659), urological supplies ($6,435) and wound care supplies ($391).
• Limit prescriptions (except lifesaving drugs) to six per month.
• Limit the number of physician or clinic visits to 10 per year.
• $5 copayments on physician/clinic/dental/and pharmacy.
• $100 per day copayment and $200 maximum for hospital stays.
• Increase monthly premiums in Healthy Families for families between 200 and 250 percent of the Federal Poverty Level.
• Increase emergency room co-payments from $15 to $50, and add hospital inpatient services co-payments of $100 per day with a $200 maximum.
• Mental health funds significantly reduced/realigned by roughly $150 million.

 

There is actually an increase in spending projected for specific health care services due to a number of federal laws requiring minimum funding, as well multiple lawsuits that the administration has lost regarding services cuts, including reinstating optometry services to Medi-Cal patients, reimbursement for nursing facilities and pediatric subacute providers, and adult day health services. Also seeing increased funding is the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program due to increased utilization, services costs and recalculations. The Governor's budget also calls for a $174 million increase to provide an estimated 3.7 percent rate increase to managed care plans.

After testimony from CAFP Director of Government Relations Tom Riley and other stakeholders this past week, the Assembly subcommittee that reviews health care budget proposals rejected a number of the Governor's proposals, including the elimination of CAFP's co-sponsored effort that increased payment to family planning providers, also known as F-PACT. This program receives $9 of federal money to every $1 the state spends, making it an unlikely target to save state funds.

 

 

May 7, 2010

CAFP to Comment on Weakened Prescription Label Regs
In late January, after months of public input from stakeholders and experts, the California Board of Pharmacy was purportedly on the verge of adopting specific new requirements for prescription drug labels. A day before the vote, however, a new appointment to the Board was made by Governor Schwarzenegger that ultimately swayed the vote away from a more stringent version of the regulations. For example, there are no requirements for pharmacies to use labels translated into threshold languages, and oral interpretation is only required to be provided "if available." In addition the regulations only require the use of 10-point font, as opposed to the original 12. The regulations stem from a 2008 bill, SB 472 (Corbett), which requires the Board to create a standardized, patient-centered prescription drug label by 2011, with the goal of providing medical information in a consistent, legible, and culturally appropriate manner.

CAFP will be commenting on the regulations, urging the Board to use the original version that required 12-point font, labels that are translated to help diverse patient populations understand how to take their medication effectively and safely, and oral interpretation for all patients. Public comment on the regulations is due by Thursday May 13. If you would also like to write a letter or email, please direct your comments to: Carolyn Klein, the Manager of Legislation and Regulations for the California State Board of Pharmacy. You can mail your letter to 1625 N. Market Blvd., N219, Sacramento, CA 95834; fax it to (916) 574-8618; or email it to Carolyn_Klein@dca.ca.gov.

 

CAFP Delegation Heads to Washington DC
A delegation of talented family physicians are giving up most of their week in the coming days to advocate for their colleagues and patients in our nation's Capital. As part of CAFP's delegation to the AAFP Family Medicine Congressional Conference, CAFP Director of Government Relations Tom Riley will be joined by Drs. Carla Kakutani, Ashby Wolfe, Kay Nelsen, Steven Kramer, and Randi Sokol. The group will be holding meetings in the offices of Representatives Becerra, Speier, Matsui, Thompson, Eshoo, and Pelosi, as well as the offices of Senator Feinstein and Boxer. The meetings will cover a wide range of important topics, including the new the health care reform law, a fix to physician Medicare payments under the SGR, and promotion of the patient centered medical home.

 

Linda Whitney Named Director of CA Medical Board
Interim executive director of the Medical Board of California, Linda Whitney, has been named director of the Medical Board. Ms. Whitney has worked with CAFP on a variety of issues including language access CME regulations and the family medicine core clinical requirements for medical students. We look forward to working with her in her new capacity as executive director. 

 

April 30, 2010

CAFP Priority Bills: Win, Lose or Draw
Today marks an important deadline in the legislative process - all bills that may have any fiscal consequence need to have passed out of policy committees. Below is an update on a few of CAFP's priority bills.

AB 1904 (Villines)
This bill would have allowed an out-of-state health insurer to offer, sell, or renew a health care service plan or a health insurance policy in California without holding a California license. It also would have exempted the carrier's plan or policy from California's minimum coverage requirements. CAFP made clear its opposition to this bill unless it was amended to ensure all coverage mandates that currently exists in CA would apply to out of state carriers selling in CA. The bill was not amended, and it failed passage in committee.

SB 1050 (Yee)
As part of the July 2009 Budget package, the Osteopathic Medical Board of California (OMBC) was changed in structure and composition by combining it with the Bureau of Naturopathic Medicine (BNM). The Academy believes that combining the OMBC with the BNM (previously slated to be "sunsetted") may have the unintended consequence of confusing the pubic, discouraging some DO medical students from entering California residency programs, and diverting OMBC staff attention from its consumer protection responsibilities. The Academy supports this bill, as it would return autonomy to the OMBC by removing the two newly appointed naturopathic doctors (and replacing them with public members), and ensures the BNM is solely responsible for the oversight of Naturopaths. This bill passed out of the Senate Appropriations Committee and will be voted on by the full Senate next week.

AB 2477 (Jones)
This bill would have fended off attempts to require Medi-Cal beneficiaries to undergo semi-annual or quarterly eligibility determination. Semi-annual renewal requirements were passed as part of previous budget agreements and have been shown to be more of a hindrance to access than an effective cost-saving measure. As part of the American Recovery and Reinvestment Act, semi-annual reporting requirements were removed in order to draw down federal funds. This reprieve, however, will end in 2011. While this bill unfortunately was put on the Suspense file in the Assembly Appropriations Committee, CAFP's Government Relations staff kept up its strong advocacy against the concept by testifying against semi-annual renewals in the Assembly Budget Committee where it has been proposed as part of the solution to the state's current fiscal crisis. Staff also testified in that committee is support of protecting family planning services and provider payment rates, and in opposition to cutting Prop 99 funding from the Early Access to Primary Care program.

 

April 23, 2010

CAFP Past President Advocates for PCMH in State Senate Hearing
CAFP past president Carla Kakutani, MD and CAFP Director of Government Relations Tom Riley testified on Wednesday in support of SB 966 (Alquist) in the Senate Health Committee. The bill would define the Patient Centered Medical Home based on the National Committees for Quality Assurance's (NCQA's) Physician Practice Connections standards and guidelines (based on The Joint Principles of the Patient Centered Medical Home). Mr. Riley told the committee it is important to create a standardized definition of the medical home so patients, employers, and any other health care purchasers know they are receiving the benefits and cost savings achieved when a practice becomes a true medical home. Dr. Kakutani stressed that, in light of the new federal health care reform law, it is important that the State support efforts by many family physicians who are already transforming their practices to become Patient Centered Medical Homes. The California Medical Association and the Western Center on Law and Poverty also testified in support of the bill. The California Association for Nurse Practitioners opposed the bill, stating that the NCQA standards and guidelines are too physician-centric.

 

Misguided Bill Could Affect Family Medicine
CAFP Government Relations staff recently became aware of a bill that could mandate continuing education requirements in the diagnosis and treatment of hepatitis. AB 2600 (Ma) would urge the Medical Board to require such a course. While the Academy is very concerned about the fact that hepatitis and many other diseases are more prevalent in society than what they could be, we disagree with the unproven argument that this situation results from lack of CME courses regarding hepatitis. A more likely cause is the continuing deterioration of primary care provider networks and lack of adequate access for patients. CAFP believes that individual physicians are in the best position to know which educational courses will best serve them in their treatment of their patients. While good intentioned, we believe this bill will only serve to pull time and resources away from more relevant issues to individual physicians in their own practices. To read the full bill, please click here: http://leginfo.ca.gov/pub/09-10/bill/asm/ab_2551-2600/ab_2600_bill_20100325_amended_asm_v98.html 

 

CURES Bill Needs Family Medicine Input
Legislation has been introduced that would make significant changes to the Controlled Substance Utilization Review and Evaluation System (CURES). AB 2548 (Block) would establish the Prescription Drug Monitoring Program (PDMP) under the Department of Justice (DOJ) to monitor practitioners and pharmacists (from here on referred to as "PDMP subscribers") who have obtained approval to use the Internet to access the electronic history of controlled substances dispensed to individuals. The author of the bill believes further action must be taken to prevent the misuse or unlawful distribution of patient and prescription information (particularly Schedule II, III, and IV controlled substances) on the part of the individuals who have been approved to access CURES. The author also believes action must be taken to assure that these prescriptions are dispensed in a safe and lawful manner, and that any theft or loss of prescription information must be reported in a timely manner DOJ to prevent the distribution of significant material to unlawful parties or individuals.

This bill would:

1) Require the DOJ to maintain CURES to monitor the prescribing and dispensing of Schedule II, III, and IV controlled substances by all practitioners authorized to prescribe or dispense them, including providers' internet access to this information (and for statistical analysis, education, and research purposes).

2) Prohibit the DOJ from providing the history of dispensed controlled substances to licensed health care practitioners or pharmacists, but allows DOJ to monitor physician prescribing patterns.

3) Requires PDMP subscribers to manually or electronically report any theft or loss of prescription information or prescription forms to the CURES program no later than three days after the discovery of the theft or loss.

Although there is no official support or opposition to this bill, some have expressed concern that physician prescribing decisions and patterns may be questioned, and that they could be investigated without sufficient cause. Some physicians contend that patients may suffer because physicians will be reluctant to prescribe appropriate controlled substances to manage a patient's pain or treat their condition.

 

CAFP Creates Timely Access Requirement FAQ
California's Department of Managed Health Care (DMHC) recently finalized regulations intended to ensure that health plan enrollees have access to timely health care services. These regulations could have a profound effect on family physicians and their patients. The regulations stem from legislation (AB 2179) enacted in 2002, and CAFP has been very active in providing input into that legislation and the subsequent regulations.  These regulations will require each health plan to ensure that its contracted provider network has adequate capacity and availability of licensed health care providers to offer enrollees appointments that meet specific timeframes. If not properly enforced, these regulations could significantly affect the duration of patient visits and office costs. CAFP has warned the DMHC of this likely outcome and has been assured by the Department that it will not tolerate added responsibility without commensurate material changes to physicians' (or their medical group's) contract. In light of this, CAFP's Government Relations Division would like to hear how these regulations affect your practice so that we may effectively monitor their impact. Please click here to read the FAQ document to learn about the compliance and enforcement provisions of the new law: http://www.familydocs.org/files/CAFPTimelyAccessFAQ.pdf

 

April 16, 2010

CAFP Legislative Affairs Committee Sets Bill Positions and Priorities
CAFP's Legislative Affairs Committee (LAC) held a two-hour meeting Tuesday to review new health care legislation introduced this year. The LAC reviewed more than 100 bills and recommended positions to the CAFP Board on more than 25 of them. If adopted, highlights of this year's efforts will include CAFP sponsorship of AB 1542 (Assembly Health Committee) which would add a more functional definition of "patient-centered medical home" to California law, and CAFP's co-sponsored AB 2093 (M. Perez) which would require health plans to reimburse physicians at a rate equal to or greater than the actual cost of acquiring a vaccine plus the cost of administration. To see the full list of CAFP priority bills, please go here: http://www.familydocs.org/advocacy/positions-legislation.php

 

New Regs Require Physicians to Inform Patients of MBC Licensure
Starting June 27, 2010, California physicians will be required to inform their patients that they are licensed by the Medical Board of California (MBC), and include the board's contact information. The purpose of the new requirement is to inform consumers where to go for information or with a complaint about California medical doctors. Physicians may provide this notice by one of three methods:

• Prominently posting a sign in an area of their office conspicuous to patients, in at least 48-point type in Arial font - you may download a copy of this sign here.
• Include the notice in a written statement, signed and dated by the patient or patient's representative, and kept in that patient's file, stating the patient understands the physician is licensed and regulated by the board.
• Include the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient's representative, where the notice is placed immediately above the signature line for the patient in at least 14-point type.

Please note the MBC emphasizes that physicians are responsible for compliance with this regulation, not facilities. In group settings, only one sign must be posted, but it must be one that each patient can see. The sign may also be printed from the board's Web site. According to MBC's notice, "the board expects a good-faith, common-sense interpretation and compliance with this regulation." More information about this regulation is available on the board's Web site at http://www.mbc.ca.gov/ - click on "Notice to Consumers regulation" under "What's New" on the home page. For more information, contact the Medical Board's information officer, Candis Cohen, at 916-263-2394.

 

April 2, 2010

Important Health Care Bills Begin Committee Gauntlet
Beginning next week, many important health care bills will be heard in policy committees. The Legislative Affairs Committee will be meeting soon and will post its complete list of bill positions on familydocs.org in the coming weeks.  You and your colleagues' efforts will be essential to helping lawmakers better understand how these bills will affect your everyday practice lives and the lives of your patients. Including AB 2093 (detailed above), here are a few important CAFP-supported bills that will be heard next week in committee:

AB 2112 (Monning) - This bill would prohibit the use of doctor-specific prescribing information for marketing purposes. Currently, the collection and use of data describing doctor prescribing practices is unregulated, allowing unwarranted access by third parties to information regarding doctors' prescribing practices. This bill would not prevent pharmaceutical company representatives from providing information about pharmaceuticals to doctors or to research organizations. The use of this information for marketing purposes belies the inherent contradiction between drug companies' claims of improving patient well-being and their insatiable push to improve pharmaceutical drugs sales.  Furthermore, such conflicts present the risk of undue influence over prescribing practices that have the potential to increase health care costs, promote irrational drug selection, and increase the prevalence of invasive marketing practices.

AB 2477 (Jones) - This bill would fend off attempts to require Medi-Cal beneficiaries to undergo semi-annual or quarterly eligibility determination. Semi-annual renewal requirements were passed as part of previous budget agreements and have been shown to be more of a hindrance to access than an effective cost-saving measure. As part of the American Recovery and Reinvestment Act, semi-annual reporting requirements were removed in order to draw down federal funds. This reprieve, however, will end in 2011. That is why this bill is needed - it will make the switch back to annual reporting permanent for children in the Medi-Cal program, thereby preventing qualified children from losing their coverage just because they are unable to complete complicated forms, because mail delivery was unreliable, or because the overloaded bureaucracy sometimes fails to process the paperwork correctly.

SB 1050 (Yee) - As part of the July 2009 Budget package, the Osteopathic Medical Board of California (OMBC) was changed in structure and composition by combining it with the Bureau of Naturopathic Medicine (BNM), making California the only state in which two non physician clinicians sit in judgment of physicians. Combining the OMBC with the BNM (previously slated for sunset) may have the unanticipated consequences of confusing the pubic, discouraging some Doctor of Osteopathy medical students from entering California residency programs, and diverting OMBC staff attention from its vital consumer protection responsibilities. This bill would remove the two newly appointed naturopathic doctors from the OMBC, replace them with public members, and allow the Naturopathic Medical Committee to appoint its own executive officer. By making the Naturopathic Medical Committee solely responsible for enforcing and implementing its duties to protect the public and giving it oversight and enforcement of its own licensees, SB 1050 effectively ensures the Department of Consumer Affairs' ability to hold each board accountable for patient protection while honoring the intent of the July budget - to keep government efficient.

 

Latest Workforce Numbers on Physician Participation in Medi-Cal
CAFP attended a Medi-Cal workforce presentation hosted by the California HealthCare Foundation in Sacramento last Friday. The purpose of the forum was to explore the implications of recently released data on how many and which types of physicians are treating Medi-Cal patients. The lead presenter was CAFP member Kevin Grumbach, MD, an expert in physician workforce, and a Professor and Chair of the Department of Family and Community Medicine at the University of California, San Francisco. The authors of the study found that there was a surprising increase in the number of physician treating Medi-Cal patients between 2001 and 2008. While the increase may be attributable to a difference in the survey methodology used in those two years, several other interesting findings were presented:

• Most CA MDs (68 percent) report participating in Medi-Cal.
• About half (57 percent) are accepting new patients.
• Access to psychiatrists may be especially problematic as only 43 percent participate in Medi-Cal.
• Medi-Cal enrollment under the recently passed health care reform bill has the potential to severely challenge the adequacy of our current physician workforce, unless the provisions contained in the bill to encourage physician participation are successful (raising Medi-Cal rates to 100 percent of Medicare rates for 2013 and 2014).

 

March 26, 2010

Federal Health Reform Law Advances Primary Care
The health care reform bill signed into law by President Obama on Tuesday (and subsequent changes included in the reconciliation bill) will expand coverage to more than 30 million people and move the country toward a more primary care-based health care system. It contains significant increases in Medicaid physician payment. CAFP and other organizations have been successful through advocacy and lawsuits at preventing the governor and legislators from cutting Medi-Cal payment rates, cuts that have been attempted despite California having some of the lowest Medicaid payment rates in the country. The health care reform bill changes all of that: for primary care services, such as those offered by family physicians, Medi-Cal provider payment rates will be equal to 100 percent of Medicare payment rates, including payments for office visits and immunizations in 2013 and 2014.

The law also provides a 10 percent Medicare bonus for many primary care physicians for the next five years, as well as an increase in funding for the National Health Service Corps and community health centers. The law reauthorizes Section 747 of Title VII of the Public Health Service Act, the only federal program that provides funds to academic departments of family medicine and family medicine residency programs to increase training of family physicians. In the area of prevention, the legislation eliminates co-payments for Medicare patients for preventive services and exempts preventive services from deductibles starting Jan 1.

In addition, the law:

• bars health insurance companies from denying coverage to individuals with pre-existing conditions -- the ban takes effect for children six months after enactment, and for all others starting in 2014;
• prohibits health insurance companies from dropping people from coverage when they get sick;
• bans health insurance companies from placing lifetime caps on coverage;
• begins to close the Medicare Part D "doughnut" coverage gap for Medicare beneficiaries who have surpassed their prescription drug coverage limit;
• requires individuals to carry insurance or pay a penalty that would be the greater of $750 or 2 percent of income by 2016;
• requires companies with 50 or more employees to help offset the cost of insurance for their employees if taxpayers are footing the bill for those workers' insurance;
• establishes 50 state-administered insurance marketplaces to allow small businesses and people without employer sponsored coverage to buy insurance that meets new federal standards;
• expands Medicaid to cover everyone earning less than 133 percent of the federal poverty level, or $29,327 for a family of four;
• allows parents to keep children on their family plans until their 26th birthdays

To read more about what the reforms may mean for your practice and your patients, please click here: http://www.aafp.org/online/en/home/policy/federal/hcrleg2010.html 

 

CAFP Past President Rallies for Alcohol Fee
As part of a coalition effort (the Coalition to Protect California Patients) spearheaded by CAFP, more than 15 organizations called on legislators to look to new revenues in order to avoid life-threatening cuts to vital health and human services programs. Specifically, the coalition called for fees on alcohol, sugar sweetened drinks, and oil (all items that would improve public health if their utilization was decreased). As part of this effort, CAFP past president Carla Kakutani, MD, took part in a press conference and rally on Tuesday for AB 1694, and testified in support of the bill in the Assembly Health Committee. The bill would charge a fee on alcoholic beverages to be used to finance alcohol abuse treatment and recovery services. Despite compelling testimony from Dr. Kakutani, the bill stalled in the committee, but has been granted reconsideration. CAFP will continue the Coalition's efforts through the budget process in the hope of raising much needed funds for primary care and other programs related to alcoholism.

 

New Assembly Speaker Shakes Up Committees
Assemblymember John Pérez (D - Los Angeles), the new Assembly Speaker, has announced changes to the membership of many committees important to family medicine issues. The most significant change is to the chair of the Assembly Health Committee. Replacing Asm. Dave Jones (D - Sacramento) will be Asm. Bill Monning (D - Santa Cruz). Assemblymember Monning has been a staunch supporter of primary care, and family medicine in particular.   

 

Assembly Health Committee
Committee Members	District		Phone
William W. Monning - Chair	Dem-27 Santa Cruz		(916) 319-2027
Nathan Fletcher - Vice Chair	Rep-75 San Diego		(916) 319-2075
Tom Ammiano	Dem-13 San Francisco		(916) 319-2013
Wilmer Amina Carter	Dem-62 Rialto		(916) 319-2062
Connie Conway	Rep-34 Visalia		(916) 319-2034
Hector De La Torre	Dem-50 South Gate		(916) 319-2050
Kevin de Leon	Dem-45 Los Angeles		(916) 319-2045
Bill Emmerson	Rep-63 Redlands		(916) 319-2063
Mike Eng	Dem-49 Monterey Park		(916) 319-2049
Ted Gaines	Rep-4 Roseville		(916) 319-2004
Mary Hayashi	Dem-18 Hayward		(916) 319-2018
Edward P. Hernandez	Dem-57 Baldwin Park		(916) 319-2057
Dave Jones	Dem-9 Sacramento		(916) 319-2009
Bonnie Lowenthal	Dem-54 Long Beach		(916) 319-2054
Pedro Nava	Dem-35 Santa Barbara		(916) 319-2035
V. Manuel Pérez	Dem-80 Cathedral City		(916) 319-2080
Mary Salas	Dem-79 Chula Vista		(916) 319-2079
Cameron Smyth	Rep-38 Santa Clarita		(916) 319-2038
Audra Strickland	Rep-37 Camarillo		(916) 319-2037

 

March 12, 2010

CAFP Asked to Support "Nickel-a-Drink" Fee on Alcohol
As part of a coalition effort (the Coalition to Protect California Patients) spearheaded by CAFP, more than 15 groups called on legislators to look to new revenues in order to avoid life-threatening cuts  vital health and human services programs. Specifically, the coalition called for fees on alcohol, sugar sweetened drinks, and oil (all items that would improve public health if their utilization was decreased). In next week's Assembly Health Committee hearing, a bill will be heard that would charge a nickel a drink fee on alcohol, the funds of which would be used to finance alcohol abuse treatment and recovery services. The sponsors of this bill, AB 1694 (Beall), have asked CAFP and the coalition for support. To read the full bill, please click here: http://leginfo.ca.gov/pub/09-10/bill/asm/ab_1651-1700/ab_1694_bill_20100308_amended_asm_v98.html 

 

Family Physicians Lobby Lawmakers After CAFP's Congress of Delegates
For the third straight year, the CAFP Congress of Delegates was held in Sacramento and was followed by a very successful CAFP Lobby Day on Monday, March 8. On CAFP Lobby Day 2010, more than thirty family physicians participated in a legislative briefing, and then spread throughout the State Capitol building for visits with their legislators. Many participants met with their home legislators, as well as the legislators who represent the areas where they practice, to let them know about the importance of the patient-centered medical home, the need to avoid state budget cuts to vital public health programs, and the value family medicine provides to communities throughout California. In addition to hearing from keynote speaker Senate President Pro Tem Darrell Steinberg (D-Sacramento), CAFP's Congress passed resolutions dealing with mental health, AAFP's partnership with Coke, the continuation of a special assessment to support advocacy efforts, physician performance reporting, access to influenza vaccine supplies, and residency program participation in Medi-Cal managed care plans. To read more about the Congress, go here: http://www.familydocs.org/about-cafp/leadership/congress-delegates.php  

 

CAFP to Comment on "Meaningful Use" Proposed Criteria for HIT
This Monday, CAFP will send a letter (attached) to the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) on the proposed regulations which stipulate how physicians and hospitals can show "meaningful use" of certified EHR systems, and therefore prove eligibility to receive payments under the Medicare and Medicaid EHR incentive programs. Subsequent revisions will be made to the criteria, with the final rule expected in the coming weeks. In order to reap the financial incentives, physicians must meet three stages of progressively more demanding goals for using HIT in their practices. The initial Stage 1 set of criteria focuses on collecting data electronically, sharing information with other providers and patients, and reporting quality measures to the government. Stage 2 criteria will be proposed by the end of 2011 and focus on structured information exchange and continuous quality improvement. Stage 3 criteria will be unveiled by the end of 2013 and focus on decision support for "national high priority conditions" and population health. 

Initial Set of Standards and Certification Criteria for EHR Technology
http://www.federalregister.gov/OFRUpload/OFRData/2009-31216_PI.pdf 

EHR Incentive Program Proposed Rule
http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

 

March 4, 2010

CAFP and Allies Win One Court Battle, Lose Another
This week Medi-Cal provider payment was protected, but Health and Human Services (HHS) funding was not. The Academy was pleased to see the U.S. Ninth Circuit Court of Appeals has ruled once again against the Schwarzenegger Administration in its attempt to slash Medi-Cal provider payment rates below its currently bare bone level. The lawsuit brought forth by CMA, and financially supported by CAFP and other health advocacy organizations, continues to stand up to judicial scrutiny and could also preclude the state from cutting payment rates in an attempt to solve part of its $18.9 billion budget deficit. The Ninth Circuit agreed with lower court decisions that granted preliminary injunctions against the cuts because the Administration did not comply with the federal Medicaid Act requirement of conducting an analysis of the payment cuts' impact on patient access to providers.

In disappointing news, a California appeals court sided with the Schwarzenegger Administration over his use of his "line-item veto authority" during last year's budget agreement that dramatically cut many programs important to family physicians' patients. After the 2009-2010 budget was passed by the legislature but before he signed it, the Governor cut almost $500 million dollars in funding from HHS programs, including $50 million from the Healthy Families Program, $25 million from community clinics in the Primary and Rural Health program, $16 million from the Domestic Violence Program, and $3 million from the Black Infant Health Program. Senate Pro Tem Darrell Steinberg (D - Sacramento) filed a lawsuit arguing the Governor did not have the right to use his line-item veto because what the legislature passed was not the actual budget but instead were changes to the, then, current budget.  Mr. Steinberg's suit argued that the Governor can only use the line-item veto when a budget is originally approved. CAFP saw validity in the case. Unfortunately, the appeals court did not.

 

CAFP and ADA Discuss Administration of Insulin in Schools
CAFP Director of Government Relations, Tom Riley, and CAFP member Francisco Prieto, MD, met recently with representatives from the American Diabetes Association to discuss legislation that would allow parents to designate a teacher or other school employee to assist their child in administering insulin in a school setting. CAFP's original concern regarding this topic arose from a bill last year that would have required that any prescribed medication administered to a pupil must be done so by a licensed nurse.  As introduced, that bill excluded physicians and parents and limited the ways in which children could access their medications. The ADA has asked CAFP to support AB 1802 (Hall) which would authorize a parent or guardian of a pupil with diabetes to designate one or more school employees to administer insulin to the pupil during the regular school day if a credentialed school nurse or other licensed health care professional is not immediately available at the school. The ADA points out that under current law, a parent can request that another adult come onto school grounds to administer insulin to a student, but the parent cannot designate school personnel, even if that person is willing. Under AB 1802, the designee would do so only (1) on a volunteer basis, (2) in accordance with the performance instructions set forth by the licensed health care provider of the pupil, and (3) after receiving appropriate training. The bill states that a designee, acting in good faith and in substantial compliance with the instructions of the pupil's licensed health care professional, is not liable in any criminal action or for civil damages in his or her individual or official capacity as a result of administering the insulin. There are an estimated 1500 children in California who have Type 1 diabetes and are too young to safely self-administer insulin.

 

February 26, 2010

1,300+ New Bills Introduced in Legislature
With the deadline to introduce bills passing last Friday, CAFP is currently reviewing more than 1,300 pieces of legislation. The Legislative Affairs Committee will review the bills related to family physicians and their patients and will recommend positions and priorities to the CAFP Board. Four bills are already of high priority to the Academy:

AB 1542 (Assembly Health Committee) - This CAFP-sponsored bill would add a functional definition of "patient-centered medical home" to California law.

SB 1050 (Yee) - This bill would exclude naturopathic doctors from the membership of the Osteopathic Medical Board (OMB), thereby reducing the membership of the board to five osteopathic physicians and surgeons. This problem arose because of budget actions from last year that combined the OMB with the Naturopathic Board.

AB 1825 (De La Torre) - Requires health insurance policies to provide coverage for maternity services.

AB 2470 (De La Torre) - The goal of this bill is to further protect patients from unfair insurance company practices such as rescinding coverage for spurious reasons when a patient requires care. To do this, the bill requires the state to establish standard information and health history questions to be used by health care service plans and insurers for their individual health care coverage application forms. This bill would also require all plans and insurers to complete medical underwriting prior to issuing a health care service plan contract or insurance policy.

 

Budget Bill Would Suspend Medical License for Unpaid Taxes
CAFP has joined a coalition of physician associations in urging Governor Schwarzenegger to veto proposed legislation that could have a profound effect on physician licensure. The Academy is specifically opposed to the provision in AB 8x 8, as passed by the Senate and Assembly, that would allow the Franchise Tax Board (FTB) to suspend a professional license issued by another state government entity if the licensee has failed to pay his or her taxes, including any penalties, interest, and any applicable fees which has resulted in a tax lien against the licensee. CAFP strongly believes the Medical Board of California and the Osteopathic Medical Board of California are the only state entities that should make decisions regarding physician licensure, not the FTB.  The number of times the FTB may exercise this new authority could be relatively small, but the decision to allow this authority would set an improper precedent by giving enforcement authority over a license to a non-licensing board.  The Academy also believes that the anticipated $19 million dollars this action would purportedly generate in uncollected taxes would not be realized.

 

LAC Member Testifies at Hearing on "Discount Health Plans"
Samantha Malm, MD, testified Monday at a Department of Managed Health Care (DMHC) hearing regarding "discount health plans." These plans often promise consumers discounts on physician visits and procedures that cannot be delivered. Then patients arrive in physicians' offices hoping to receive treatment or believing that they are insured when they are not. In 2001, the Attorney General reviewed the discount health plan business model and concluded that a corporation may not charge an annual subscription fee, including a reasonable profit, for furnishing a list of physicians willing to provide medical services at discounted rates to uninsured indigent persons. Dr. Malm explained to the DMHC that the very act of developing these regulations will legitimize such illegal activity. Further, while these regulations may inhibit unfair (and dangerous) business activity, their complexity may make full enforcement difficult or impossible. Partial adherence of the regulations by unscrupulous discount plans may create the appearance of legitimacy. In short, to regulate something that has already been determined to be illegal is inappropriate and dangerous.

 

CAFP Needs to Hear from YOU about the Medical Home
CAFP is surveying members about the Patient Centered Medical (PCMH) to know what tools and resources we can provide that would be of greatest valuable to our members and to better understand where CAFP members see themselves on the PCMH adoption continuum. We know members have a range of views on the PCMH concept and have been involved in many PCMH activities and functions (i.e., improving patient access and communication). Understanding these views will help shape the development of programs and resources. The survey should take less than 15 minutes; access it here: http://www.surveymonkey.com/s/PQZKBZH.

 

February 19, 2010

CAFP Lobby Day Approaches - Monday, March 8!
Join CAFP and dozens of your colleagues in Sacramento on March 8 as we let lawmakers know the importance of family medicine and what they can do to advance family medicine practices and the health of your patients. This is the best opportunity for family physicians' collective voice to be heard in the halls of the State Capitol. The more family physicians that attend, the better chance our voice will be heard on issues ranging from payment to public health

 

Take Five Minutes to Stop 21 Percent Medicare Payment Cut
The delay of federal efforts to pass a health care reform bill continues to hurt patients and may result in a significant payment cut to Medicare providers. Although a fix was included in health reform legislation to avoid the scheduled March 1 payment cut of 21.2 percent, Congress must act quickly to remedy the situation since no action on the bill has been taken. The bill to stimulate employment (the "Jobs Bill") no longer includes language to prevent the cut. Most California Congressional delegation members agree that such a cut would be devastating to physicians, but we can't rely on this. We must convince them of the urgency of preventing the cuts and of the havoc that a retroactive fix will wreak on physician practices throughout the state. Click here to find out how you can take action to help stop the Medicare payment cuts: http://www.familydocs.org/news-media/news/take-five-minutes-stop-planned-cut-medicare-payment.php

 

Senate Budget Committee Approves Corporate Tax Rollback
After issuing an urgent press release in January calling for the elimination of non-job-producing tax cuts passed in last year's budget agreement, CAFP was pleased to see the Senate Budget Committee approve of a bill that would accomplish that goal. With the prospects of 9,000 women who have been diagnosed with breast or cervical cancer losing their health care because of cuts to the Breast and Cervical Cancer Treatment Program, or low-income children losing Healthy Families Program eligibility, continuing corporate welfare programs at the expense of their health care would be unconscionable.  The committee also approved a 4.8 percent surcharge on residential and commercial property insurance. These measures will need to be approved by the full Senate and Assembly by a two-thirds margin.

Despite Senate President Pro Tem Darrell Steinberg saying this week that he doesn't plan to pursue a general tax hike this year (he believes Republicans will not sign on), on Thursday the Senate passed a bill that requires online retailers to charge sales taxes on purchases in California (currently consumers are supposed to be paying those taxes when they file their state income taxes, though few if any do), which is estimated to generate $107 million annually. Unfortunately, the Senate also voted to continue a three percent cut for regional developmental centers that care for people with disabilities.

If you have yet to visit CAFP's Budget Resource Center please do so TODAY, and contact your legislators to let them know how the proposed health care cuts will affect your patients:  http://www.familydocs.org/advocacy/budget-resource-center.php  

 

CAFP's LAC Chair Discusses Legislation with Assemblymember Skinner
Taejoon Ahn, MD, MPH met today with Assemblymember Nancy Skinner (D - Berkeley), a key member of the Assembly who is very active with health care legislation. Dr. Ahn discussed CAFP's budget advocacy efforts, the patient centered medical home, and CAFP's previous opposition to one of her bills (AB 977) which would have allowed pharmacists the ability to furnish vaccines outside of physician protocol.  Dr. Ahn and CAFP look forward to further communication with Assemblymember Skinner, and hope to work together to reach a solution to several mutual areas of concern in health care. 

 

CAFP Gives Advocacy Training Talk to 1st Year Residents
CAFP Director of Government Relations, Tom Riley, spoke to first-year family medicine residents at UC Davis School of Medicine about how they can be more involved in family medicine advocacy efforts.  Wednesday's talk included tips on meeting with legislators, a discussion of current issues affecting family medicine, and an overview of the legislative process and why family physician involvement in it is so crucial now. CAFP will be giving a more in depth version of this training on March 7 at CAFP's Congress of Delegates in Sacramento (see item at top).  

 

February 12, 2010

Assembly Subcommittee on HHS Budget Contemplates Deep Health Care Cuts
Assemblymember Jerry Hill (D - South San Francisco), chair of the Assembly Budget Subcommittee on Health and Human Services (HHS), held a hearing yesterday on the Governor's proposed cuts to HHS programs. Due to the speed at which this budget must be resolved, many believe this hearing was one of few chances for consumers and providers to weigh in, despite details of many of the proposed cuts being vague. CAFP and other health care, social service, and patient advocacy organizations urged the committee to oppose cuts to health care, mental health and social services proposed by the Governor. Among the proposed reductions were:

• Using Mental Health Services Act (Prop 63) funds to backfill the General Fund
• Reducing children's eligibility in the Healthy Families Program
• Eliminating vision benefits and increase premiums paid by families in Healthy Families
• Seek federal approval to limit Medi-Cal benefits and expand cost sharing
• Eliminating Medi-Cal to newly qualified, non-pregnant, non-emergency, adult immigrants
• Reducing reimbursement codes for eight family planning service codes
• Capturing increased state revenue by stepping up physician and pharmacy anti-fraud measures in Medi-Cal
• Delaying Medi-Cal payment for institutional providers at the end of the fiscal year into the next fiscal year
• Eliminating Adult Day Health Care
• Reducing support for Regional Centers

Mr. Riley also encouraged the committee to think seriously about the letter our coalition sent to them (detailed in last week's Update). In an encouraging sign, many comments from the committee members led CAFP to believe they did not support the Governor's proposals. Not supporting it and not voting for it are, unfortunately, two separate things.

 

Senate Budget Committee Approves Health Care and Other Cuts
This week, the state Senate Budget Committee voted to allow $2.5 billion of cuts proposed by the Governor for the 2010-11 state budget. This is the first step in creating a budget package (a collection of bills that will need final approval from 2/3rds of the Senate and Assembly, as well as the Governor's signature) to help address the $18.9 billion shortfall facing California. The main crux of the recently approved cuts is an $811 million reduction in prison health care system funding, and a 5% across the board government payroll reduction. Further cuts are likely to be part of the final midyear budget plan that will be voted on as soon as next week. If you have yet to visit CAFP's Budget Resource Center please do so TODAY, and contact your legislators to let them know how the proposed health care cuts will affect your patients:  http://www.familydocs.org/advocacy/budget-resource-center.php 

Lawmakers have decided to avoid discussing California's biggest budget programs (education and social services) and how much to cut them, until after the May Revise when they have a clearer idea of new income tax revenue generated from April's income tax filings. For most of the fiscal year (which began on July 1, 2009) California has not been meeting expected revenue collection amounts. In January, however, the state Controller announced that the state collected $1.28 billion more revenue than expected, which leaves California about 1% ($459 million) above projections for the year. The state, however, is projected to run out of cash on July 1, 2010 if no budget is put into place.

 

CAFP Asked to Sign Letter in Support of Immunizations
The California Immunization Coalition, in collaboration with Every Child By Two, is spearheading a coalition letter in support of immunizations and has asked CAFP to be a co-signer. In light of the recent invalidation and retraction of a 1998 study that linked autism to immunizations for diseases such as measles and rubella, this may be a good time for CAFP to join this effort to underscore the importance of immunizations. The letter is entitled "Open Letter to Californians Supporting the Importance of Immunizations." The letter would further emphasize the Academy's support of immunizations as the safest, most effective way to control and eradicate infectious diseases in California and across the globe.

 

CAFP Attends Medi-Cal Waiver Discussion on CCS
As part of the 1115 Medi-Cal Waiver renewal process that, in part, aims to incorporate the medical home into care for managed care patients, the state has been holding informational stakeholder meetings. The latest meeting focused on the California Children's Services (CCS) program, ironically coming at a time in which the Governor has proposed making substantial cuts to its funding to help bridge the state's budget gap. Over the past two years, CAFP (spearheaded by Academy member Jeannine Rodems, MD) has been engaged in discussion with officials at the California Department of Health Care Services in an attempt to correct privileging and access issues in the CCS program. Specifically, Dr. Rodems and the Academy were given assurances that a small but important administrative policy that for decades has limited family physicians' participation in the program had been removed. Previous state policy stipulated that in order for a family physician to participate in the CCS program, the physician must "...have expertise in the care of children, shall have at least five years of experience treating physically handicapped children or have treated 100 or more such children." No similar requirement has ever been imposed on other physician specialists participating in the program, including those practicing general internal medicine. Unfortunately, the application form on the CCS website has yet to be changed. The Academy will continue to put pressure on the administration to follow through on their commitment, and will remain engaged in the waiver stakeholder process to ensure CCS patients have access to family physicians.

 

February 5, 2010

CAFP Member Pushes for FM Residency Support at Committee Hearing
Sutter Sacramento Residency Program Director Marion Leff, MD was an invited guest at Wednesday's Health Care Workforce Access Select Committee hearing led by Assemblymember Ed Hernandez, OD (D - Baldwin Park). Dr. Leff detailed the challenges facing family medicine residency programs and suggested ways California could actively support the primary care infrastructure. Leff urged lawmakers to increase support for medical school loan repayment programs and enhance Song Brown physician training funding. Also invited was CAFP Foundation Trustee Kiki Nocella, PhD. Dr. Nocella advocated for an update to the 1994 Memorandum of Understanding (which CAFP-spearheaded with then Assemblyman Phil Isenberg (D-Sacramento)) between the state and the UC system to ensure adequate funding of family medicine and primary care training. The hearing also addressed ways to increase primary care residency slots, to improve transparency and data availability to facilitate model training programs and enhance the state's primary care capacity and to identify the most promising opportunities for stabilizing and/or developing programs in high need areas.

 

Governor Won't Be Able to Balance the Budget with New Federal Funds
President Barack Obama released a budget this past week that provided only $1.5 billion of the $6.9 billion in new funding that Governor Schwarzenegger hoped would help bridge part of the California's $18.9 billion budget gap. There is still a chance through the federal budget process that California will be able to receive additional funds, including $700 million of the $1 billion the Governor hoped to obtain from additional Medicare reimbursements and for past billing errors. The federal government has yet to weigh in on the Governor's request to change federal law to allow him authority to slash social services below federal minimums.  This comes on the heels of recent court decisions that blocked $1.4 billion in cuts to social service the Governor hoped to pursue. Notably absent from the Governor's original letter was a request to change Medicaid rules and reverse the federal injunction that a coalition of organizations (including CAFP) was able to achieve. 

If the Governor is unable to obtain these funds, he has asked the legislator to cut or eliminate many essential health and human services programs, including the Healthy Families Program. As part of the Academy's budget advocacy efforts, CAFP has spearheaded a coalition effort calling on the Governor and all California lawmakers to find alternatives to the permanent elimination and reduction of these programs. The attached letter was mailed this Wednesday to every legislator, as well as the Governor and his health policy staff.

 

Political Reform Propositions Qualify for June 2010 Election
One proposition has qualified for the June 2010 election that may indirectly affect family medicine's priority objectives. In order to secure the budget vote of moderate Senate republican Abel Maldonado (R - Santa Maria), party leaders agreed to place a ballot initiative before voters that would allow open primary voting. Please read the description below of that ballot measure, as well as brief descriptions of the three other initiatives that have qualified for the June 2010 ballot.

Proposition 14 - Elections: open primaries
This measure, which would be known as the "Top Two Primaries Act," would allow a voter to vote at the primary election for any candidate for a congressional or state elective office without regard to the political party preference disclosed by the candidate or the voter. The two candidates receiving the two highest vote totals for each office at a primary election, regardless of party preference, would then compete for the office at the ensuing general election.  How this could change California politics is unknown, but proponents hope it would help elect moderate candidates, especially in regions where there are large conservative or liberal majorities.

Proposition 15 - Political Reform Act of 1974: California Fair Elections Act of 2008
This measure would enact the California Fair Elections Act of 2008, which would authorize eligible candidates for Secretary of State to obtain public funds according to specified procedures and requirements, provided that certain thresholds are attained. The initiative would also establish nonrefundable fees to be imposed on lobbyists, lobbying firms, and lobbyist employers. The fees collected are to be deposited, in part, in the Fair Elections Fund. This initiative would additionally allow taxpayers to designate on their tax returns that a specified amount in excess of their tax liability be transferred to the Voters Fair Elections Fund, which would be created by this initiative.

Proposition 16 - New Two-Thirds Vote Requirement for Local Public Electricity Providers
This measure would require local governments to obtain the approval of two-thirds of the voters before providing electricity to new customers or expanding such service to new territories if any public funds or bonds are involved.

Proposition 17 - Auto Insurance Prices and Driver's History of Insurance Coverage
This measure would change current law to permit insurance companies to offer a discount to drivers who have continuously maintained their auto insurance coverage, even if they change their insurance company, and notwithstanding the ban on using the absence of prior insurance for purposes of pricing. It would also establish that lapses in coverage due to nonpayment of premiums may prevent a driver from qualifying for the discount.

 

February 1, 2010

CAFP Teams Up With IBM to Promote the PCMH in Meetings with Legislators
CAFP staff and members of IBM's Global Healthcare team have joined forces in a series of legislative "meet-and-greets" to help legislative leaders in both parties to further understand the patient centered medical home (PCMH). Last week's meetings included staff for Assemblymember Bill Emmerson (R - Redlands), whose district includes the Loma Linda Residency Program which has achieved NCQA certification as a PCMH. The group also met with Assemblywoman Nancy Skinner (D - Berkeley), staff for the Assembly Health Committee, and David Panush, legislative consultant to the Senate President Pro Tem.  As the medical home gains more traction in the minds of policymakers, CAFP wants to ensure that they have a full understanding of the thorough transformation necessary for practices to become medical homes, and the financial and technical assistance needed to transform practices into advanced medical homes. The Academy has scheduled another day of meetings with legislators later this month to show the cost-saving and improved health that PCMHs can bring to our health system.

 

CAFP Asked to Weigh in on "Mother Friendly Worksite" Bill
Assemblymember Kevin De Leon (D - Los Angeles) plans to introduce legislation this year with the intent of encouraging employers to provide supportive work environments for new mothers who want to continue breastfeeding their babies when they return to work. Studies show that breast feeding significantly reduces children's risk for obesity and chronic diseases, and provide significant health benefits for breastfeeding mothers. Existing state law regarding lactation accommodation requires employers to provide a reasonable amount of break time for employees desiring to express breast milk, and the use of a private room or location, other than a toilet stall, in close proximity to the employee's work area. Assemblymember De Leon's proposal would allow employers to promote their companies by using the designation "Mother-Friendly Worksite" on its promotional materials if the employer voluntarily has a workplace breastfeeding policy approved by the California Labor Commissioner that addresses at least the following: Flexible work scheduling, including scheduling breaks and permitting work patterns that provide time for expression of breast milk; a convenient, sanitary, safe and private location, other than a toilet stall, allowing privacy for breastfeeding or expressing breast milk; a convenient clean and safe water source with facilities for washing hands and rinsing breast-pumping equipment located in or near the private location; and a convenient hygienic refrigerator in the workplace for the temporary storage of the mother's breast milk.

 

State Budget Hearings Begin on Governor's Proposed 2010-11 Budget
Last week, the state Senate Budget Committee held the first of many hearings regarding the 2010-11 Budget. The hearing focused on the Governor's proposed slashing of health care funding to numerous state programs. CAFP has spearheaded a coalition urging the Governor and other lawmakers to explore new revenue solutions to the budget shortfall, such as increased taxes on alcohol, cigarettes, and sugar-sweetened beverages, rather than making deep cuts to vital health and human services program. This week the Assembly Budget Committee will meet to discuss the Governor's proposal as well.  CAFP will keep members apprised of future budget hearings.

Your Legislators need to hear from you about the effect these cuts will have on your patients and your practice. Please visit CAFP's new State Budget Resource Center page (http://www.familydocs.org/advocacy/budget-resource-center.php) to find everything you need to help advocate against these inhumane cuts. Please go there and TAKE ACTION NOW!

 

January 22, 2010

CAFP Drafts Coalition Letter to Advocate Against Health Care Cuts
As part of the Academy's budget advocacy efforts, CAFP has spearheaded a coalition effort calling on the Governor and all California lawmakers to find alternatives to the permanent elimination and reduction of vital health and human service programs now being considered. In order to prevent needless loss of life, maintain public health, and avoid debilitating chronic illness among children, seniors and other Californians, our coalition is calling for an increase in specific revenue sources (temporary alcohol, tobacco and soda tax increased, and implementing an oil severance tax) that will have the least impact on struggling businesses.  The letter was sent to numerous organizations in the hopes that they will add their organization's name.

 

AIM Program to Remove Barriers to Enrollment
The Managed Risk Medical Insurance Board (MRMIB), which operates the Access for Infants and Mothers (AIM) program, has released an emergency rule to remove a provision requiring six continuous months of residency in the state for pregnant women to receive comprehensive health insurance through the AIM program. The rule is effective December 1, 2009. CAFP has continually fought to prevent increased barriers to care, including unnecessary enrollment hurdles, and are pleased to see this rule go into effect.

 

CAFP Teams Up With IBM to Promote the PCMH
Next Thursday, CAFP staff and members of IBM's Global Healthcare team will meet with legislative leaders in both parties to further their understanding of the patient centered medical home (PCMH). As the medical home gains more traction in the minds of policymakers, CAFP wants to ensure that they have a full understanding of the thorough transformation necessary for practices to become medical homes, and the financial and technical assistance needed to become an advanced medical home that will achieve desired results. After a very fruitful meeting with IBM's Director of Healthcare Transformation and Global Healthcare and Life Service (Paul Grundy, MD, MPH, FACOEM, FACPM) and his colleagues last month, we are joining forces to show the cost-saving, health-improving results PCMHs can bring to our health system in a series of CAFP/IBM meet and greets at the State Capitol.

 

"Timely Access" Regulations' Untimely Release
After eight years in the making, the Department of Managed Care (DMHC) began the 12 month implementation process on the final version of regulations released this week intended to ensure that health plan enrollees have access to needed health care services in a "timely manner." CAFP commented extensively on these proposed regulations and their underlying legislation, AB 2179 (Cohn, 2002) over the past 10 years. Similar, although less extensive, regulations were promulgated by the Department of Insurance (DOI) in 2008 and already apply to insurers and contracted PPOs and IPAs in the state. Many of the early iterations of the proposed "timely access" regulations put the burden on already-overstretched primary care physicians to comply with the new wait times, regardless of patient volume. CAFP urged regulators to require health plans to provide sufficient provider networks in order to ensure timely access to care, instead of requiring physicians to see more patients in less time. CAFP was pleased that the DMHC incorporated much of the Academy's input in the final regulations, especially provisions that make clear the responsibility for change is on health plans to ensure the adequacy of physician networks, and that any new requirements on physicians must correlate with material changes to provider contracts. With proper enforcement and provider feedback to the DMHC, the Academy believes the regulations could, over time, improve contract provisions. Ultimately, whether the new regulations works or not will depend on consumers and the DMHC watching health plans vigilantly to ensure they make the real changes that are needed. To read the 10-page regulations, please go to: http://wpso.dmhc.ca.gov/regulations/docs/regs/20/1261420231445.pdf. CAFP will be keeping regulators alerted as to violations of contracting provision (i.e., health plans expecting physicians to do more at a faster rate without making material modifications to contracts in order to accommodate this added requirement) and would like to hear from you.