September 18, 2018
Attention CAFP Members: Effective January 1, 2019 You Will Be Required to Offer a Naloxone Prescription to Patients Receiving Opioids
Although CAFP opposed Assembly Bill 2760, it passed through the Legislature and was signed by the Governor. Beginning January 1, 2019, physicians and other licensed prescribers must:
- a. The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.
- b. An opioid medication is prescribed concurrently with a prescription for benzodiazepine.
- c. The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.
- a. This section does not apply to a prescriber when prescribing to an inmate or a youth under the jurisdiction of the Department of Corrections and Rehabilitation or the Division of Juvenile Justice within the Department of Corrections and Rehabilitation.
According to the new law, a prescriber who fails to offer a prescription or provide the education and use information required shall be referred to the appropriate licensing board solely for the imposition of administrative sanctions deemed appropriate by that board.
CAFP will provide additional information and resources as the deadline nears.
Introducing CAFP’s New CEO Lisa Folberg, MPP
Lisa Folberg, MPP began work September 17 as CAFP’s new Chief Executive Officer (CEO). Ms. Folberg has 18 years of experience in government relations, management, health policy and program development and most recently served for three years as President and CEO of the California Medical Association Foundation (CMAF), now known as Physicians for a Healthy California. Previously, Ms. Folberg served as Vice President for Medical and Regulatory Policy and as an Associate Director for Government Relations for the California Medical Association and as Senior Fiscal and Policy Analyst for the California Legislative Analyst’s Office. She received her undergraduate degree at San Francisco State University and her Master of Public Policy from Georgetown University.
Congratulations, Ms. Folberg, and welcome to CAFP. CAFP members are invited to send welcome emails to Ms. Folberg to firstname.lastname@example.org.
Susan Hogeland Health Policy Fellowship Launched
Applications are now open for the Susan Hogeland Health Policy Fellowship, which will be awarded annually to one medical student and one family medicine resident who have demonstrated their commitment to family medicine and interest in learning about, and advocating for, family medicine-driven health policy. The Fellowship’s goal is to increase the number and quality of family medicine physicians trained in health care policy at the state and federal level. Because pursuing a medical degree and graduating from a residency program are intense and time-consuming, the Fellowship provides an annual stipend to support participation in activities over the course of a year.
Susan Hogeland served as the Executive Vice President of California Academy of Family Physicians for 27 years. Susan started her career in advocacy and health policy in the office of US Senator Everett Dirksen, worked as a federal legislative analyst with the California Medical Association and then became Assistant Executive Director of the San Francisco Medical Society (SFMS), overseeing all policy and advocacy work of the SFMS. In 1991, she became the Executive Vice President of California Academy of Family Physicians; her tenure ends on September 30, 2018. The Fellowship is sponsored by the CAFP Foundation and open to any third or fourth-year medical student and any second or third-year family medicine resident CAFP member.
For more information, visit our website, email Shelly Rodrigues or call 415-345-8667.
CAFP Shares Concerns with CMS on Proposed Medicare Changes
CAFP joined AAFP in submitting comments to the Centers for Medicare and Medicaid Services (CMS) about its proposed Medicare rule titled, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program.”
CAFP was particularly concerned about several changes that would have an immediate and measurable impact on family medicine:
- Simplify payment by adopting a single payment rate for evaluation and management (E/M) codes for new patients (99201-99205) and existing patients (99211-99215);
- Reduce documentation burden by allowing physicians to document only at the 99202 or 99212 levels;
- Establish a new G-code valued at approximately $5.00 per visit that could be added to the newly established value for existing patient E/M services; and
- Reduce by 50 percent payment for services provided in connection with an E/M code using the modifier -25.
These proposed changes likely will fracture care by creating an incentive for a higher volume of shorter office visits; endanger the sustainability of smaller independent physician practices by reducing payment for comprehensive care; and increase out-of-pocket costs for some beneficiaries. CAFP recommended six major changes to strengthen the proposed rule, including advancing alternative payment methods in lieu of changes within the fee-for-service framework.
You can read CAFP’s submission and AAFP’s submission.
L.A. Care Issues Letters to Physicians Seeking to Recoup Medi-Cal Payments Dating Back to 2012
L.A. Care Health Plan has issued letters to physicians requesting the refund of Medi-Cal overpayments dating back to 2012. The letters state that L.A. Care incorrectly processed Medi-Medi claims as the primary payor instead of secondary to Medicare, and mistakenly paid the Medicare co-pay, co-insurance and/or deductible even though the primary insurer’s reimbursement for the claim had already exceeded the maximum allowable Medi-Cal amount.
California law allows 365 days from the date of payment to request a refund. Physicians who receive refund requests beyond the 365-day timeframe from the date of payment are encouraged to submit a formal written dispute to L.A. Care to the address listed on the recoupment letter:
L.A. Care Health Plan
P.O. Box 811610
Los Angeles, CA 90081
Fax (213) 438-5057
Please note that the “Improper Payment Findings” attachment to the overpayment letter asks physicians to sign, date and return to L.A. Care if they agree to have the overpayments deducted from payment for future services. Physicians are not required to sign the document and should carefully consider whether they wish to dispute recoupment requests. [Source: California Medical Association]
Support CAFP-Sponsored Bill to Regulate PBMs
CAFP’s co-sponsored legislation, AB 315 (Wood, Dahle, Nazarian and Stone), to regulate pharmacy benefit managers (PBMs) and protect patients from unfair drug pricing sits on the Governor’s desk awaiting his signature or veto. Please use the Governor’s website and the drop-down menu to indicate your SUPPORT for AB 315.
The bill requires PBMs to register with the state and notify purchasers of any conflicts of interest in their practices. It also requires PBMs to disclose any financial benefits associated with pushing particular prescription products and disclose any material changes to contracts that affect reimbursement. In addition to regulating PBMs, the bill seeks to guide patients to the lowest cost for their medication. The bill does this by barring PBMs and health plans from prohibiting providers from informing patients of a less costly alternative to a prescribed medication, as well as requiring pharmacies to inform customers whether the retail price of a prescription drug is lower than the applicable cost-sharing amount for that drug.
CalHIPSO Launches Educational Webinar Series Starting with MIPS Reporting for 2018
The California Health Information Partnership and Services Organization (CalHIPSO) has launched an educational webinar series, the first of which is a webinar by SA Ignite to cover what you need to know about reporting for MIPS Year 2 (2018). SA Ignite is a cloud-based software provider specializing in successful adherence to MIPS and other value-based payment programs. They will explore various scenarios related to MIPS reporting and their impact on clinicians and groups. The webinar will take place on October 4 at noon (PST). Register here: http://bit.ly/calhipsoMIPS