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CMA takes on public health, Medi-Cal with 2015 sponsored legislation



March 23, 2015
Area(s) of Interest: Access to Care Advocacy Public Health 

California Medical Association (CMA) sponsored bills for 2015 include a $2 per pack tax on cigarettes, increasing provider rates for Medi-Cal and establishing a Graduate Medical Education Trust Fund in light of inadequate funding levels from the federal government.


SB 591 (Pan) – Cigarette and tobacco products taxes: California Tobacco Tax Act of 2015
This bill is the CMA-led Save Lives Coalition’s legislative strategy to increase the state’s tobacco tax by $2 per pack. The bill would allocate funds raised by the tax to tobacco prevention and education, programs provided by the California Department of Health Care Services (DHCS) and enforcement of tobacco laws. The Los Angeles Times recently editorialized in favor of SB 591.


AB 1396 (Bonta) – Tobacco Tax Funding Implementation Medi-Cal
The bill would provide oversight for allocation of the funds raised by the SB 591 (Pan) tobacco tax that are slated for use by DHCS for Medi-Cal. It would require that DHCS meet the federal government mandate that Medi-Cal payments are consistent with certain standards and are sufficient to enlist enough providers to serve eligible populations. It would also require an annual independent assessment of whether Medi-Cal provider rates achieve those standards.


SB 243 (Hernandez) and AB 366 (Bonta) – Medi-Cal Reimbursement Rates
Introduced in the 2015-16 California Assembly legislative session, these bills would dramatically improve access to care for Medi-Cal beneficiaries by repealing recent cuts to Medi-Cal provider reimbursement rates; increasing reimbursement rates for most outpatient providers to Medicare levels, for both fee-for-service and Medi-Cal managed care providers; and increasing hospital Medi-Cal rates on a one-time basis and requiring annual increases thereafter.


Medi-Cal is one of the lowest paying Medicaid programs in the country. Despite the fact that California now has an estimated 12 million people eligible for Medi-Cal (nearly one third of the state’s population), California pays the third-lowest reimbursement rate in the country (California Healthcare Foundation, March 2014). By the middle of 2016, it is estimated that California’s Medi-Cal population will have grown by over 4.6 million people since 2011. The state needs to ensure that expanded coverage translates into timely access to medical services.


AB 637 (Campos) – POLST forms
This bill would allow nurse practitioners and physician assistants, under physician supervision, to sign Physician Orders for Life-Sustaining Treatment (POLST) forms in an effort to increase utilization and to make a POLST an immediately actionable order.


AB 1086 (Dababneh) – Assignment of reimbursement rights
Would require Knox-Keene regulated health care service plans to honor assignment of benefit agreements, thereby sending any payment directly to the out-of-network provider when such an agreement is present. It also requires that assignment of benefits agreements contain certain information that will assist the consumer/patient in determining out-of-network cost exposure.


AB 1434 (McCarty) – Health insurance prohibition on health insurance sales: health care service plans
The bill seeks to close an existing loophole that allows Blue Cross of California and Anthem Blue Shield to choose the regulator with which to file their PPO products. This loophole has resulted in the General Fund foregoing more than $1 billion from 2004 to 2011. The bill also requires the Department of Finance, in consultation with DHCS, as a part of the annual budget process, to determine if the implementation of AB 1434 has resulted in increased revenues to the General Fund. If so, the equivalent amount of that increase shall be appropriated to DHCS for the purpose of increasing provider rates under the Medi-Cal program.


SB 22 (Roth) – Medical residency training program grants
Establishes a Graduate Medical Education Trust Fund that can receive contributions from private sources in order to provide grants to residency programs in areas with the greatest need. This bill is intended to serve as a vehicle for discussion among various health care stakeholders (physicians, provider groups, hospitals, clinics and health plans) about how to adequately and sustainably fund graduate medical education in light of inadequate funding levels from the federal government.


SB 289 (Mitchell) – Telephonic and electronic patient management services
This bill requires health insurance companies licensed in California to pay providers for telephone and electronic patient management telehealth services. Currently, reimbursement for these services vary. Plans often deny physician requests for coverage, depriving patients of a reasonable alternative to face-to-face physician evaluations.


SB 563 (Pan) – Workers' compensation: utilization review
This bill seeks to limit potential conflicts of interest by requiring employers and insurers to disclose payment methodologies for those involved in the process of reviewing and approving, modifying, delaying or denying requests by physicians related to providing medical services to injured workers. It will also look to limit the ability to reopen old cases with lifetime medical awards through utilization review to deny treatment plans that were already approved and settled.


SB 781 (Allen) – Emergency room physicians
Because emergency physicians see patients irrespective of their insurance status, they are not guaranteed a certain amount for treatment. This bill would create a system that provides the treating physician fair payment, with the insurer required to pay the amount of the 70th percentile of the Fair Health Database. If either the provider or the insurer disputes the payment, they must enter a mandatory, binding arbitration to determine whether the provider’s charges or the proposed payment by the insurer is “more” fair.


For more information on these and other bills of interest to physicians, subscribe to CMA's Legislative Hot List.

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