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CMS signals additional prior auth reforms for Medicare Advantage, prescription drugs

May 30, 2013


The United States Ninth Circuit Court of Appeals has denied a request for an en banc review in the case of CMA et al. v. Douglas to stop the State of California from implementing a 10 percent cut to Medi-Cal provider reimbursement rates.

In January, a three judge panel of the 9th Circuit court that the state could move forward with the rate cuts, passed by the Legislature in the spring of 2011, despite an earlier district court ruling that found that the cuts would irreparably harm the millions of patients who rely on Medi-Cal for health care. The California Medical Association (CMA) and the other plaintiffs in the case had requested a rehearing from the full Ninth Circuit Court of Appeals, which was denied.

"While we are not surprised by the Ninth Circuit Court ruling, we are certainly disappointed, as the 10 percent cut to Medi-Cal will have devastating effects on California’s poorest and most vulnerable patients," said Paul R. Phinney, M.D., CMA president. "California already has the lowest Medicaid rates in the nation and with the implementation of health reform, millions of new patients will be enrolled in the program in coming months."

CMA and the other plaintiffs – California Hospital Association, California Dental Association, California Pharmacists Association , National Association of Chain Drug Stores, California Association of Medical Product Suppliers, AIDS Healthcare Foundation and American Medical Response – believe that reducing California's already dismal Medi-Cal rates will force providers out of the program at a time when millions of new patients will be diverted into the Medi-Cal system under the Affordable Care Act (ACA).

Even though California's fiscal outlook is much brighter than it was in 2011 when the legislature first passed the 10 percent cut, the state has continued to pursue these cuts and has indicated that it will retroactively collect payment. Actions like this will assuredly force physicians out the Medi-Cal program, which is expected to assume care for more than 2 million new patients in 2014 under the ACA Medicaid expansion.

CMA has joined an unprecedented coalition of physicians, dentists, health care workers and hospitals working to stop the cuts. In a first of its kind rally, the coalition, called “We Care for California," will gather in Sacramento on the California State Capitol steps on Tuesday, June 4 from 11 a.m. to 4 p.m. Thousands of health care providers, health care workers and patients from across the state will be in attendance.

So often in the past, health care advocates have been divided in their efforts, so focused on individual organizational interests that collective strength was weakened. “We Care for California” intends to stand undivided, using its collective influence in defense of health care.

The coalition’s first major effort is to ensure the Legislature and Governor Brown understand how harmful these cuts would be for California’s poorest and most vulnerable patients. Advocacy efforts of the coalition aim to stop the 10 percent Medi-Cal rate cut.

For more information, and to register for the event, visit http://www.wecareforca.org.

 

 

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