CalDerm Alert
Recent Medicare - Palmetto Billing Issues
CalDerm President Attends CMA Council on Legislation
CalDerm President, Ann Haas, MD, Karmi Ferguson, Executive Director, and Tom Riley, Government Relations Director, attended Wednesday's California Medical Association's (CMA) Council on Legislation in Sacramento. The Council meets at least once each year to consider and make recommendations on CMA's positions on newly introduced legislation. At yesterday's meeting, more than 150 bills were considered, including five with direct implications for the practice of dermatology. CalDerm will keep you apprised of these and other legislation that will be considered by CalDerm's Legislative & Regulatory Committee in April.
You can review the CalDerm preliminary list of legislative bills at this link on the CalDerm web site: 2010 CalDerm Legislative Bill Report (preliminary) The CalDerm Legislative & Regulatory Committee will finalize positions on these bills at its next meeting.
SB 726: Health Care Districts -- An Analysis by CalDerm
Last week, CalDerm wrote to all members of the California State Assembly urging them to OPPOSE Senator Ashburn's Senate Bill 726 which expands the ability of hospitals in the state to directly employ physicians. The full state Assembly may be asked to vote on the measure in the coming weeks or days. Subsequently, CalDerm and some of its members received alerts from other state and national organizations urging dermatologists to write letters of opposition. We have been contacted by some CalDerm members asking for clarification of some aspects of claims made in these alerts. To this end, CalDerm has prepared analysis of the bill that can be read in full on the CalDerm web site: SB 726 CalDerm Analysis
FAQS: Timely Access Regulations
New Department of Managed Health Care (DMHC) regulations, intended to ensure that health plan enrollees have access to needed health care services in a "timely manner," could have a profound affect on California Dermatologists and their patients. Similar, though 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. The new regulations stem from legislation (AB 2179) enacted in 2002 that allows the DMHC director to impose various legal remedies which may include a combination with civil, criminal and other administrative proceedings.
The director also has the authority to evaluate grievances to determine if any audit, investigative, or enforcement actions should be undertaken by the department. Moreover, the director has the authority to determine whether a health care service plan has knowingly abused the requirements, so that it indicates a general business practice. In addition, contracting providers are also included and must abide by the requirements.
A list of frequently asked questions (FAQS) has been developed by CalDerm to help you better understand compliance and enforcement provisions of these new regulations. Click Here: CalDerm Timely Access FAQs
CalDerm Supports CMA Supreme Court Lawsuit
The CalDerm Board of Directors has voted to support a lawsuit affecting rates for dermatological and other physician services. At issue is whether the CMA and a provider coalition has standing to sue the State in order to block a 10 percent Medi-Cal rate cut to physicians. Even more important, however, is that the lawsuit is likely to settle, once and for all, the standard and process the state must adhere to when setting Medi-Cal rates. The State has filed a cert petition with the US Supreme Court seeking to overturn the Ninth Circuit decision regarding the ten percent Medi-Cal cut. This is the State's last option to overturn the Ninth Circuit decisions; if they fail, California will have one of the strongest laws in the country to not only protect the current injunction but also to prevent future cuts.
In short, this lawsuit will affect the outcome of past and future efforts to cut physician rates, rates that could affect rates and processes outside of the Medi-Cal program. For more information on the CMA lawsuit, please visit http://www.calphys.org/html/dd059.asp
DMHC Hearing Covering Discount Health Plans
The Department of Managed Health Care (DMHC) held a hearing Monday, February 22 to discuss the legality and regulation of discount health plans. Physician organizations, individual doctors and health plans alike spoke in opposition to regulating these plans with the consensus that doing so legitimizes and legalizes an illegal product that is harmful to physicians and patients. Despite the fact that the California Attorney General has expressed that discount health plans are illegal and the Minnesota Attorney General sued discount health plans for falsely representing themselves as medical insurers, several nursing and dental associations took the approach of "they're here to stay, so we may as well regulate them and here's how you can improve it". Some have expressed concern that in this, the final year of the Schwarzenegger administration, these regulations could signal a new and less than responsible push to accomplish policy goals using administrative and regulatory fiat.
For more information on the DMHC hearing on discount health plans, please visit
http://articles.sfgate.com/2010-02-23/bay-area/17952153_1_discount-health-global-healthcare-numbers-of-consumer-complaints
CalDerm Now Accepting 2010 Membership Dues
Please check your standard mail - the 2010 dues application has been sent and we hope to count on your continued support. CalDerm, protecting California dermatologists since 1972, expects another busy year in government. Bureaucrats continue to explore taxing cosmetic procedures at the state level and in this tight economy other medical professionals are looking for ways to expand their scope of practice - into yours!
Don't miss out on time-critical information through the CalDermAlert which is made available to members only. CalDerm is the only organization that exclusively represents California dermatologists before the state legislature, state health and business agencies, the CA Medical Board and private insurers. To renew your membership online and update your member profile, please visit CalDerm Membership Information.
CalDerm Alerts - Archive
Legislative Alert
- Oct 23, 2008
Legislative Alert
- June 2, 2008
NPI: Use It Now!
- February 28, 2008
Anatomic Pathology Services
Signed into Law Effective January 1, 2008
- November, 7, 2007
