ASAP e-newsletter: Oct. 10, 2019
State releases proposal for state option for health insurance coverage; CMS to provide comments by Oct. 25
After months of stakeholder meetings, the Colorado Division of Insurance (DOI) and the Department of Health Care Policy and Financing (HCPF) issued a draft report Monday on the development of a state option for health insurance coverage. CMS has been actively involved in the stakeholder process, by providing testimony and other comments, following the CMS Board of Directors’ stated hope to support a public option plan that increases competition in health insurance markets, reduces insurance premiums, facilitates quality improvement and administrative simplification, and inspires physician network participation. While a complete analysis of the proposal is underway, a key takeaway within the proposal is that it sets hospital rates at 175 to 225 percent of Medicare. Physician rates are not affected by this proposed plan. Read more here.
Thanks for a successful Legislative Reception and Awards Ceremony
Thank you to the legislators and physicians who attended the CMS Annual Legislative Reception and Awards Ceremony on Thursday, Sept. 26, at Walker Fine Art in Denver. Attendees met the legislators that championed physicians' issues during the 2019 session, and enjoyed refreshments and live music. From left: Sen. Angela Williams, Rep. Kyle Mullica, Rep. Yadira Caraveo, Sen. Joann Ginal, Sen. John Cooke, Sen. Rhonda Fields, Rep. Hugh McKean, House Majority Leader Alec Garnett, and Rep. Kevin Van Winkle.
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CMS comments on draft bills from the 2019 interim opioid legislative committee
Colorado Medical Society President David Markenson, MD, MBA, and American Medical Association CEO/EVP James Madara, MD, submitted comments last week on draft bills under consideration by the Colorado legislature’s Opioid and Other Substance Use Disorders Study Committee. While CMS supports all five draft bills and strongly supports provisions in the first bill that will increase access to non-opioid pain care, Markenson and Madara raised several points of concern -- namely the efficacy of continuing the seven-day opioid prescribing limit indefinitely, and new mandates for PDMP use and provider education. Read more here.
Look into the future of health care with the September-October Colorado Medicine
The latest issue of Colorado Medicine covers nine emerging themes in health care as teased out by a Colorado Health Institute expert. Not surprisingly, most of the emerging themes are related to health care costs and some have already begun playing out in Colorado. Costs are also the focus of the thought-provoking Final Word column by Robert Smith, MBA, of the Colorado Business Group on Health. Also in this issue: three features on opioids – how the state is approaching opioid legislation, what physicians say should be done to address the epidemic and what you can do if your patients are turned away at the pharmacy counter for a legitimate opioid prescription. Read the electronic issue here.
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Colorado Medical Society and Pueblo County Medical Society honor Senate President Leroy Garcia
The Colorado Medical Society and Pueblo County Medical Society presented an award to Senate President Leroy Garcia on Friday, Oct. 4, in recognition of his support of physicians’ health policy issues in the 2019 Colorado General Assembly – specifically his work on the Professional Review Act Sunset bill. The award presentation occurred at Solar Roast in Pueblo. From left: Gordon Rheaume, DPM; Cheryl Walker, DO; Senate President Leroy Garcia; Brad Roberts, MD; and Kendall Rockler, MD.
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CMS and AMA urge comprehensive action on prior authorization reform
The Colorado Medical Society joined the American Medical Association and 103 other national, state and specialty organizations in a letter to the Centers for Medicare and Medicaid Services urging additional actions to address the burdens of prior authorization and warning against focusing on automation as the only vehicle for PA reforms.  Read more here.
CMS provides comments on regulations for prompt investigation of health claims involving utilization review and denial of benefits
The Colorado Medical Society provided comments to the Division of Insurance on draft regulation related to implementation of HB 19-1211, which was strongly supported by CMS and passed by the 2019 Colorado General Assembly to streamline and standardize prior authorization. CMS carefully examined different sections in the regulation to be sure the goals of the bill are fully effectuated -- particularly timelines for carriers to respond to PA requests. Read more here.
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Register for the Colorado Consortium poster session and provider education symposium - Oct. 22
The Colorado Consortium’s Provider Education Work Group invites you to a poster session on Oct. 22, the evening before the Consortium Annual Meeting. The poster session will take place from 5 - 5:45 p.m. on the student community bridge, between Education 2 North and Education 2 South on the Anschutz Medical Campus. This session is free. Heavy hors d’oeuvres will be provided. Register here to indicate your interest in attending the poster session.
 
Poster topics include:
 
  • Local strategies to address the opioid crisis
  • Analyses of public policies addressing the opioid crisis
  • Special topics around Medication Assisted Treatment (MAT)
  • Research on opioid use disorder and chronic pain
  • … and many others
 
If you are interested in attending the provider education symposium SCOPE of Pain, which will immediately follow the poster session, please register here. This symposium will run from 5:45 - 9 p.m. and is free of charge. The registration deadline is Wednesday, Oct. 16.
 
Contact Susanna Cooper at susanna.cooper@cuanschutz.edu with questions.
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AMA submits comments on 2020 Physician Fee Schedule and Quality Payment Program proposed rule
The American Medical Association provided comments on the Centers for Medicare and Medicaid Services (federal CMS) proposed rule for the 2020 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP), focusing on Evaluation/Management (E/M) office visit services and the new participation framework in the Merit-based Incentive Payment System (MIPS). Comments address positive and negative aspects in the proposed rule. Read the AMA’s letter here.
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Payer issues: We want to hear from you!
CMS, with Colorado MGMA, is gathering intelligence for advocacy efforts
As we approach the upcoming legislative session, we need to hear from you concerning issues impacting your practice. In partnership with the Colorado Medical Group Management Association, the Colorado Medical Society seeks intelligence from practices on the "front lines." Please contact us at payerissues@cms.org with your payer issues.

And remember to use the members-only Know Your Legal Rights online catalog of provider protection statutes that you can use in disputes with health plans. It contains decades of public policy victories that may assist you in your dealings with payers. Make sure all of the physicians in your practice are members of the Colorado Medical Society so you have access to this great resource today!

*Accessing Know Your Legal Rights requires a CMS member login. Member physicians’ staff can obtain their own login by contacting Tim Yanetta at tim_yanetta@cms.org
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