July 15, 2022

2022-23 Budget Positions CA to be First State to Achieve Universal Health Care



The California Legislature passed and Governor Gavin Newsom signed the 2022-23 state budget, which continues California’s commitment to achieving universal health care access. The $308-billion budget addresses many of CMA’s key priorities, including a phased-in system to provide full scope Medi-Cal coverage to all income eligible Californians regardless of age or documentation status by January 1, 2024. Click here to read some of the provisions included in the final budget.

Medicare Payments Decreased 1%



On April 1, the Centers for Medicare and Medicaid Services began to phase back in the suspended sequestration cuts, with a 1% cut taking effect April 1. Effective July 1, the sequestration cuts have now reverted to 2% — the rate that was in effect prior to the public health emergency. 

Cigna to Reevaluate Burdensome Modifier 25 Policy



Cigna is delaying the implementation of its recently announced policy to require the submission of medical records with all E/M claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. CMA and AMA reached out to Cigna addressing the administrative burden and compliance cost to physician practices, and urged the payor to rescind the policy. Due to this advocacy, Cigna has delayed implementation and the policy is under additional review. The reimbursement policy update therefore will not go into effect on August 13 as originally scheduled.

PHE Extended Through Mid-October

HHS has extended the COVID-19 public health emergency, which expired on Friday, for another 90 days. The designation allows millions of Californians special access to Medi-Cal and COVID telehealth flexibilities will remain in place until October 2022. Congress also extended the COVID-19 telehealth waivers for 5 months beyond the end of the PHE. See CMA’s Telehealth Policy Update for more information.

DHCS Sunsets Medi-Cal Value-Based Payments

DHCS has sunset the Prop. 56 funded Medi-Cal Value-Based Payments program, effective July 1. The program incentivized providers for meeting specific measures and benchmarks that improve the quality of care provided to Medi-Cal beneficiaries. The Prop. 56-funded Medi-Cal supplemental payments that apply to a set of 23 primary care focused CPT codes and family planning services will not be affected and were made permanent as part of the 2021-22 state budget. 

EMTALA Overrides State Laws Restricting Access to Abortion

This week Secretary Becerra sent a letter to all hospitals and health care providers reminding them of their obligation to comply with the Emergency Medical Treatment and Active Labor Act (EMTALA). The EMTALA statute protects your clinical judgment and the action that you take to provide stabilizing medical care to your pregnant patients. The letter clarifies that EMTALA requirements preempt any state laws that restrict access to stabilizing medical treatment, including abortion procedures and other treatments that may result in the termination of a pregnancy. CMS also released an updated guidance to hospitals reinforcing that EMTALA requirements apply to all hospitals in all states regardless of the state law to the contrary. 

Revised Public Service Loan Forgiveness Regulations Still Excludes CA Physicians

Recently, the US Department of Education released draft regulations to reform the Public Service Loan Forgiveness (PSLF) program. The language in the draft regulations attempts to solve the problem of requiring “direct employment” in California and Texas by instead requiring that physicians “contract with” private non-profit hospitals “to provide payroll or similar services” to receive loan forgiveness. While well-intended, the proposed regulation still excludes California and Texas physicians because they do not contract with hospitals to provide payroll services. Moreover, many physicians in these states do not practice in nonprofit hospitals with a contract and would still be ineligible regardless of whether the contract must be for payroll services. CMA and TMA are urging the Department of Education reconsider the proposed solution. 

Prior Authorization for Cataract Surgeries Rescinded

Aetna recently announced it will no longer require pre-approval for most cataract surgeries. This decision came a year after Aetna implemented a policy requiring all cataract surgeries to be “pre-certified,” claiming that it would “help members avoid unnecessary surgery.” CMA continues to support state and federal legislation that would streamline and standardize prior authorization requirements. Click here to learn more. 

Share Your Story: How Has the Dobbs Decision Impacted You and Your Patients?

AMA is seeking additional information and specific examples of how physicians and patients are being impacted by the Dobbs decision and state prohibitions on abortion. If you have examples of access problems related to reproductive health (e.g. miscarriage management) or other areas of care (e.g. prescribing of medications for other conditions), please email terri.otten@ama-assn.org. Identifying information for the physician or patient is not required, but otherwise please be as specific as possible. Firsthand accounts from physicians and patients would be especially helpful. 

Provider Relief Fund Reporting Period 3 Now Open



Physicians who received more than $10,000 in the aggregate between January 1 to June 30, 2021 may now access the PRF Reporting Portal. The reporting window will close September 30, 2022. The deadline to use these funds is June 30, 2022. Physicians are encouraged to complete their reporting well before the deadline.

Managing Pain Safely: Non-Pharmacological Treatments 

Available On Demand | Free 

This webinar discusses some of the evidence-based non-pharmacological treatments recommended in the treatment guidelines. Conditions usually not considered for non-pharmacological treatments are discussed to help improve the management of more difficult conditions such as osteoarthritis and disc herniations. A colleague that regularly utilizes non-pharmacological treatments shares tips in patient management. This webinar is hosted by the East Bay Safe Prescribing Coalition, Alameda-Contra Costa Medical Association, and Napa Solano Medical Society. 

Access the webinar here. 

Things I Didn’t Learn in Training About Firearms

Wednesday, July 20 | 12:00 to 1:00 pm 

CME Available | Hosted by Sonoma-Mendocino-Lake Medical Association 

As our nation continues to reel amidst the ongoing epidemic of gun violence, it is more important than ever that physicians and healthcare professionals understand and engage in education and advocacy. Whether with family, the general public, or at the bedside, our profession has incredible opportunities to help people make safe, responsible decisions when it comes to firearms. The activity content is geared toward all physician specialties. The educational formats for this activity will be Case Presentation with Learner Participation, Lecture with Q&A Period. 

Call (707) 525-4375 or email Rachel@smlma.org to RSVP. Click here to join via zoom.

Medicare Payment Principles 

Wednesday, July 27 | 8:00 to 9:00 am 

Hosted by AMA 

The Medicare physician payment system needs an overhaul to remedy financial instabilities impacting physician practices due to the pandemic, statutory payment cuts, lack of inflationary updates and significant administrative burdens. To define the goals of reform, the AMA and 120 state medical and national specialty societies created the Characteristics of a Rational Medicare Physician Payment System. Hear what these principles call on Congress to do to improve the Medicare physician payment system in a new AMA webinar hosted by Sandra Fryhofer, MD, chair, AMA Board of Trustees. 

Register here. 

Leadership Reading and Discussion Group 

Wednesday, September 7 | 6:00 to 7:30 pm    

FREE | CME Available | Online    

Physicians are free to join any meeting of the Leadership Reading and Discussion Group; reading the book is not required. Doctor Hilary Worthen, course director of the Physician Leadership Program, facilitates the discussion group that is held on Zoom. The book selection for September 7 is “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” by Elisabeth Rosenthal, MD. This book describes how the flawed system of health insurance and delivery has failed patients in the US, and proposes solutions for far-reaching reform. 

Register here. 

Ballots & Brews 

Mare Island Brewing Co., Vallejo | Friday, Sept. 9 | 6:30 to 9:00 pm 

Free for members | $50/person for non-members 

Bring the family to Mare Island Brewing Co.'s "Whaleboat Room" to enjoy good food and good company. Sip some suds and learn about the biggest health care issues on the November ballot or eat some free food and play games outside (e.g. cornhole, giant Jenga, foosball, or bring your own from home!) with waterfront views. Micah Scheindlin, CMA Associate Vice President of Political Operations, will present on how 2022 ballot measures could impact you and your patients.  

Register here.

NEPO Summit: Beyond Unconscious Bias to Health Care Equity 

Thursday, October 6 | 9:30 am to 4:00 pm 

Hosted by PHC and NEPO | $50 for members & non-members 

The Network of Ethnic Physician Organizations (NEPO) is a network of diverse physicians and patients that convene annually to advocate for community health, encourage physician leadership development, and promote cultural and linguistic competency in patient care. The summit will be virtual and cover topics critical to diverse physicians and patients including reproductive and maternal health outcome disparities, women physician well-being, and practice transformation. The NEPO Summit will also include the presentation of the Physicians for a Healthy California 2022 Leadership Awards. These awards are a wonderful opportunity to celebrate individuals or organizations who are champions of health equity. Nominations are open through July 18. 

Register here.