Page 1 of Resolution 1- TITLE: SINGLE-PAYER HEALTH CARE FOR CALIFORNIA Author: Corinne Frugoni, MD Contact: cfrugoni@reninet.com Introduced by: Corinne Frugoni, MD Endorsed by: Reference Committee October -, 1 0 1 This resolution constitutes a proposal for consideration by the California Medical Association House of Delegates and does not represent official CMA policy. WHEREAS, the United States ranks number 1 in health care spending per capita in the world; and WHEREAS, the United States ranks th for infant mortality, rd for adult female mortality, nd for adult male mortality and th for life expectancy in the world; and WHEREAS, exorbitant profits of the private health insurance companies contribute to both the inequitable distribution of American health care and excessive administrative costs; and WHEREAS, the competitiveness of American businesses at home and abroad is compromised because insurance coverage costs are so high; and WHEREAS, the competitiveness of American businesses at home and abroad is compromised because insurance coverage costs are so high; and WHEREAS, to million California residents will still be uninsured under the Affordable Care Act; and WHEREAS, California could save $ billion dollars the first year and $ billion dollars over the next years if the state implements single payer health care; and WHEREAS, California could save $ billion dollars the first year and $ billion dollars over the next years if the state implements single payer health care; and WHEREAS, CMA support of Single Payer Health Care legislation would be a positive membership recruitment tool; and WHEREAS, CMA support of Single Payer Health Care legislation would be a positive membership recruitment tool; and WHEREAS, with a uniform insurance program (Single Payer), administrative costs would not be duplicated, and health costs would be distributed equally and equitably; and WHEREAS, the implementation of a Single Payer Health Care Plan for Californians would streamline administrative bureaucracy and alleviate multiple critical problems caused by our
1 Page of Resolution 1- current health care system along with the anticipated challenges posed by implementation of the Affordable Care Act; therefore be it That CMA actively support the implementation of single payer health care legislation for the State of California during the - legislative session. Current CMA Policy: CMA policy (HOD a-0) allows CMA to consider supporting a single-payer plan if the following criteria, at minimum, are in place: 1) Physicians must be provided a means to ensure payment of their usual and customary charges as defined by the Gould criteria; ) a scientific, apolitical body must make benefit/coverage decisions; ) Pluralistic delivery system options must be retained (e.g., pre-paid group practices, FFS); ) There must be a mechanism for addressing fraud; ) Patients allowed to buy up -to purchase additional coverage outside the single plan; ) There must be a mechanism to address capital investment and infrastructure building; ) Medically appropriate co-payments on a sliding scale must be incorporated to discourage excessive utilization and ) Physicians must be permitted to collectively negotiate. Fiscal Impact: The potential cost of legislative activity is speculative and dependent on many factors over which CMA has no control, such as the extent of external opposition or support for the proposal, communications, and commitment of resources by opponents and proponents. The cost of CMA sponsoring or opposing a bill could be $,000 or more; in individual legislative actions, costs can be much higher. Endorsement or support of bills sponsored by others requires less effort and less cost.
Page 1 of 1 Resolution - TITLE: MEDICARE PAYMENT OF PENALTIES AND INTEREST TO PHYSICIANS FOR RAC AUDITS Author: Jeffrey Young, MD Contact: jly@hotmail.com Joseph Young, MD Introduced by: Jeffrey Young, MD Endorsed by: California Society of Physical Medicine and Rehabilitation Reference Committee October -, 1 This resolution constitutes a proposal for consideration by the California Medical Association House of Delegates and does not represent official CMA policy. WHEREAS, up to % of Medicare claims denied by the recovery audit unit are accepted upon appeal; and WHEREAS, physicians are required to return monies paid by Medicare when a claim is being audited by the recovery audit unit or face additional penalties and interest if a claim was determined to be incorrectly paid; and WHEREAS, medical practices already expend substantial resources when Medicare audits their claims; therefore be it That CMA advocate for the payment of penalties and interest to the physician when a RAC audit or appeal for a claim has been found in favor of the physician; and be it further That this matter be referred for national action. Current CMA Policy: CMA policy urges AMA to seek legislation requiring the federal government to reimburse physician costs associated with a RAC audit (HOD1a-0). CMA opposes the audit of E&M codes and requires physician reimbursement for time and expense of successful appeals (HOD -). ot --:a states that CMA and AMA will urge HCFA to stop the practice of requiring physicians to repay alleged Medicare overpayments before an appeal is rejected or a final administrative decision or a court order is rendered. Fiscal Impact: Within budget to adopt as policy and request action by the AMA; however, if CMA were to undertake the advocacy that would be required, costs could be as high as $0,000 and is dependent on many factors over which CMA has no control, such as the extent of external opposition or support for the proposal, communications, and commitment of resources by opponents and proponents.
Page 1 of 1 Resolution - TITLE: OPPOSITION TO MEDICARE RECOUPMENT Author: Jeffrey Young, MD Contact: jly@hotmail.com Joseph Young, MD Introduced by: Jeffrey Young, MD Endorsed by: California Society of Physical Medicine and Rehabilitation Reference Committee October -, 1 0 1 This resolution constitutes a proposal for consideration by the California Medical Association House of Delegates and does not represent official CMA policy. WHEREAS, up to % of Medicare claims denied by the recovery audit unit are accepted upon appeal; and WHEREAS, recoupment is the practice of subtracting money paid to the physician from current services rendered to pay for claims denied on audit; and WHEREAS, this can result in no money being paid to the physician in any given pay period in addition to an invoice for monies owed; and WHEREAS, recoupment is done before the physician is aware of the denial and before an appeal may be made; therefore be it That CMA oppose the Medicare practice of recoupment; and be it further That penalties and interest for monies determined to be owed in a RAC audit not be imposed until a decision from a second level appeal has been rendered; and be it further That this matter be referred for national action. Current CMA Policy: CMA policy urges AMA to seek legislation requiring the federal government to reimburse physician costs associated with a RAC audit (HOD1a-0). CMA opposes the audit of E&M codes and requires physician reimbursement for time and expense of successful appeals (HOD -). ot --:a states that CMA and AMA will urge HCFA to stop the practice of requiring physicians to repay alleged Medicare overpayments before an appeal is rejected or a final administrative decision or a court order is rendered. Fiscal Impact: Within budget to adopt as policy and request action by the AMA; however, if CMA were to undertake the advocacy that would be required, costs could be as high as $0,000 and is dependent on many factors over which CMA has no control, such as the extent of external opposition or support for the proposal, communications, and commitment of resources by opponents and proponents.
Page 1 of 1 Resolution - TITLE: REIMURSEMENT REDUCTION FOR NON- PARTICIPATION IN MEDICARE PHYSICIAN QUALITY REPORTING SYSTEM Author: Michael orok, MD Contact: mborokmd@roadrunner.com Introduced by: Michael orok, MD Endorsed by: District IV Delegation Reference Committee October -, 1 This resolution constitutes a proposal for consideration by the California Medical Association House of Delegates and does not represent official CMA policy. WHEREAS, CMS/Medicare has a planned 1.% reduction in physician payment for nonparticipation in the Physician Quality Reporting System (PQRS) program; and WHEREAS, it takes significant time and effort to satisfy the PQRS requirements, especially to qualify for the 0.% bonus payment; and WHEREAS, participation in the PQRS program does not influence patient care, patient outcomes, or quality of care; therefore be it That CMA support the elimination of any penalty or payment reduction for non-participation in the Medicare Physician Quality Reporting System program; and be it further That this matter be referred for national action. Current CMA Policy: HOD -0 directed CMA to register a formal public complaint to the Centers for Medicare and Medicaid Services' (CMS) about failures with the Physician Quality Reporting Initiative (PQRI) program and request that remedies, retroactive to the initiation of the PQRI program in 0, be instituted immediately (including notifying physicians if their practice was not "recognized" by the PQRI intermediary and making payment to them promptly once their practice is in compliance for payment) and that this be referred for national action. Fiscal Impact: No cost to adopt as policy. If legislation is required, the potential cost is speculative and dependent on many factors over which CMA has no control, such as the extent of external opposition or support for the proposal, communications and commitment of resources by opponents and proponents. The cost of CMA sponsoring or opposing a bill could be $,000 or more; in individual legislative actions, costs can be much higher. Endorsement or support of bills sponsored by others requires less effort and less cost.
Page 1 of 1 Resolution - TITLE: MEDICAL LOSS RATIO FOR MEDI-CAL MANAGED CARE INSURANCE COMPANIES Author: Michael orok, MD Contact: mborokmd@roadrunner.com Introduced by: Michael orok, MD Endorsed by: District IV Delegation Reference Committee October -, 1 This resolution constitutes a proposal for consideration by the California Medical Association House of Delegates and does not represent official CMA policy. WHEREAS, the Governor is moving all Medi-Cal only patients into capitated health plans; and WHEREAS, the Governor will get his % cut in Medi-Cal reimbursement to all Medi-Cal providers, especially physicians; and WHEREAS, at this time there is no means to stop decreasing Medi-Cal reimbursement even with legislation restoring the % Medi-Cal payment reduction, since the Governor will veto any legislation that eliminates any Medi-Cal reimbursement reduction; therefore be it That CMA sponsor legislation raising the medical loss ratio for health plans or health insurance companies participating in Medi-Cal managed care from 0% to % and increasing the reimbursement to Medi-Cal managed care providers, especially physician medical groups. Current CMA Policy: CMA s Guiding Principle of Health Reform (--0) # states: Health plans and insurers should spend at least % of their health-related revenue on the direct provision of patient care. Health plans and insurers shall be required to disclose all performance and financial information necessary for the protection of the public interest. Fiscal Impact: The potential cost of legislative activity is speculative and dependent on many factors over which CMA has no control, such as the extent of external opposition or support for the proposal, communications, and commitment of resources by opponents and proponents. The cost of CMA sponsoring or opposing a bill could be $,000 or more; in individual legislative actions, costs can be much higher. Endorsement or support of bills sponsored by others requires less effort and less cost.
Page 1 of 1 Resolution - TITLE: MEDI-CAL CLAWACK ON PHYSICIAN- ADMINISTERED DRUGS Author: Edward Alexson, MD Contact: ealexson@sbcglobal.net Introduced by: Edward Alexson, MD Endorsed by: Reference Committee October -, 1 0 1 This resolution constitutes a proposal for consideration by the California Medical Association House of Delegates and does not represent official CMA policy. WHEREAS, in Senate ill of, the California State Legislature gave Medi-Cal the authority to cut reimbursement for physician-administered drugs by changing to Medicare-based pricing starting on September 1, ; and WHEREAS, Medi-Cal submitted the state plan amendment to implement this change on September, four weeks after it took effect; and WHEREAS, CMS did not approve the state plan amendment until nine months later, on June, ; and WHEREAS, physicians were not notified of this approval until October ; and WHEREAS, because of these delays, physicians now face a retroactive reduction, or clawback, on physician-administered drug rates for one year; and WHEREAS, for many physicians, especially oncologists, the clawback on physicianadministered drugs could represent a bigger loss than the reduction to professional fees; and WHEREAS, legislative efforts to protect physicians from changes to professional fees have not included provisions relative to physician-administered drugs; therefore be it That CMA support all legal and legislative efforts to protect physicians from retroactive reductions to physician-administered drug rates. Current CMA Policy: HOD a-00 directed CMA to research and support all possible mechanisms to improve Medi-Cal and Medicare reimbursement rates, including tax credits for physicians that participate in the Medi-Cal and Medicare programs. Fiscal Impact: Within budget to adopt as policy. Should legislation be required, the potential cost is speculative and dependent on many factors over which CMA has no control, such as the extent of external opposition or support for the proposal, communications and commitment of resources by opponents and proponents. The cost of CMA sponsoring or opposing a bill could be $,000 or more; in individual legislative actions, costs can be much higher. Endorsement or support of bills sponsored by others requires less effort and less cost.
Page 1 of Resolution - TITLE: IMPROVING ACCESS TO MEDI-CAL MENTAL HEALTH SERVICES Author: Julia Jezmir and Swati Yanamadala Contact: Eduardo Martinez (emartinez@cmanet.org) Introduced by: Medical Student Section Endorsed by: Reference Committee October -, 1 0 1 This resolution constitutes a proposal for consideration by the California Medical Association House of Delegates and does not represent official CMA policy. WHEREAS, implementation of the Patient Protection and Affordable Care Act (PPACA), with the establishment of exchanges and expansion of Medicaid, will likely increase the demand for mental health services in California; and WHEREAS, there exist severe disparities in access to mental health services across counties in California, with some of the counties with the highest rates of serious mental illness, such as Kings County and Lassen County, having some of the lowest rates of psychiatrists/0,000 people; and WHEREAS, as of 0, only 0% of psychiatry physicians were accepting new Medi-Cal patients, the lowest rate among medical specialties, which may exacerbate the limited access to mental health providers; and WHEREAS, the PPACA mandates that for two years, Medi-Cal reimbursement for primary care physicians in the specialties of family, general internal, and pediatric medicine be 0% of Medicare reimbursements for primary care services; and WHEREAS, as of 0, Medi-Cal reimbursements across medical specialties were only % that of Medicare, with many physicians providing care for Medi-Cal beneficiaries at a financial cost; and WHEREAS, Governor Jerry rown s - budget proposal includes a % decrease in reimbursements for Medi-Cal patients, which may provide further disincentive for physicians to treat the Medi-Cal population; and WHEREAS, tax credits and loan forgiveness programs are utilized by multiple states to incentivize physicians to work in underserved areas; and WHEREAS, tax credits and loan forgiveness programs are utilized by multiple states to incentivize physicians to work in underserved areas; and WHEREAS, non-physician mental health providers can provide critical services, such as cognitive behavioral therapy, to support and follow up on the work of physicians; therefore be it
1 Page of Resolution - That CMA advocate for Medi-Cal reimbursement for mental health services to match or exceed Medicare-reimbursed rates; and be it further That CMA, in order to increase psychiatrist participation in Medi-Cal, advocate for incentive structures, including but not limited to tax credits and loan forgiveness programs, to be used to incentivize existing mental health providers to accept more Medi-Cal patients and to incentivize new mental health providers to locate to underserved states and areas; and be it further That CMA, in order to expand the availability of mental health counseling services, advocate for the ability of non-physician mental health providers (including psychologists, clinical social workers, nurse practitioners, and marriage and family therapists) who provide counseling for mental health patients to independently-bill Medi-Cal for outpatient mental health services. Current CMA Policy: CMA continues to support increased Medi-Cal and Medicare funding for mental health services (HOD 0a-1). CMA supports financial incentives such as tax credits to encourage new or experienced physicians to practice in underserved areas and to treat underserved populations such as Medi-Cal (HOD --0:-1). CMA supports the development of partial loan forgiveness programs in exchange for service in appropriately designated underserved areas as one means of effectively addressing the urgent financial needs of California medical students (HOD 0- ). Fiscal Impact: Within budget to adopt as policy, however, if CMA were to undertake the advocacy that would be required, costs could be as high as $0,000 and is dependent on many factors over which CMA has no control, such as the extent of external opposition or support for the proposal, communications, and commitment of resources by opponents and proponents.
1 0 1 0 1 Report -1- Reference Committee CALIFORNIA MEDICAL ASSOCIATION HOUSE OF DELEGATES October -, TITLE: POLICY SUNSET REVIEW Introduced by: Speaker of the House Luther F. Cobb, MD Author: Speaker of the House Attached are the policies assigned to Reference Committee for review pursuant to the process adopted by the House of Delegates in Report C--0, CMA Policy Review. The process provides that all House of Delegates policy presumptively terminates after ten years unless specifically renewed by further action of the House, based on recommendations of the relevant reference committee. CMA staff renewal/non-renewal recommendations to the reference committee, based on research of actions and developments subsequent to adoption ten years ago, are shown beneath each policy. Reasons cited for non-renewal are those set forth in Report C-- 0. After hearing testimony and evaluating staff recommendations and any available background information, the reference committee will recommend to the House of Delegates whether the policies should be renewed or allowed to sunset. It should be emphasized that policy reviewed is subject only to renewal or non-renewal (termination). Accordingly, amendment of the reviewed policies is not in order. Should a delegate wish to recommend renewal of a particular policy not recommended for renewal by the reference committee, the policy review report of that reference committee must be extracted when the committee s report is presented to the House. When the policy review report is being considered, an opportunity will be offered to then extract an individual policy or policies for renewal. After adoption of the recommendations concerning the remaining reviewed policies, the extracted policies will be considered individually. Debate will be limited to the decision to renew or not renew the particular policy. ###
Report -1- Attachment Page 1 POLICY SUNSET REVIEW: POLICIES ASSIGNED TO REFERENCE COMMITTEE Staff recommendations appear below each resolution Resolution a-0 PATIENT EDUCATION ON HEALTH SYSTEM REFORM That CMA continue to keep its physician members apprised of the current events in health care through a variety of means, including the use of the media; and be it further That CMA evaluate the use of a patient education program that would encourage patients to become involved with CMA efforts to stabilize the health care delivery system; and be it further That CMA design and implement a statewide program to enlist patient support of major CMA issues (e.g., MICRA, Medicare and Medi-Cal funding). Resolved 1&: Resolved : Sunset Action has been carried out Resolution -0 CLARIFYING CMA S HEALTH CARE FINANCING POLICIES That CMA reaffirm its policy endorsing legislation for health care financial reform incorporating the principles as adopted by the CMA oard of Trustees on November, 0; and be it further That any CMA sponsorship or support of specific legislation on access to care, whose core features include an employer mandate, shall require oard of Trustees or House of Delegates approval. Resolution a-0 FINANCIAL INCENTIVES TO PROMOTE HEALTH That CMA support efforts by businesses and employers to offer educational options to employees on the costs of high-risk behavior and to promote healthy lifestyle changes. Resolution 0a-0 EMPLOYER-OFFERED ALTERNATIVES TO HMOs That CMA strongly encourage employers that offer an HMO to also offer affordable, comprehensive alternatives (for example, a catastrophic plan coupled with a Medical Savings Account). Resolution -0 PRIORITY OPPORTUNITY FOR EXPANDED COVERAGE AND TAX EQUITY That CMA will give high priority in 0 to using opportunities with the new Congress and administration to urge each California federal legislator to change tax laws and medical savings account regulations to assure that all Americans may use pre-tax dollars for their medical care; and be it further That CMA will, in 0, urge these same California federal legislators to support refundable tax credits for those uninsured individuals not able to purchase adequate medical care; and be it further That this matter be referred for national action. Sunset Action has been carried out Resolution a-0 MEDICARE REFORM
Report -1- Attachment Page That CMA continue to advocate for changes within the Medicare program to assure that access is available for seniors, that physicians are offered fair reimbursement rates, and that physicians continue to be offered the choice of participating in or opting out of the Medicare program; and be it further That CMA offer, design and implement, and encourage AMA to offer, design and implement, programs to assist doctors in opting out of Medicare if they so choose, and publicize this service widely and actively as a major emphasis shift. Resolved 1: Resolved : Sunset Action has been carried out Resolution a-0 ELIGIILITY AGE FOR MEDICARE PATIENTS That CMA evaluate the implications of incrementally raising the Medicare eligibility age (from the current age of sixty-five years) within the larger context of any Medicare reform proposal; and be it further That this matter be referred for national action. Resolved 1: Resolved : Sunset Action has been carried out Resolution a-0 MEDI-CAL EXCLUSION OF HOSPICE That CMA join with interested organizations to educate the public and the California Legislature as to the ethical, medical, and fiscal impact of loss of hospice care under Medi-Cal; and be it further That CMA join with other organizations to maintain access of Medi-Cal patients to hospice services as necessary. Resolved 1: Resolved : Sunset Action has been carried out Resolution a-0 ACCOUNTAILITY OF CALIFORNIA S CHILD PROTECTIVE SERVICES That CMA endorse all efforts to assure that the California Child Protective Services is appropriately audited for clinical performance, and that it has a standardized approach to provide protection; and that if concerns arise, the state take appropriate actions to correct them; and be it further That CMA request that the California Child Protective Services give substantial weight to the recommendations of the treating physician in the disposition of any at-risk child. Resolution -0 AUGMENTATION TO CALIFORNIA TRAUMA UDGET That CMA consider supporting the development of a specialty license plate, using the funds generated from this specialty license plate fee to pay physicians for emergency services; and that these reimbursements remain in the county in which the license plates were purchased. Resolution -0 MEDICAID LOCK GRANTS That CMA oppose the block granting of Medicaid programs from the federal government to the states. Resolution 1-0 MEDICARE PHARMACEUTICAL ENEFIT That CMA utilize the following principles in evaluating legislative proposals for the addition of a Medicare pharmaceutical benefit: 1) Any pharmaceutical benefit should be fully funded, as a separate new part of the Medicare program by additional budgetary allocations and
Report -1- Attachment Page should provide for adequate accounting so that drug program expenditures can be tracked separately from all other expenditures; That CMA assist its members in encouraging local hospitals and hospital organizations to support these efforts. ) The pharmaceutical benefit should be targeted to reduce hardship for those with low-incomes and those with catastrophic costs; ) Any legislation should provide a pharmaceutical benefit that is consistent across geographic regions and across all Medicare plans; ) A pharmaceutical benefit should include a tiered deductible and co-payment structure that encourages economically responsible behavior without interfering with medically necessary treatment; ) A pharmaceutical benefit should be designed to prevent adverse selection; ) Any pharmaceutical benefit should be designed in a manner that prevents interference with clinical decision-making and physician prescribing decisions; and ) Any pharmaceutical benefit should be designed in a manner that minimizes the administrative burden placed on physicians. Resolution 0-0 ELIMINATE MEDICARE REIMURSEMENT CAPS That CMA continue to advocate that the Centers for Medicare and Medicaid Services eliminate all caps on balance billing. Resolution -0 CMS PHARMACEUTICAL REIMURSEMENT METHOD That pharmaceutical costs be excluded from the Sustainable Growth Rate (SGR) formula; and be it further That this issue be referred for national action. Resolution -0 PROVISION OF UPDATED ILLING SOFTWARE Y CMS That CMA work with the AMA and other professional physician organizations to advocate that CMS provide, free of charge to all licensed physicians who treat Medicare-eligible patients, current updated computer software programs for posting, coding, and electronic claims submission which physicians may, at their option, use; and be it further That this computer software be updated semiannually and be compatible with all payors, including crossover with Medi-Cal and other secondary plans; and be it further That local Medicare carriers provide toll-free phone access for electronic claims submission. Resolution 0-0 HOSPITAL SUPPORT FOR RESTORING MEDICARE FEE CUTS That CMA encourage California hospitals and hospital organizations to support CMA and AMA efforts to reverse or ameliorate scheduled cuts in Medicare reimbursement for physician services; and be it further Resolution -0 TEACHING PHYSICIAN DOCUMENTATION GUIDELINES That CMA support the use of the Center for Medicare and Medicaid Services Teaching Physician Documentation Guidelines in place of the
Report -1- Attachment Page current Medi-Cal guidelines; and be it further That CMA encourage the Department of Health Services to adopt the CMS Teaching Physician Documentation Guidelines in place of the current Medi-Cal guidelines. Resolution a-0 NEW MEDICARE PHYSICIANS FEE LOCALITIES That CMA request studies from both the Government Accounting Office (GAO) and MedPac to address the appropriateness of the data sources and the methodology employed in establishing and updating the Medical Practice Cost Index; and be it further That CMA work with our legislators and the AMA to endeavor to remove the budget neutrality language in those sections of the law that relate to the Physician Fee Schedule and to develop a more appropriate formula; and be it further That CMA create a task force to work with CMS to review the process and methodology used to determine the Medicare Geographic Cost Index for the State of California. Resolved 1&: Sunset Action has been carried out Resolved : Report D--0 MEDICARE REIMURSEMENT FOR PREVENTIVE CARE RECOMMENDATION 1: That the House of Delegates adopt the following substitute for Resolution 0-0: That CMA support an expansion of Medicare preventive benefits only if the expansion is accompanied by a program funding increase and elimination of all caps on balance billing; and be it further That CMA provide education to physician members on billing for preventive services in the Medicare program.