California Oncology Weekly Newsletter 9.27.16

California consumers will have the strongest protections in the nation against getting blindsided by unexpected out-of-network medical bills as part of legislation signed into law by Gov. Jerry Brown. AB72 was one of 10 consumer-protection measures — eight related to health care — signed by the governor, last Friday. For more information click here.

Noridian/JEMAC will soon be deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to CMS. Noridian/JEMAC reports that only 19% of physicians have responded to the most recent revalidation process. To prevent deactivation, CMA recommends that practices look up their revalidation dates through the CMS look-up tool. For more information click here.

DHCS/Medi-Cal continues to survey physicians for feedback on the effectiveness of DHCS/Medi-Cal’s fee-for-service provider relations activities.  For more information click here.

The Community Oncology Alliance (COA) recently testified before the House Committee on the Budget regarding CMS’s proposed Medicare Part B drug reimbursement experiment. After the hearing, several Representatives began circulating a letter to CMS that looks to rein in overreach by CMMI asking CMMI to stop experimenting with Americans’ health and cease all mandatory demos. Additionally, they ask CMMI to ensure that future models comply with current law, including appropriate limitations on the size and scope of the models and not expanding models without Congressional approval. For more information click here. 

MOASC encourages all to write to your Congressperson making them aware of, and asking them to sign on to, the letter by Rep. Sinema of Arizona regarding the broad authority of the Center for Medicare & Medicaid Innovation (CMMI).  Earlier this year, CMMI proposed the “Medicare Part B Payment Model”, which would reduce payment for many providers and make centralized, one-size-fits-all decisions about treatment, ignoring patient differences and perspectives. For more information click here. 

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September 27, 2016

The CMA is concerned that United Healthcare (UHC) failed to properly notify physicians before implementation of its Clinical Data Submission Protocol. Although California law requires payors to provide contracted physicians with the 45 business days’ advance notice of any material contracting changes, UHC’s only notification to physicians about this new protocol was in its Network Bulletin. For more information click here.

Noridian/JEMAC will soon be deactivating billing privileges for physicians who received re-validation notices from Noridian but have not submitted completed applications to CMS. Noridian/JEMAC reports that only 19% of physicians have responded to the most recent re-validation process. To prevent deactivation, CMA recommends that practices look up their re-validation dates through the CMS look-up tool. For more information click here.

About 1 of every 6 Californians lives in poverty, which helps explain why almost 12 million state residents are enrolled in Medi-Cal. Medi-Cal is the health insurance program for impoverished Americans that’s jointly funded by federal and state taxpayers. California’s enrollment is by far the largest in the country. Because the state is relatively wealthy, California has to pick up a larger share of its Medicaid costs than almost every other state does. For more information click here.

HHS finalized a rule that expands and clarifies what clinical-trial data legally needs to be made public. Universities and drug companies that use human volunteers for research face tough new rules designed to make sure that valuable information from these volunteers is widely available, not only to the volunteers themselves but to scientists trying to advance medical science. The rules currently on the books are confusing and often ignored. For more information click here.

CMS has announced major change to the implementation of MACRA and has outlined how physicians can choose to participate at their own pace in the new quality program and avoid any penalties in the first year of implementation. For more information click here.

Eligible providers and hospitals completing their meaningful use requirements for the EHR Incentive Programs can get help from the CMS through a central repository that will indicate which clinical data registries and public health agencies are ready to electronically receive public health reporting data. For more information click here.

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September 20, 2016

Rising drug costs are often blamed for driving up health insurance premiums, but a major consumer group says the numbers don’t add up, at least in California. The advocacy group Consumers Union says two large Blue Cross Blue Shield insurers in the state may be exploiting the outrage over high drug prices to artificially inflate their premiums for individual coverage under the Affordable Care Act. For more information click here.

Noridian/JEMAC will soon be deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to CMS. Noridian/JEMAC reports that only 19% of physicians have responded to the most recent revalidation process. For more information click here.

The Department of Health Care Services (DHCS) has released its plan to evaluate California’s new waiver program to strengthen care in public safety net hospitals and care systems, and is seeking feedback from the public while the proposal is being reviewed by the Centers for Medicare & Medicaid Services (CMS). The improvement effort, known as PRIME, is one of the major initiatives of DHCS’ Medi-Cal 2020 waiver, approved in December 2015 by CMS. For more information click here.

Read COA’s White Paper on Pharmacy Benefit Manager’s Attack on Physician dispensing and Impact on Patient Care: Case study on CVS/Caremark’s efforts to Restrict Access to Cancer Care. After reading the white paper, MOASC encourages you to write to the CMS and your representative, expressing your concern over CVS/Caremark’s misinterpretation of CMS’ directive on in-office physician dispensing. For more information click here.

Join expert faculty for, “When First-Line Treatment Fails: Navigating New Treatment Paradigms in Relapsed/Refractory Multiple Myeloma,” Tuesday, September 20 at The Huntley Hotel, Santa Monica. Lead by Jonathan L. Kaufman, MD, Emory University School of Medicine, Atlanta, Georgia, and Jatin J. Shah, MD, The University of Texas MD Anderson Cancer Center, Houston, Texas, this CE accredited for physicians, nurses and pharmacists, complimentary program, will discuss recent advances in the treatment of relapsed/refractory multiple myeloma and how to navigate current agents to find the right option for your patients. For more information click here.

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September 13, 2016.

“… they are all gone!” These were the words of the California Cancer PAC lobbyist, regarding the California state legislator’s completion of its business for the year. Meeting their August 31st deadline, they have all gone back to their districts to meet with their constituents, campaigning for some and vacation for most. Take the opportunity to invite your district senator and assembly person to your practice. For more information click here.

Noridian/JEMAC will soon be deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to CMS. Noridian/JEMAC reports that only 19% of physicians have responded to the most recent revalidation process. To prevent deactivation, CMA recommends that practices look up their revalidation dates through the CMS look-up tool. For more information click here.

DHCS/Medi-Cal is surveying physicians for feedback on the effectiveness of DCHS/Medi-Cal’s fee-for-service provider relations activities, including the telephone service center, cash control unit, regional reps, publications, and provider seminars/trainings. For more information click here.

The Federal Fair Labor Standards Act, Family Medical Leave Act and Employee Polygraph Protection Act notices have changed. There were updates to mandatory labor law posting requirements that affect businesses. In order to stay in compliance with these recent changes, the updated postings must be downloaded, printed, and then posted next to your current labor law poster. For more information click here.

The 2017 ICD-10-CM and ICD-10-PCS code updates, including a complete list of code titles, are available online. In addition, CMS has published Clarifying Questions and Answers Related to the July 6, 2015, CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities that addresses some of the issues regarding the 12-month grace period or flexible implementation date ending in October 2016 (see page 8 of the document.  For more information click here.

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September 6, 2016