Breast Density Bill Moves to Assembly

SB 173 (Simitian) has passed the Senate and two policy committees in the Assembly. It will be heard in the Assembly Appropriations Committee next week. The bill would require that any woman who obtains screening mammography and is determined to have dense breast tissue by the radiologist, a 3 or 4 density under the ACR BIRADS reporting system, would  receive notification from the radiologist that she has dense breast tissue. The notice which would likely be included in the MQSA patient letter would indicate that breast density;

1) Could hide small abnormalities;

2) Patient might benefit from supplementary screening tests depending on individual risk factors, and;

3) A similar report has been sent to your physician and you should contact your physician with questions.

CRS has continued to oppose this bill along with OB-GYNs and the CMA with concerns over increased utilization of breast ultrasound and the inherent additional follow-up costs for biopsies. Though California law does require health insurers and plans to cover all medically indicated breast cancer screening tests, there is no clear consensus that breast ultrasound is appropriate where the only factor is dense breast tissue. In the last two weeks, we have suggested several amendments to the author with the commitment to move to a neutral position. SB 173 originally required that any subsequent procedures such as breast ultrasound or MRI would be required to be covered by the patient's insurance or HMO. That requirement, however was deleted from bill language prior to the first hearing on the bill.

CRS has suggested a number of changes including: (1) that the requirement apply to a mammography facility under MQSA, rather than a physician who provides mammography; (2) that a provision be included that the absence of such notice prior to the effective date of the law is not a source of liability; (3) language in the patient notice that the determination of density by the radiologist is subjective; (4) a 5-year sunset on the new law; and (5) a delayed implementation date until June 1, 2012. There is no final resolution on the suggested amendments but would we hope to finalize this week. Once the provisions are resolved we will provide the final version to our members. 

Governor Signs Clean-Up Bill on CT Radiation Safety Law

Last week, the Governor signed SB 38 (Padilla), an urgency bill that officially delays the operative date on reporting of adverse CT radiation or radiation oncology exposures until July 1, 2012. In the original bill signed last year, the operative date could have been January 1, 2011. The urgency bill took a while to make its way through the legislative process, but all parties were in agreement with the actual intent in terms of operative dates. CRS continues to work with the author and other interested parties on additional possible changes to the original law in an additional bill. However, it remains to be seen whether that is accomplished or not.

Medi-Cal Provider Rate Reductions

The state budget adopted last year for the current fiscal year ending June 30, 2011 called for a reduction in radiology reimbursement under Medi-Cal to no more than 80% of the average Medicare allowable for the same procedure. CRS has established a legal fund to file a challenge to this reduction. Though the budget states that the change would take effect on 10/1/10, no one has seen evidence of take backs on prior paid claims. We continue to monitor the situation.

In the meantime, the Legislature has passed and the Governor has signed a budget and a series of bills to enact cuts in an effort to balance the 2011-12 budget. Those cuts to Medi-Cal are targeted for $1.7 billion in reductions which include:

• A 10% provider rate cut for all Medi-Cal providers effective 7/1/11.
• Co-pays of $5 for physician or clinic visits, $50 co-pay for use of ER, $100 per day for in-patient stays ($200 max).
• A cap on physician visits of seven per year, provision for waiver in certain situations.

All of these changes require approval via a State Plan Amendment that is submitted and reviewed by CMS. It's also likely that there will be court challenges to the rate cuts and perhaps other service reductions. Provider groups have been meeting with CMS officials in both San Francisco Region IX and Washington, DC to encourage them to not approve these rate reductions. There is also a pending appeal with the U.S. Supreme Court on the 10% provider rate cut that was enjoined in 2009. We will keep you updated on the status of these changes.

CRS Nominating Committee Report

The CRS Nominating Committee has recommended the following individuals as 2011-2012 Officers:

• President - Michael Puckett, MD, FACR
• President-Elect - Vivian W. Wing, MD, FACR
• Secretary - Roger S. Eng, MD. MPH
• Treasurer - Janak Raval, MD, FACR

These nominations will be considered during our Annual Meeting, Friday September 16, 2011, during the Business Meeting at the Grand Hyatt Hotel in San Francisco, CA.