DMHC Finds Plans in Violation for Provider Directories  
 

The Department of Managed Health Care issued a report finding both Anthem and Blue Shield in violation for maintaining inaccurate directories of participating providers. The report found that 25% of the providers listed in their directories were not accepting patients with Covered California or no longer practicing at the location listed in their directory. It follows on a lawsuit recently filed by Consumer Watchdog against Anthem in Los Angeles over alleged errors in their listing of network providers. In the DMHC matter both plans indicated that they have taken corrective actions to verify their provider listings.

 

The issue of both the adequacy and accuracy of provider directories and participation in plan offerings in Covered California will continue to garner regulatory and legislative scrutiny. Similarly as the Medi-Cal rolls expand dramatically due to the ACA we expect that the shortage of specialists and primary care physicians accepting new Medi-Cal patients will be a major concern. Some plans have had contracts in place with physicians for many years and simply added new products or patients to the underlying agreement.   


Medi-Cal and the Duals Initiative   
 

DHCS recently announced some changes in the implementation of the Duals Initiative or MediConnect program to transition dual eligible beneficiaries to a Medi-Cal managed care plan. The initial pilot program involving 8 large counties has been slowed multiple times, staggered implementation dates or delays, and the use of passive enrollment.

 

DHCS announced this week that Alameda Count and the use of the Alameda Alliance will not go forward. The Alliance has had serious financial issues and the Department of Managed Health Care recently took action to restore their financial solvency. They also announced that due to the prior issues identified in Medi-Cal and Medicare audits of Cal Optima they will not allow passive enrollment until at least August 2015 and that patients may opt in no earlier than July 2015.

 

The Medi-Cal program has also had recent criticisms about problems in enrolling new beneficiaries eligible due to the ACA roll-out. Similarly, even those who were successfully enrolled in Medi-Cal earlier must reenroll in the last quarter of 2014 during the open enrollment period for 2015. A lawsuit was filed against DHCS by a patient advocacy group over the time constraints and requests for additional information on renewal that was not required in initial enrollment.    

 


CMA Survey on Workers Compensation Changes    
 

 

We are providing the survey notice and link form the CMA regarding feedback on the implementation of the Workers Compensation reforms that were implemented as on 1/1/14. For radiology the most important changes was conversion to the RBRVS and a unique conversion factor for radiology. The other reforms including Independent Medical Review ( IMR) may not have had very much impact on your specialty. The survey is very brief and if you see Work Comp patients it would be helpful for them to have your feedback.

 

IMPORTANT - Feedback requested by Friday, December 4th

 

The California Medical Association (CMA) is asking for physician feedback through a survey on how the worker's compensation reforms implemented last year have impacted their practices.

 

The reforms were implemented in phases beginning on January 1, 2013, and have incorporated changes to the worker's compensation program including implementation of an independent medical review process to resolve disputes about the medical treatment of injured employees, an independent bill review process to resolve disputes regarding provider payment issues and a fee schedule based on resource-based relative value scale (RBRVS) similar to Medicare's. CMA's survey is focused on these key areas.

 

Feedback from physician members thus far indicates potential problems with workers' compensation reform. CMA is asking physicians to share their experience by responding to our brief survey. The results of the survey will help CMA assess areas of reform that working and those that need improvement so we can focus our efforts accordingly.

 

Please share your experience by responding to our brief survey at https://www.surveymonkey.com/s/MQ5N3XS.

 

The survey will close on Friday, December 4th.