April 21, 2015
SB 259 provider out-of-network legislation defeated
Colorado Medical Society prevails on interim study

On the strength of physician grassroots advocacy by CMS members from across the state, the Senate Business, Labor and Technology Committee voted late yesterday afternoon to postpone indefinitely Senate Bill 15-259, relating to charges for out-of-network services provided at an in-network facility.

As an alternative to the legislation, a coalition led by CMS that included most component and state specialty societies, Colorado Medical Group Management Association and others persuaded the committee that the dynamics surrounding out-of network charges and network adequacy are complex and interrelated, and should be studied in the legislative interim to develop sustainable, equitable and fair policy solutions for consideration in the 2016 General Assembly.

The three-hour hearing was a wholesale airing of grievances by physicians, consumers and insurance companies over issues of out-of-network billings, network adequacy and market power. A common theme emerged from virtually all of the participants that the issues are complex and need thoughtful, deliberate study. Committee members on both sides of the aisle demonstrated great sensitivity to the array of issues presented in testimony and were particularly focused on the need for greater transparency in pricing, the need to protect consumers and enhanced overall fairness in the system.

Five Republican senators voted against the bill in the Senate Business, Labor and Technology Committee: Chair David Balmer (R-Centennial), Vice-chair Chris Holbert (R-Parker), Randy Baumgardner (R-Hot Sulfur Springs), Tim Neville (R-Littleton), and Laura Woods (R-Arvada).

The vote to postpone the bill indefinitely along party lines passed narrowly 5-4. Physicians should click on the names of these Republican senators to send them an email to thank them for their support and confirm medicine's commitment to actively participate in what may prove to be the most important interim study of the decade for physicians and patients.

Sen. Irene Aguilar (D-Denver), filed SB 259 for for the stated purpose of protecting consumers from excessive out-of-network charges. She worked with stakeholders, including CMS, on several drafts before filing the legislation, and offered a substitute bill that removed many of medicine's objections but was not able to gain a consensus within the medical community.

CMS President Tamaan Osbourne-Roberts, MD, told the committee "while these issues are not new, they are more prominent in today's marketplace and more disconcerting given health insurance narrow networks."

CMS thanks the following physicians who took time from their patients to testify at the hearing: Tamaan Osbourne-Roberts, MD; David Markenson, MD; Ron Pelton, MD, PhD; David Friedenson, MD; Eric Olsen, MD; John C. Kefer, MD; F. Brent Keeler, MD; Ron Lepoff, MD; Peter Ricci, MD; James Regan, MD; and J.T. Boyd, MD.

CMS will depend on its members for an exam room perspective as the interim study develops.

HCFP: Enhanced primary care rates now available

Effective immediately, the enhanced payment rates for evaluation and management (E&M) and vaccination codes for Medicaid beneficiaries are available and the difference for all claims submitted since Jan. 1 will be retroactively paid, the Colorado Department of Health Care Policy and Financing announced.

It was announced last year that Colorado Medicaid will reimburse covered office visit (E&M) and vaccine administration procedure codes at a rate equal to 100 percent of the December 2014 Medicare reimbursement rate from Jan. 1, 2015 to June 30, 2016. This adjustment was previously delayed as HCFP awaited approval by the Centers for Medicare and Medicaid Services before being able to load the enhanced rates into their claims processing system.

The new rates are now available to all enrolled providers who submit fee schedule claims for office visits or vaccine administrations; providers are not required to attest to providing primary care.

Click here to read more on CMS.org.

Colorado Public Radio reports PDMP registrations are up but not complete for docs

Have you registered your account with the Colorado Prescription Drug Monitoring Program (PDMP)? A Colorado law passed in 2014 requires physicians with a DEA-Registration to create an account to use the PDMP. This topic has garnered the attention of local media, with Colorado Public Radio publishing the statistics concerning registration and utilization of the PDMP on March 20.

The deadline to register a PDMP account has now passed and, as of January 2015, 91 percent of physicians had registered. While this is an enormous leap from the 30 percent registered in December 2013, it falls short of the 100 percent required by law. Registration takes about five minutes. If you have not yet registered an account, please do so now at www.hidesigns.com/copdmp.

If you already have an account, you may consider adding delegated sub-accounts for members of your team to check the PDMP on your behalf. Learn more at www.hidesigns.com/copdmp.

Click here to read the full CPR story, "A surge in doctors checking opioid prescriptions, but for how long?," which includes an interview with Director Lauren Larson on how DORA's Division of Professions and Occupations is implementing the changes to the PDMP.

Get covered with COPIC

COPIC Insurance Company is Colorado's leading medical liability insurance provider. Three out of four physicians choose COPIC for this critically important coverage. CMS members receive a 10 percent premium discount from COPIC.

For more information, call (720) 858-6000 or visit www.callcopic.com.

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Volunteers needed for Stroke Advisory Board

CDPHE seeks volunteers for vacancies on the governor-appointed Stroke Advisory Board. Appointees can attend meetings in person or via teleconference. Meetings are held every other month for approximately three hours.

The vacancies include:
  • A rural hospital administrator
  • An administrator from a stroke rehab facility
  • A primary care physician
  • A member of the public who has suffered a stroke or is a caregiver for a stroke survivor

Those interested should contact Eileen Brown, STEMI/stroke coordinator, at eileen.brown@state.co.us.The deadline is May 15.

Online CME
The Opioid Crisis: Guidelines and Tools for Improving Chronic Pain Management,
presented by the Colorado School of Public Health and accredited for two credits of CME and approved for COPIC points. This activity examines the best practices and universal precautions for treating chronic pain. Click here for more.
Upcoming events
CMS Spring Conference
May 1-3, 2015
Theme: Breaking down barriers
Sonnenalp Hotel, Vail
COPIC: HR Roundtable
Tuesday, May 19
CPEP presents: "Prescribing Controlled Drugs: Critical Issues and Common Pitfalls"
July 20-22
Hilton Garden Inn, South Colorado Blvd in Denver
CMS Annual Meeting
Sept. 18-20, 2015
Beaver Run Resort, Breckenridge
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