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.

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.

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.