Blue Cross
Sherry L Daley
Description
Collection
Title:
Blue Cross
Creator:
Sherry L Daley
Date:
1/3/2006
Text:
Attention California O&P community: Recently O&P providers who contract
with Blue Cross have been notified that there is a reimbursement cut of
15%. Please note that the cut goes into effect even if the provider does
not respond. The response date is 30 days from the date of the letter,
which in most cases was December 12, 2005, making January 12th for those
wishing to correspond concerning the change in the contract. Several COPA
members have responded to Blue Cross who claimed that the industry should
find cheaper materials and become more efficient. The only option for
those unwilling to accept the cut is to send notification of termination
of the contract (an option that many providers are taking). COPA has the
following contact information for Blue Cross:
Shawn Habibi, Contract Manager
Health Care Management
Blue Cross of California
<Email Address Redacted>
COPA is addressing the issue in several ways. Firstly, COPA has forwarded
a copy of the notice of the reduction to Halper Litigation Group with an
urgent plea that the aggressive pricing be investigated as retaliatory
and as an obstruction to the ongoing suit (Solomon v. Blue Cross Blue
Shield) in which ancillary providers, including O&P, are suing the said
organizations for reimbursement abuses. Secondly, COPA has requested an
immediate meeting with the Department of Managed Health Care to seek
their intervention. COPA has requested the Department to use its
oversight ability to declare the predatory pricing effort of Blue Cross
as invalid for contracting purposes and harmful to consumers, who in most
cases had already made their plan decision during the recent open
enrollment period. Lastly, COPA has pending legislation that addresses
coverage for O&P in managed care plans. This is active legislation that
we can modify if the previous remedies are ineffective.
In another area, COPA continues to actively fight the cuts of 5% for
Medi-Cal reimbursement. Our new lobbyist has been at the forefront of
negotiations during his employment with the California Medical
Association. The reason the cuts are scheduled to begin now is that the
governor reneged on a deal last year (AB 1735) to not retroactively or
currently implement the reduction, which was authorized after CMA lost an
appeal for their lawsuit. The CMA is crafting emergency legislation to
stave off these cuts, which will undoubtedly be part of the governor’s
budget that will be presented the second week of January (see article
below). COPA belongs to the coalition that is leading the charge against
the cuts and will notify members what the specific bill number is once
it is introduced so that they can urge its passage. In addition, COPA has
been successful in gaining a review of reimbursement rates for O&P under
Medi-Cal. We will inform all as to the outcome of the review as soon as
the report is made available. Due to changes in the law, this is the
procedure that leads to an increase in rates for any category that is not
sufficiently reimbursed. COPA will continue this important work on behalf
of the Medi-Cal beneficiary and their respective providers. Hopefully
relief will be forthcoming soon.
Although COPA finds the list serve resource helpful in reaching the
California O&P community, the COPA Board of Directors has voted in favor
of changing COPA's communication format from a traditional bimonthly
newsletter, to a monthly e-letter format. The first edition is being
posted via COPA's web site and should be available next week. COPA will
post the web address to access the e-letter as soon as it is functional.
In the meantime, COPA needs to develop a more accurate data base to
communicate breaking news and gather input from the field. Please e-mail
COPA so that we can add you to our list: <Email Address Redacted>
_________________________________________________________________________
___
December 22, 2005
CMA and a broad coalition of health care groups Wednesday called on
Governor Schwarzenegger to join them to stop the 5 percent cut in
Medi-Cal payments due to begin January 1.
“These cuts will devastate the weak, the young, disabled, aged, and the
most vulnerable in California by making it more difficult for them to get
medical care,” says CMA CEO Jack Lewin, M.D. “It will cost our state far
more in damaged lives and unnecessary emergency room visits than it will
save.”
The Medi-Cal cuts are the result of a law sought and signed in 2003 by
Governor Davis. The cut was to be effective on January 1, 2004 and sunset
on January 1, 2007.
CMA in 2003 won a federal court injunction blocking the 5 percent cut.
Unfortunately, that injunction was overturned in August 2005, opening the
door for the state to immediately reduce Medi-Cal reimbursement rates by
5 percent retroactive to January 2004. The cuts were delayed, however, as
CMA worked with the state legislature and the Governor to pass
legislation to prevent implementation of the cuts through December 31,
2005.
The Department of Health Services announced last week that the law
requires it to implement the 5 percent cut on fee-for-service Medi-Cal,
which provides care to 3 million poor, children, elderly, and disabled.
The coalition of patient and physician groups said it would seek a bill
to rescind the statute mandating the cuts, and invited the administration
to join it in supporting the effort. The coalition—Californians United
for Quality Health—includes more than 50 health care advocacy groups and
was created several years ago by CMA to preserve access to care for
California’s Medi-Cal patients.
The 5 percent cut would save the state general fund about $60 million,
but because the federal government matches, the total cuts to patient
care would be $120 million. “Eliminating this cut would be a win-win for
California,” says Dr. Lewin. “It just doesn’t make sense to lose the
match the federal government provides for Medi-Cal payments. Why give
more federal dollars to other states instead of ensuring that the most
vulnerable have access to care?”
Even without the cut, California ranks last among the 50 states and the
District of Columbia in Medi-Cal payments for patient care. About 6.5
million people in the state are eligible for Medi-Cal in any given month.
In the most recent data available (2001), California was ranked 51 out of
all states and Puerto Rico for payments per beneficiary. Even though in
the past 20 years, inflation has increased 80 percent, there’s only been
one overall Medi-Cal rate increase of 17 percent. That increase was in
2000-01.
The 5 percent cut means that an internist or family physician would
receive about $20 for a typical office visit, substantially below the
cost of providing the service. The low level of reimbursement has
undermined physicians’ financial ability to treat Medi-Cal patients and
still maintain a viable medical practice.
If payment rates are cut, more primary care physicians will be forced to
decrease the number of Medi-Cal patients they accept or to leave the
program entirely. This will further reduce access to care and force
Medi-Cal beneficiaries to forgo care or use hospital emergency
departments as their primary health care provider, thereby lengthening
waits, increasing costs, and decreasing quality of care for everyone.
with Blue Cross have been notified that there is a reimbursement cut of
15%. Please note that the cut goes into effect even if the provider does
not respond. The response date is 30 days from the date of the letter,
which in most cases was December 12, 2005, making January 12th for those
wishing to correspond concerning the change in the contract. Several COPA
members have responded to Blue Cross who claimed that the industry should
find cheaper materials and become more efficient. The only option for
those unwilling to accept the cut is to send notification of termination
of the contract (an option that many providers are taking). COPA has the
following contact information for Blue Cross:
Shawn Habibi, Contract Manager
Health Care Management
Blue Cross of California
<Email Address Redacted>
COPA is addressing the issue in several ways. Firstly, COPA has forwarded
a copy of the notice of the reduction to Halper Litigation Group with an
urgent plea that the aggressive pricing be investigated as retaliatory
and as an obstruction to the ongoing suit (Solomon v. Blue Cross Blue
Shield) in which ancillary providers, including O&P, are suing the said
organizations for reimbursement abuses. Secondly, COPA has requested an
immediate meeting with the Department of Managed Health Care to seek
their intervention. COPA has requested the Department to use its
oversight ability to declare the predatory pricing effort of Blue Cross
as invalid for contracting purposes and harmful to consumers, who in most
cases had already made their plan decision during the recent open
enrollment period. Lastly, COPA has pending legislation that addresses
coverage for O&P in managed care plans. This is active legislation that
we can modify if the previous remedies are ineffective.
In another area, COPA continues to actively fight the cuts of 5% for
Medi-Cal reimbursement. Our new lobbyist has been at the forefront of
negotiations during his employment with the California Medical
Association. The reason the cuts are scheduled to begin now is that the
governor reneged on a deal last year (AB 1735) to not retroactively or
currently implement the reduction, which was authorized after CMA lost an
appeal for their lawsuit. The CMA is crafting emergency legislation to
stave off these cuts, which will undoubtedly be part of the governor’s
budget that will be presented the second week of January (see article
below). COPA belongs to the coalition that is leading the charge against
the cuts and will notify members what the specific bill number is once
it is introduced so that they can urge its passage. In addition, COPA has
been successful in gaining a review of reimbursement rates for O&P under
Medi-Cal. We will inform all as to the outcome of the review as soon as
the report is made available. Due to changes in the law, this is the
procedure that leads to an increase in rates for any category that is not
sufficiently reimbursed. COPA will continue this important work on behalf
of the Medi-Cal beneficiary and their respective providers. Hopefully
relief will be forthcoming soon.
Although COPA finds the list serve resource helpful in reaching the
California O&P community, the COPA Board of Directors has voted in favor
of changing COPA's communication format from a traditional bimonthly
newsletter, to a monthly e-letter format. The first edition is being
posted via COPA's web site and should be available next week. COPA will
post the web address to access the e-letter as soon as it is functional.
In the meantime, COPA needs to develop a more accurate data base to
communicate breaking news and gather input from the field. Please e-mail
COPA so that we can add you to our list: <Email Address Redacted>
_________________________________________________________________________
___
December 22, 2005
CMA and a broad coalition of health care groups Wednesday called on
Governor Schwarzenegger to join them to stop the 5 percent cut in
Medi-Cal payments due to begin January 1.
“These cuts will devastate the weak, the young, disabled, aged, and the
most vulnerable in California by making it more difficult for them to get
medical care,” says CMA CEO Jack Lewin, M.D. “It will cost our state far
more in damaged lives and unnecessary emergency room visits than it will
save.”
The Medi-Cal cuts are the result of a law sought and signed in 2003 by
Governor Davis. The cut was to be effective on January 1, 2004 and sunset
on January 1, 2007.
CMA in 2003 won a federal court injunction blocking the 5 percent cut.
Unfortunately, that injunction was overturned in August 2005, opening the
door for the state to immediately reduce Medi-Cal reimbursement rates by
5 percent retroactive to January 2004. The cuts were delayed, however, as
CMA worked with the state legislature and the Governor to pass
legislation to prevent implementation of the cuts through December 31,
2005.
The Department of Health Services announced last week that the law
requires it to implement the 5 percent cut on fee-for-service Medi-Cal,
which provides care to 3 million poor, children, elderly, and disabled.
The coalition of patient and physician groups said it would seek a bill
to rescind the statute mandating the cuts, and invited the administration
to join it in supporting the effort. The coalition—Californians United
for Quality Health—includes more than 50 health care advocacy groups and
was created several years ago by CMA to preserve access to care for
California’s Medi-Cal patients.
The 5 percent cut would save the state general fund about $60 million,
but because the federal government matches, the total cuts to patient
care would be $120 million. “Eliminating this cut would be a win-win for
California,” says Dr. Lewin. “It just doesn’t make sense to lose the
match the federal government provides for Medi-Cal payments. Why give
more federal dollars to other states instead of ensuring that the most
vulnerable have access to care?”
Even without the cut, California ranks last among the 50 states and the
District of Columbia in Medi-Cal payments for patient care. About 6.5
million people in the state are eligible for Medi-Cal in any given month.
In the most recent data available (2001), California was ranked 51 out of
all states and Puerto Rico for payments per beneficiary. Even though in
the past 20 years, inflation has increased 80 percent, there’s only been
one overall Medi-Cal rate increase of 17 percent. That increase was in
2000-01.
The 5 percent cut means that an internist or family physician would
receive about $20 for a typical office visit, substantially below the
cost of providing the service. The low level of reimbursement has
undermined physicians’ financial ability to treat Medi-Cal patients and
still maintain a viable medical practice.
If payment rates are cut, more primary care physicians will be forced to
decrease the number of Medi-Cal patients they accept or to leave the
program entirely. This will further reduce access to care and force
Medi-Cal beneficiaries to forgo care or use hospital emergency
departments as their primary health care provider, thereby lengthening
waits, increasing costs, and decreasing quality of care for everyone.
Citation
Sherry L Daley, “Blue Cross,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/225957.
