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2008 Legislative Day in Sacramento Santa Clara County Medical Association and Alliance members joined over 400 physicians from around California to meet at the California State Capitol for the CMA’s 2008 Legislative Day, which was held on April 15. The contingent met with members of the Assembly and Senate, which provided physicians an opportunity to educate elected officials about how pending legislation will impact patients and physicians. While there are many bills under consideration in the legislature that affect doctors and patients, emphasis was placed on five key issues of concern:

application. Additionally, the plans and insurers must show willful misrepresentation. Notwithstanding existing law, it is well publicized that health plans and insurers pay large bonuses to their employees for rescission of policies, practice illegal rescission, and put patients in harms way by yanking their health coverage when they need it most, based on the fines and lawsuits that have occurred since 2006. AB 1945 is intended to stop the HMO’s unscrupulous practice of dumping policyholders after their policy has been approved. This legislation will ensure that health plans and insurers do not act as “judge and jury” whenever they want to rescind or cancel a policy. The time has come to have an unbiased analysis on whether a

The Budget: Stopping the 10% Medi-Cal Cuts In response to a $16 billion projected deficit and the Governor’s declared fiscal emergency, the Legislature passed and the Governor signed legislation to slash Medi-Cal provider reimbursement rates by 10% beginning July 1, 2008. This $1.2 billion cut will further undermine California’s struggling health care system. CMA is trying to reverse the cuts in the 2008-2009 budget. On May

policy should be rescinded or cancelled, and to provide the utmost protection to patients whenever their health plans and insurers want to yank their health coverage away from them. AB 1945 provides consumers two protections whenever health care service plans and insurers attempt to rescind or take away their health coverage. Key points included: •

analyze and adjudicate on any rescission of a policy, similar to

5, a coalition of health care providers led by CMA filed a class action

the current Independent Medical Review process now in place

lawsuit to seek an immediate injunction to block the reduction in Medi-Cal reimbursement rates. The lawsuit contends that the cuts violate state and federal laws which require that Medicaid (MediCal) payments “must be sufficient to enlist enough providers so that services under the (state’s Medicaid) plan are available to recipients at least to the extent that those services are available to the general public.” According to the complaint, the reimbursement cuts authorized in February were implemented “solely due to state budgetary woes, without regard to the impact on the availability of Medi-Cal services.” Such cuts are illegal, according to the complaint, and are “being imposed on a system already in crisis, wherein inadequate payment levels have resulted in a scarcity of willing providers, creating serious access hurdles for Medi-Cal beneficiaries.”

AB 1945: Preventing Unlawful Health Plan Rescissions and Cancellations (CMA-Sponsored Bill) Current law prohibits plans and insurers from post claims underwriting, which includes rescinding, canceling, or limiting a plan contract due to the plan’s failure to complete medical underwriting and resolve all reasonable questions arising from the


the bulletin


Protects physicians. Allows regulators to independently

(IMR). •

Prevents confusion in application process. Requires regulators to develop a standardized application that health plans and insurers must use.

SB 1406: Optometry Scope of Practice Expansion (CMA Oppose) Current law related to optometry allows optometrists with appropriate training to provide treatment of certain disorders of the eye. It prohibits surgical intervention and stipulates the types of medicinal treatments that an optometrist may prescribe. Current law also provides an appropriate clinical pathway whereby optometrists can treat and manage patients suffering from glaucoma. This includes the development of collaborative treatment protocols with optometrists and eye physicians and surgeons. SB 1406 would dramatically expand the scope of practice for optometrists in California by allowing them to independently diagnose and treat the human eye or any part of the visual system, as well as perform minor surgical procedures not requiring general anesthesia. The bill removes statutory specifications of the types of

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2008 July/August  

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