ACCMA November/December 2020 Bulletin

BULLETIN ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION

Serving East Bay physicians since 1860

ISSUE FOCUS:

November/December 2020

Healthcare Laws & Changes in Store for 2021

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ACCMA EXECUTIVE COMMITTEE Suparna Dutta, MD, President Robert Edelman, MD, President-Elect Edmon Soliman, MD, SecretaryTreasurer Katrina Peters, MD, MPH, Immediate Past President COUNCILORS & CMA DELEGATES Eric Chen, MD Rollington Ferguson, MD Harshkumar Gohil, MD Russ Granich, MD James Hanson, MD Shakir Hyder, MD Alexander Kao, MD Irina Kolomey, MD Arden Kwan, MD Terence Lin, MD Lilia Lizano, MD Abbas Mahdavi, MD Ross Pirkle, MD Jeffrey Poage, MD Stephen Post, MD Thomas Powers, MD Richard Rabens, MD Steven Rosenthal, MD Katrina Saba, MD Suresh Sachdeva, MD Ahmed Sadiq, MD Jonathan Savell, MD Edmon Soliman, MD Judith Stanton, MD Clifford Wong, MD CMA & AMA REPRESENTATIVES Patricia L. Austin, MD, AMA Delegate Mark Kogan, MD, CMA Trustee, AMA Alternate-Delegate Suparna Dutta, MD, AMA Alternate Delegate (at Large) Ronald Wyatt, Jr., MD, CMA Trustee MEMBERSHIP & COMMUNICATIONS COMMITTEE Mark Kogan, MD, Chair Patricia Austin, MD Sharon Drager, MD Robert Edelman, MD James Hanson, MD Jeffrey Klingman, MD Stephen Larmore, MD Terence Lin, MD Irene Lo, MD Lamont Paxton, MD Katrina Peters, MD Frank Staggers, Jr., MD Ronald Wyatt, MD

Serving East Bay physicians since 1860

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PRESIDENT’S PAGE An Honor to Serve

By Suparna Dutta, MD, ACCMA President

HAPPENING NOW 8

2020–2021 New Health Laws

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2020 Election Results

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ONC Final Rule on Information Blocking By the Medical Insurance Exchange of California (MIEC)

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Op-Ed – Health Insurers Must Divest from Fossil Fuels

By Ashley McClure, MD, FACP

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November/December 2020 | Vol. LXXVI, No. 6

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E/M Changes Taking Effect January 2021

By Mary Jean Sage, CMA-AC

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Operation Access: The Story of Dr. Nseyo and Latoya Maddox

By Operation Access

ENGAGE WITH THE ACCMA 6

Celebrating Our Long-Term Members

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ACCMA 152nd (Virtual) Annual Meeting

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ACCMA Physicians Take Steps Toward Wellness

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NEW MEMBERS

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COUNCIL REPORTS

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Medi-Cal Rx: California’s New Pharmacy Benefit System

By Scott Coffin, CEO, Alameda Alliance for Health

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CLASSIFIED LISTINGS

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IN MEMORIAM

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Get Involved – ACCMA Leadership Opportunities

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION 6230 Claremont Avenue, Oakland, CA 94618 Tel: 510/654-5383 Fax: 510/654-8959 www.accma.org

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ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

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PRESIDENT’S PAGE

MEDICARE 2021 WHAT YOU NEED TO KNOW

On-demand Webinar

FEES:

Members: FREE Non Members: $49

SUMMARY

REGISTRATION LINK: https://bit.ly/3mViOzw or go to learning.accma.org

TOPICS WILL INCLUDE

Don’t miss your opportunity to make the most of the ever-changing healthcare reimbursement landscape! First you must understand the challenges you may be facing.

Learn the important changes in Medicare for 2021 and how they may affect your practice reimbursement for the coming year(s). Changes are sometimes subtle, but they can have a lasting effect on your practice.

Overall Payment Update Medicare Telehealth Services E & M Services: 2021 & beyond Coding and documentation Payment Advanced Diagnostic Imaging: Latest update MIPS 2021 – What you need to report

SPEAKER: MARY JEAN SAGE, CMA-AC Mary Jean Sage has many, many years of experience working with physicians and other healthcare professionals across the U.S. MJ’s lecture engagements have included the AMA, and many state and local Medical Associations, Specialty Societies and Medical Group Management Associations. She is recognized for her expertise in coding, billing, healthcare compliance and Medicare audit response. Her presentations are known for the practical information she conveys in a clear and concise style.

For Questions about this online seminar, please contact Jenn Mullins, ACCMA Education and Event Associate at jmullins@accma.org or 510-654-5383.

PRESIDENT'S PAGE

An Honor to Serve

By Suparna Dutta, MD, ACCMA President

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ver the past 15 years, I have had the opportunity to learn about the amazing history of the ACCMA, including its many pioneering accomplishments and the generations of inspiring East Bay physician leaders who have led this organization. It is truly my humble honor to be a part of this organization and to serve as your ACCMA President for the coming year.

Every year, the ACCMA Annual Meeting is an opportunity to celebrate the accomplishments of the past year and to give thanks to the many people who have led us. Although there are just too many people to mention, I do want to publicly acknowledge and offer a heartfelt thank you to our immediate past president, Doctor Katrina Peters, for her extraordinary term as ACCMA President. Through the challenges of this past year, her exemplary leadership and dedication led us through some of the most challenging days and months that physicians have ever faced.

Over the years, I’ve also become accustomed to the exceptional support by the ACCMA staff, but the team’s ability to shift quickly to a virtual operation, the development of new programs and resources to support physicians through COVID, and the support provided for our advocacy efforts, was truly remarkable.

This was, of course, in addition to the multiple ongoing events and projects that they already had on their plate. Thank you for all the helpful communications, programs and seminars, and for keeping physicians connected and informed during such a trying time.

Looking ahead, the pandemic continues to affect our practices and challenge us all. But, by continuing to come together through the ACCMA, we can progress through these challenges and stay true to our mission. Through advocacy at the local, state, and federal levels, we can keep promoting financial support for our clinics during these unpredictable times and hopefully beyond.

It will be important to persist in our focus on advocacy for patient and physician safety. This year, our advocacy efforts led

to the distribution of critically needed PPE to over 500 private practices in our two counties. It was an impressive undertaking and partnership between CMA and ACCMA, and I thank all of you who volunteered your time and energy to address this urgent need.

Without question, the pandemic has affected us all, not just professionally but also personally, contributing to burnout and emotional exhaustion for some physicians. The ACCMA Clinician Wellness Program has served as a hub for information about the programs offered by ACCMA and others to help physicians deal with professional and personal stress. The creation of peer support networks, discussion groups, and free group psychotherapy sessions has provided much-needed support.

Going forward, it will be vital that we continue our efforts and support the emotional needs of physicians and healthcare workers through not just this pandemic, but beyond.

The pandemic also put a spotlight on health inequity in our country and exposed disparities that have contributed to COVID-19’s disproportionate impact on certain communities.

The creation of the ACCMA Health Equity Task Force, chaired by Doctor Peters, is an important step in connecting thought leaders and physician leaders from the community to begin transformative changes that are long overdue in health care.

Given the rich history of this organization and knowing our ACCMA members and team, I can’t think of a better group to tackle such a critical issue. These are challenging times in so many ways, and 2021 will undoubtedly bring even more challenges. But together we can continue our tradition of facing adversity headon, advocating for positive change in health care, and supporting the communities and patients we serve.

I’m truly proud to be part of this organization and honored to serve as your ACCMA President.

Explore ACCMA Volunteer Opportunities! Visit ACCMA.org/Volunteer, or call ACCMA at (510) 654-5383 to find out more.

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CELEBRATING OUR MEMBERS

Celebrating Our Long-Term Members

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he ACCMA would like to offer our warmest thanks to physicians who have been a part of the ACCMA organization for over 40 years. The support that you have provided throughout the years has enabled the ACCMA and

CMA to offer a wide range of services and programs to help physicians and patients, both locally and across California.

Thank you for choosing to be a part of the ACCMA and helping the organization grow over the years.

Myles Abbott, MD, FAAP Harry Andrews, MD Ravinder Arora, MD Patricia Austin, MD Eric Bachelor, MD, FACS Calvin Benton, MD Ronald Berman, MD Fred Blackwell, MD Arnold Blustein, MD Albert Brooks, MD Ann Chappell, MD David Cheng, MD Michael Cohn, MD Gerald Delrio, MD Robeert Deutsch, MD William Dewolf, MD Robert Dolgoff, MD Melvin Donaldson, MD Loretta Early, MD John Edelen, MD Lee Eisan, MD William Ellis, MD Ervin Epstein, MD Stanley Fong, MD Richard Fraioli, MD Peter Freedman, MD Janet Gaston, MD Robeert Gingery, MD Stuart Gold, MD Robert Goldberg, MD Hayman Gong, MD Avrum Gratch, MD Ravinder Gupta, MD Joseph Helms, MD Leslie Hilger, MD Early Holloway, MD

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

Romesh Japra, MD Richard Kahn, MD Mildred Kawachi, MD Kenneth Kelsen, MD Jerrold Kram, MD Elwood Kronick, MD F Calvin Lemon, MD Craig Leong, MD John Linfoot, MD Richard Litwin, MD David Louis, MD Harry MacDannald, MD Anmol Mahal, MD Roger Mann, MD Gary Marcus, MD Kenneth Matsumura, MD Bruce Merl, MD Krishna Moorthy, MD Jim Nishimine, MD Richard Oken, MD David Paslin, MD R Rajah, MD Sanjay Ray, MD Elizabeth Ringrose, MD Steven Rosenthal, MD Peter Rowe, MD Ronald Rubenstein, MD John Salzman, MD Vin Sawhney, MD Michael Schwab, MD Lionel Sorenson, MD Michael Stein, MD Stephen Sturges, MD Amater Traylor, MD David Varon, MD

ANNUAL MEETING

ACCMA 152nd (Virtual) Annual Meeting

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he 152nd Annual Meeting of the ACCMA was held virtually on Thursday, November 5 for the first time in its history. All ACCMA members and their guests were invited to join in the online happy hour at 5:30 PM to socialize with their colleagues and to celebrate this past year’s accomplishments in the medical community.

The Annual Meeting also served to honor the outgoing ACCMA President, Katrina Peters, MD, and install the 2021 ACCMA President, Suparna Dutta, MD, and other incoming officers – President-Elect Robert Edelman, MD and SecretaryTreasurer Edmon Soliman, MD. A video was shown that highlighted some of the outstanding work that ACCMA physician leaders did in 2020; this video can be viewed at accma.org/2020AM. It covers the ACCMA’s early response to the pandemic by establishing a COVID-19 task force, hosting coordinating calls for medical groups and skilled nursing facilities, and producing educational programs for physicians to sustain their practice during the pandemic, such as getting started with telemedicine. The ACCMA also quickly pivoted its scheduled Spring 2020 Physician Leadership Program to a free Leadership Under Pressure series of four sessions starting in May, featuring nationally recognized physicians experienced in leading during crises and in teaching effective leadership in challenging and chaotic situations. The ACCMA Clinician Wellness Program was accelerated to offer immediate peer support, wellness webinars, resource toolkits, daily wellness tips, and free group psychotherapy sessions. And in the late summer, the ACCMA distributed a two-month supply of much-needed PPE to 522 East Bay private medical practices, free of charge, at drive-through events in Oakland and Pleasant Hill. The estimated value of the PPE distributed is over $3.4 million.

During the ACCMA Annual Meeting, the ACCMA recognized and honored the truly remarkable leadership displayed by our outgoing ACCMA President, Dr. Katrina Peters, who faced the difficult task of navigating the organization through a year of turmoil. The ACCMA looks forward to a hopefully less challenging year with our new ACCMA President, Dr. Suparna Dutta, at the helm.

Doctor Dutta said that she was especially proud of what the ACCMA has accomplished over the past year – providing PPE to hundreds of East Bay physicians, creating numerous wellness resources to help physicians manage the stress of the pandemic, and beginning a new committee to address health equity.

“I’m truly proud to be part of this organization and honored to serve as your president.”

Doctor Dutta has worked in the Kaiser-East Bay region since 2001. She works in the spine clinic where she evaluates and manages patients primarily with spine pain. She received her undergraduate and medical degrees at the University of MissouriKansas City, completed her internship at Mercy Hospital in Pittsburgh, PA, and completed residency training in Physical Medicine and Rehabilitation at the University of Michigan in Ann Arbor, MI. Doctor Dutta has been active in organized medicine for most of her career. She has been a member of the ACCMA Council and the ACCMA Delegation to the CMA House of Delegates since 2009. She has served as an Alternate Delegate on the CMA Delegation to the American Medical Association since 2014. She is a member of the CMA Council on Legislation, the ACCMA Legislative Committee, and numerous other committees.

The ACCMA Annual Meeting also serves to raise money for its medical student scholarship fund to support students in the UCSF-UC Berkeley Joint Medical Program conducting summer research projects. You can still donate by clicking the PayPal button at www.accma.org/2020AM. The ACCMA looks forward to celebrating its 153rd Annual Meeting on November 5, 2021 at the Claremont Hotel & Spa in Berkeley. Please save the date!

If you missed the 2020 Annual Meeting, a video recording is available on YouTube at https://bit.ly/2ISVHH9.

Join the ACCMA at www.accma.org/membership/join-now

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NEW HEALTH LAWS

2020–2021 New Health Laws

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he California Legislature had an interesting year, passing a number of new health care laws in the midst of a pandemic, resulting in considerable operational challenges. While the number of new laws overall is significantly reduced as compared to other years, there was a strong focus on the impacts of COVID19 pandemic, allied health professionals, mental health, and workforce and labor issues. Below is a list of the most significant new health laws of interest to physicians.

AB 890 (WOOD) – NURSE PRACTITIONERS: SCOPE OF PRACTICE: PRACTICE WITHOUT STANDARDIZED PROCEDURES CMA Position Oppose Authorizes nurse practitioners who meet certain education, experience, and certification requirements to perform, in certain settings or organizations, specified functions without standardized procedures. Requires the Board of Registered Nursing, by regulation, to define minimum standards for a nurse practitioner to transition to practice without standardized procedures.

Establishes the Nurse Practitioner Advisory Committee to advise and give recommendations to the BRN on matters relating to nurse practitioners. Specifies that nurse practitioners performing certain functions without standardized procedures in listed settings are eligible to serve on medical staffs and are subject to peer review. Requires the Department of Consumer Affairs’ Office of Professional Examination Services to perform an occupational analysis to assess competencies and to develop a supplemental examination for nurse practitioners if needed based on the assessment.

SB 1237 (DODD) – NURSE-MIDWIVES: SCOPE OF PRACTICE CMA Position: Neutral Authorizes a certified nurse-midwife to attend cases of low-risk pregnancy, as defined, and childbirth and to provide prenatal, intrapartum, and postpartum care, including family-planning services, interconception care, and immediate care of the newborn, as specified and as approved by the Board of Registered Nursing.

Authorizes a certified nurse-midwife to practice with a physician and surgeon under mutually agreed upon policies and protocols that delineate the parameters for consultation, collaboration, and referral, and transfer of a patient’s care, as specified. Requires certified nurse practitioners not under supervision of a physician and 8

surgeon to provided specified disclosures and to obtain a patient’s written consent. Requires the Board of Registered Nursing to appoint the Nurse-Midwifery Advisory Committee, as specified, to make recommendations to the board.

AB 80 (COMMITTEE ON BUDGET) – PUBLIC HEALTH OMNIBUS Omnibus budget trailer bill establishes policy on budget items, including suspension of Proposition 56 allocations for valuebased payments, extension of funding to the Medi-Cal Promoting Interoperability Program until 2024, authorization for DHCS to seek federal approval to extend California’s 1115 Waiver, and adjustment of managed care capitation payments for July 2019-December 2020 for pandemic-related decreased utilization.

AB 81 (COMMITTEE ON BUDGET) – PUBLIC HEALTH FUNDING: HEALTH FACILITIES AND SERVICES Budget trailer bill reauthorizes the skilled nursing facilities quality assurance fee and provides counties temporary flexibility in the implementation of the Mental Health Services Act in light of the COVID-19 Public Health Emergency.

AB 713 (MULLIN) – CALIFORNIA CONSUMER PRIVACY ACT OF 2018 CMA Position: Support Effective September 25, 2020, exempts from the California Consumer Privacy Act of 2018 (CCPA) certain types of medical information and for business associates of covered entities subject to HIPAA, information collected, used, or disclosed in clinical trials, and any patient information that has been deidentified under HIPAA, as specified.

AB 685 (REYES) – COVID-19: IMMINENT HAZARD TO EMPLOYEES: EXPOSURE: NOTIFICATION: SERIOUS VIOLATIONS CMA Position: Neutral Authorizes the Division of Occupational Safety and Health (OSHA), until January 1, 2023, to limit operations or prevent entry into a place of employment if it believes the location or operation presents an imminent risk of COVID-19 infection to employees, as specified. Authorizes OSHA, until January 1, 2023, to issue a citation alleging a serious violation relating to

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

NEW HEALTH LAWS

COVID-19 before considering mitigating factors or explanations.

Requires employers to provide written notice, as specified, to employees who may have been exposed to COVID-19 at their worksite, as defined, unless an exception applies. Requires an employer to notify the local public health agency if the employer receives notice of the number of cases that meet the CDPH definition of a COVID-19 outbreak.

AB 1577 (BURKE) – INCOME TAXES: FEDERAL CARES ACT: GROSS INCOME: LOAN FORGIVENESS CMA Position: Support For taxable years beginning on or after January 1, 2020, excludes from gross income, for state income tax purposes, any covered loan amount forgiven pursuant to the federal CARES Act and its subsequent amendments in the Paycheck Protection Program and Health Care Enhancement Act and the Paycheck Protection Program Flexibility Act of 2020.

AB 1710 (WOOD) – PHARMACY PRACTICE: VACCINES Authorizes a pharmacist to independently initiate and administer any COVID-19 vaccines approved or authorized by the federal Food and Drug Administration (FDA) as specified.

AB 2537 (RODRIGUEZ) – PERSONAL PROTECTIVE EQUIPMENT: HEALTH CARE EMPLOYEES Requires public and private employers of workers in a general acute care hospital, as defined, to maintain a stockpile of personal protective equipment, as specified, to supply those employees who provide direct patient care or provide services that directly support personal care with the personal protective equipment, as specified, and to ensure that the employees use the personal protective equipment supplied to them.

AB 2644 (WOOD) – SKILLED NURSING FACILITIES: DEATHS: REPORTING In the event of a declared emergency related to a communicable disease, requires a skilled nursing facility to report each diseaserelated death and suspected disease-related death to the State Department of Public Health within 24 hours of that death and to notify residents and their representatives about cases of communicable diseases, in compliance with state and federal privacy laws.

Requires the State Department of Public Health to report information related to those deaths on its internet website as specified.

(continued)

AB 2520 (CHIU) – ACCESS TO MEDICAL RECORDS Requires a health care provider, as specified, to provide an employee of a nonprofit legal services entity, who is representing a patient, a copy of medical records that are relevant to specified public benefit programs at no charge.

SB 275 (PAN) – HEALTH CARE AND ESSENTIAL WORKERS: PERSONAL PROTECTIVE EQUIPMENT CMA Position: Neutral Requires the Department of Public Health to establish a personal protective equipment (PPE) stockpile, as specified, and requires CDPH to establish guidelines for the procurement, management, and distribution of PPE. Requires health care employers, as defined, to establish a PPE inventory sufficient for at least 45 days of surge consumption.

SB 1159 (HILL) – WORKERS’ COMPENSATION: COVID-19: CRITICAL WORKERS Defines “injury” for an employee to include illness or death resulting from the 2019 novel coronavirus disease (COVID-19) under specified circumstances, until January 1, 2023 and creates a disputable presumption, as specified, that the injury arose out of and in the course of the employment and is compensable, for specified dates of injury.

AB 1544 (GIPSON) – COMMUNITY PARAMEDICINE OR TRIAGE TO ALTERNATE DESTINATION ACT CMA Position: Support Until January 1, 2024, establishes the Community Paramedicine or Triage to Alternate Destination Act of 2020 which authorizes a local EMS agency, with approval by the Emergency Medical Services Authority, to develop a community paramedicine or triage to alternate destination program, as defined, to provide specified community paramedicine services.

SB 406 (PAN) – HEALTH CARE: OMNIBUS BILL CMA Position: Support Health care omnibus bill addresses issues related to the Affordable Care Act (ACA), vital records, substance use recovery residences, and the Program of All-Inclusive Care for the Elderly (PACE).

With regard to the ACA, codifies existing federal provisions that prohibit lifetime or annual limits and require coverage of preventative services without cost sharing into state law. continued on page 10 ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

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NEW HEALTH LAWS

(continued from page 9)

AB 2157 (WOOD) – HEALTH CARE COVERAGE: INDEPENDENT DISPUTE RESOLUTION PROCESS Makes changes to the independent dispute resolution process established by AB 72 (Bonta, 2016), which limited the ability of out-of-network physicians to bill patients for non-emergent services provided at an in-network facility and established an interim payment rate for those services. Requires the procedures established by the Department of Managed Health Care and the Department of Insurance for independent dispute resolution to include a process for each party to submit into evidence information that will be kept confidential from the other party and to specify that a de novo review of the claim dispute shall be conducted.

AB 1976 (EGGMAN) MENTAL HEALTH SERVICES: ASSISTED OUTPATIENT TREATMENT CMA Position: Support Requires each county to implement the Assisted Outpatient Treatment Demonstration Project Act of 2002, known as Laura’s Law, to offer specified mental health programs or to opt out of the requirement through a resolution by the governing body of the county which explains the reasons for opting out. Permits a county, in combination with one or more counties, to implement an AOT program and repeals makes Laura’s Law permanent.

SB 855 (WIENER) – HEALTH COVERAGE: MENTAL HEALTH OR SUBSTANCE USE DISORDERS CMA Position: Neutral Amends the California Mental Health Parity Act to require health care service plans and health insurers to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions.

AB 2037 (WICKS) – HEALTH FACILITIES: NOTICES Requires a hospital that provides emergency medical services to provide notice, as specified, at least 180 days before a planned reduction or elimination of the level of emergency medical services. Require a health facility to provide at least 120 days’ notice, as specified, prior to closing the health facility and at least 90 days prior to eliminating or relocating a supplemental service, except as specified.

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AB 115 (COMMITTEE ON BUDGET) – MEDICAL: MANAGED CARE ORGANIZATION PROVIDER TAX Effective July 1, 2019, implements a managed care organization provider tax contingent upon federal approval, to be effective for 3.5 fiscal years.

AB 465 (EGGMAN) – MENTAL HEALTH WORKERS: SUPERVISION Requires any program permitting mental health professionals to respond to emergency mental health crisis calls in collaboration with law enforcement to ensure the program is supervised by a licensed mental health professional, as specified.

AB 2265 (QUIRK-SILVA) – MENTAL HEALTH SERVICES ACT: USE OF FUNDS FOR SUBSTANCE USE DISORDER TREATMENT CMA Position: Support Clarifies that the Mental Health Services Fund, which is continuously appropriated to, and administered by, the Department of Health Care Services can be used to fund substance use disorder treatment for children, adults, and older adults with cooccurring mental health and substance use disorders who are eligible to receive mental health services, as specified, and requires counties to report to DHCS specified information about individuals treated pursuant to these provisions.

AB 3330 (CALDERON) – DEPARTMENT OF CONSUMER AFFAIRS: BOARDS: LICENSEES: REGULATORY FEES CMA Position: Neutral Beginning April 1, 2021, increases the Controlled Substance Utilization Review and Evaluation System (CURES) fee from $6 annually to $11 and subsequently, beginning April 1, 2023, decreases the fee to $9.

AB 1989 (GARCIA, CRISTINA) – MENSTRUAL PRODUCTS RIGHT TO KNOW ACT OF 2020 CMA Position: Support Enacts the Menstrual Products Right to Know Act of 2020, which requires a package or box containing menstrual products manufactured on or after January 1, 2023 to have printed on the label a plain and conspicuous list of all ingredients, as defined, in the product, by weight. Requires the same information to be posted online, as specified.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

NEW HEALTH LAWS

AB 2273 (BLOOM) – PHYSICIANS AND SURGEONS: FOREIGN MEDICAL GRADUATES: SPECIAL FACULTY PERMITS CMA Position: Neutral Under current law, any person who meets certain eligibility requirements may apply for a special faculty permit that authorizes the holder to practice medicine, without a physician’s and surgeon’s certificate, within a medical school and certain affiliated institutions. This bill Authorizes the holder of a special faculty permit, a visiting fellow, and a holder of a certificate of registration to practice medicine at an academic medical center.

SB 852 (PAN) – HEALTH CARE: PRESCRIPTION DRUGS CMA Position: Support if Amended Requires the California Health and Human Services Agency (CHHSA) to enter partnerships, to increase patient access to affordable drugs, including entering into partnerships to produce or distribute generic prescription drugs as specified. Subject to appropriation by the Legislature, requires CHHSA to submit a report to the Legislature on or before July 1, 2023, assessing the feasibility and advantages of directly manufacturing generic prescription drugs and selling generic prescription drugs at a fair price.

AB 2276 (REYES) – CHILDHOOD LEAD POISONING: SCREENING AND PREVENTION CMA Positions: Neutral Requires a contract between the Department of Health Care Services (DHCS) and a Medi-Cal managed care plan to require the plan to identify enrolled children that have no record of blood lead screening, as specified, and to remind the contracting health care provider of the requirement to perform the screening, as specified. Requires a Medi-Cal managed care plan to maintain a list of children who missed or are without a record of blood lead screening test, as specified SB 793 (HILL) FLAVORED TOBACCO PRODUCTS CMA Position: Support Prohibits a tobacco retailer, or any of the tobacco retailer’s agents or employees, from selling, offering for sale, or possessing with the intent to sell or offer for sale, a flavored tobacco product or a tobacco product flavor enhancer, as those terms are defined, except as specified.

(continued)

AB 2112 (RAMOS) – SUICIDE PREVENTION Subject to an appropriation, authorizes the Department of Public Health to establish the Office of Suicide Prevention and requires it to perform specified duties, including providing information and technical assistance to statewide and regional partners regarding best practices on suicide prevention policies and programs, as specified, consulting with the Mental Health Services Oversight and Accountability Commission.

AB 2218 (SANTIAGO) – TRANSGENDER WELLNESS AND EQUITY FUND CMA Position: Support Establishes the Transgender Wellness and Equity Fund within the California Department of Public Health’s Office of Health Equity. Upon appropriation, the monies in the Fund may fund grants to organizations serving people that identify as transgender, gender nonconforming, or intersex (TGI), TGI-specific housing programs and partnerships with hospitals, health care clinics, and other medical providers to provide TGI-focused health care, as defined, and related education programs for health care providers.

AB 3092 (WICKS) SEXUAL ASSAULT AND OTHER SEXUAL MISCONDUCT: STATUTES OF LIMITATIONS ON CIVIL ACTIONS CMA Position: Neutral Revives claims for damages arising out of a sexual assault or other inappropriate contact, communication, or activity of a sexual nature by a physician while employed by a medical clinic owned and operated by the University of California, Los Angeles, or a physician who held active privileges at a hospital owned and operated by the University of California, Los Angeles, between January 1, 1983 and January 1, 2019, that would otherwise be barred before January 1, 2021 because the applicable statute of limitations has or had expired.

SB 932 (WIENER) – COMMUNICABLE DISEASES: DATA COLLECTION Requires any electronic tool used by a health officer, as defined, for the purpose of reporting cases of communicable diseases to the department, as specified, to include the capacity to collect and report data relating to sexual orientation and gender identity.

Requires a health care provider, as defined, that knows of or is in attendance on a case or suspected case of specified communicable diseases to report to the health officer for the jurisdiction in which the patient resides the patient’s sexual orientation and gender identity, if known.

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ELECTION RESULTS

2020 Election Results

KEY RACES AND MEASURES IN THE EAST BAY, CALIFORNIA, AND THE U.S. PRESIDENTIAL RACE: Joseph R. Biden Jr. was elected the 46th president of the United States, with Kamala Harris as vice-president-elect. The results for this race are as follows: Joseph Biden (D) received 306 electoral college votes (56.9% of electoral college votes.)

STATE PROPOSITIONS: Proposition 23 – Prop 23 would put the lives of vulnerable dialysis patients at serious risk. Prop 23 would force dialysis clinics to have a physician administrator on site at all times, even though they would not be involved in patient care. Prop 23 was denied by voters with 63.5% to 36.5% margin.

LOCAL RACES: California Assembly District 25 – AD 25 includes the Alameda County communities of Fremont and Newark, and the Santa Clara County communities of Milpitas, San José and Santa Clara. The results for this race are as follows: Alex Lee (D) received 73.1% of the votes.

Alameda County Board of Supervisors District 1– District 1 covers the cities of Dublin and Livermore; most of the city of Fremont; a portion of the unincorporated community of Sunol; and most of the unincorporated area of the Livermore-Amador Valley. The results for this race

are as follows: David Haubert received 53.03% of the votes.

LOCAL MEASURES: Measure X – Measure X would levy a half-cent sales tax, exempting food sales, to provide an estimated $81 million annually for 20 years to fund hospitals, health centers, fire services, childhood services, among other community services. Measure X was approved by voters with 58.2% to 41.8% margin.

EAST BAY OFFICIALS SEEKING RE-ELECTION: U.S. House of Representatives: District 5: Mike Thompson received 67.5% of the votes District 9: Jerry McNerney received 57.0% of the votes District 11: Mark DeSaulnier received 71.2% of the votes District 13: Barbara Lee received 92.6% of the votes District 15: Eric Swalwell received 59.0% of the votes District 17: Ro Khanna received 78.6% of the votes

California State Senate District: SD 3: Bill Dodd received 98.6% of the votes SD 7: Steve Glazer received 48.3% of the votes SD: 9: Nancy Skinner received 99.9% of the votes continued on page 17

BIDEN-HARRIS COVID-19 PLAN President-elect Joe Biden and vice-president-elect Kamala Harris have released a comprehensive plan to address COVID-19 during their transition and once in office. The seven-point plan will include the following priorities: • Ensure all Americans have access to regular, reliable, and free testing.

• Fix personal protective equipment (PPE) problems for good.

• Provide clear, consistent, evidence-based guidance for how communities should navigate the pandemic – and the resources for schools, small businesses, and families to make it through.

• Plan for the effective, equitable distribution of

12

treatments and vaccines – because development isn’t enough if they aren’t effectively distributed.

• Protect older Americans and others at high risk.

• Rebuild and expand defenses to predict, prevent, and mitigate pandemic threats, including those coming from China.

• Implement mask mandates nationwide by working with governors and mayors and by asking the American people to do what they do best: step up in a time of crisis.

For more information and an in-depth look at the Biden-Harris COVID-19 plan, visit buildbackbetter.gov/priorities/covid-19/.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

GET INVOLVED

GET INVOLVED

ACCMA Leadership Opportunities

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s scientists, physicians expect medical policy development to be evidence-based. However, in the political process, where policies are translated into laws that can have a huge impact on quality and access to medical care, there are numerous perspectives and levels of understanding at play in the public policy debate. This makes physician involvement in the political process essential to ensure that sound health care policy is enacted and that physicians’ interests are taken into consideration.

Involvement in the legislative process can also help physicians feel more empowered in their daily life and report fewer feelings of being “burnt out.”

The ACCMA makes it easy for members to get involved with health care policy and community projects. One of the easiest ways for members to get involved is through the annual CMA Legislative Advocacy Day. In previous years, attendees visited the Capitol in Sacramento and met with legislators face-to-face to discuss health care issues. Due to the COVID-19 pandemic, the 2020 Legislative Advocacy Day was held completely virtually; participants were able to meet with three California State Senators and six Assemblymembers throughout the day via Zoom. In 2021, the Annual CMA Legislative Day will be converted to a week-long Legislative Advocacy Conference, held from Monday, April 6 to Friday, April 10. This is a unique event for California physicians and is completely free of charge to all ACCMA members. If you are interested in participating in the 2021 Legislative Advocacy Conference, contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives, at dlopez@accma.org or by calling 510-654-5383.

Physicians can also get involved through the ACCMA

Legislative Committee. This committee conducts political action on behalf of the ACCMA, meeting with local legislators to discuss health care policies and conducting candidate interviews during election season. In 2020, the ACCMA Legislative Committee coordinated meetings with State Senators, local Assemblymembers, and members of State Congress. While these meetings are coordinated by the ACCMA Legislative Committee, most of the meetings with legislators are open to all members of the ACCMA. If you are interested in hearing about upcoming legislative meetings, please contact David Lopez by emailing dlopez@accma.org or calling 510-654-5383.

ACCMA committees are the workshops of the association and are responsible for developing many of the ACCMA’s policies and programs that assist physicians and improve the quality of medical care in our community. Over 300 ACCMA members currently serve on ACCMA committees. In addition to the Legislative Committee, members can be nominated for the Advisory Committee on Physician Wellbeing, the Community Health Committee, the Continuing Medical Education (CME) Committee, the Emergency Committee, the Medical Services, Technology, and Quality of Care Committee, and more. To read more about the ACCMA committees and the nomination process, visit accma.org/Leadership/ACCMA-Committees.

All physicians are welcome to contribute their interest and expertise to influence the development and implementation of health care policy at the ACCMA. Visit www.accma.org/ GetInvolved to find out more about ACCMA Committees, CMA Legislative Advocacy Day, meeting with local legislators, and other ways to become a physician advocate.

CALMEDFORCE 2020–21 AWARDEES In November 2020, CalMedForce awarded $38 million to support medical training and residency programs across the state to help grow the physician workforce. The funding, generated by the Proposition 56 tobacco tax in 2016, will pay for 202 residency positions in 101 Graduate Medical Education (GME) programs at hospitals and clinics, with an emphasis on programs serving medically underserved groups and communities.

In total, hundreds of programs in hospitals, medical centers and community clinics have received grants to retain and expand GME programs in primary care and emergency medicine. In Alameda County, awardees include Alameda Health System – Highland Hospital, UCSF Benioff Children’s Hospital Oakland, and Lifelong Medical Care. In Contra Costa County, Contra Costa Regional Medial Center received an award.

ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

13

COVID-19 SURVEY RESULTS

BUILD & BALANCE

A ROADMAP TO FINANCIAL SUCCESS

THURSDAY, JANUARY 21, 2020 6:00PM – 7:00PM PST Online Seminar

FEES: Members: FREE Non Members: FREE

REGISTRATION LINK: https://bit.ly/3nB2unE or go to learning.accma.org

Interested in setting yourself up for financial success in the New Year? Join Gayatri Brar and Natalie Schnuck of First Republic on Thursday, January 21st for a special presentation and Q&A to learn more.

Whether you are focused on saving for retirement, purchasing a home, or paying down debt, First Republic can help you achieve your financial goals.

GAYATRI BRAR

NATALIE SCHNUCK

Gayatri Brar is a Managing Director and Banker at First Republic Bank. With over 12 years of experience in private banking and ¬finance. Her expertise includes providing customer service tailored to each individual’s unique situations with an emphasis on various types of lending (personal (real estate, student loan refinance, partner buy-in loans) and business lending).

Natalie Schnuck is a Managing Director and Wealth Manager at First Republic Investment Management. Ms. Schnuck is responsible for helping clients target their financial needs and goals and gives special focus to strategic asset allocation and risk assessment analysis. Prior to joining First Republic in 2015, Ms. Schnuck was with Merrill Lynch, most recently a Vice President and Financial Advisor, following roles as a Financial Analyst in the Private Banking and Investment Group and a Client Associate at the firm.

For Questions about this online seminar, please contact Jenn Mullins, Education and Event Associate at jmullins@accma.org or 510-654-5383.

ONC FINAL RULE

ONC Final Rule on Information Blocking By the Medical Insurance Exchange of California (MIEC)

B

eginning in April 2021, patients will have the right to directly access their electronic health information under a new federal requirement. On May 1, 2020 the DHS Office of the National Coordinator for Health Information Technology (ONC) issued a Final Rule1 on Interoperability, Information Blocking, and the ONC Health IT Certification Program (part of the 21st Century Cures Act). The law is also known informally as the “Open Charts law.”

The Final Rule prohibits the practice of “information blocking,” which is defined as any practice which is likely to interfere with access, exchange, or use of electronic health information (EHI) by patients or other health care providers.

The Final Rule does not affect patients’ existing right of access2 to their own health information, as required under HIPAA and state laws; rather, it outlines how this information needs to be made available to patients and other providers.

The Final Rule applies to all “health care providers” as defined by the Public Health Service Act (42 U.S.C. 300jj)3. Physicians, physician assistants, nurse practitioners, clinical nurse specialists, CRNAs, CNMs, clinical social workers, clinical psychologists, and registered dieticians/nutritionists are included in this definition. Additionally, the Final Rule applies to all “actors” including hospitals and other medical facilities, developers of certified health IT, Health Information Exchanges and Health Information Networks (HIEs/HINs).

Importantly, the deadline for provider compliance was recently delayed4 from November 2, 2020 to April 5, 2021 in light of the ongoing COVID-19 pandemic. However, with the approaching November deadline, many health care systems, hospitals, and other healthcare facilities have already changed their EMR systems to comply with the new requirements.

Now that the deadline has been extended, individual medical practices now have more time to prepare for compliance with the requirements of the Final Rule. In essence, providers are required do two things5: • Provide patients with access to electronic health information in a form convenient for the patient, such as through the adoption of standards and certification criteria.

• Implement information blocking policies that support patient electronic access to their EHI at no cost.

WHAT TYPES OF INFORMATION ARE INCLUDED? There are 8 types of clinical notes that must be made available according to the U.S. Core Data for Interoperability (USCDI): (1) Consultation notes (2) Discharge summary notes (3) History & physical (4) Imaging narratives (5) Laboratory report narratives (6) Pathology report narratives (7) Procedure notes (8) Progress notes

•

Importantly, the following types of notes are not included: Psychotherapy notes: As defined in 45 CFR 164.501, notes recorded (in any medium) by a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session.

Psychotherapy notes must be separated from the rest of the medical record.

Providers must still share other mental health records, including: • Medication information • Counseling session start/stop times • Treatment modalities and frequency • Results of clinical tests • Summaries of symptoms, diagnosis, functional status, treatment plan, progress to date, and prognosis • Information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding.

ARE THERE ANY EXCEPTIONS? The ONC lists 8 different exceptions6 to the information blocking provision, each with its own set of conditions and requirements.

These exceptions are as follows: 1. Preventing Harm Exception: It will not be information blocking for an actor to engage in practices that are reasonable and necessary to prevent harm to a patient continued on page 16 ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

15

ONC FINAL RULE

(continued from page 15)

or another person, provided certain conditions are met.

2. Privacy Exception: It will not be information blocking if an actor does not fulfill a request to access, exchange, or use EHI in order to protect an individual’s privacy, provided certain conditions are met.

3. Security Exception: It will not be information blocking for an actor to interfere with the access, exchange, or use of EHI in order to protect the security of EHI, provided certain conditions are met.

4. Infeasibility Exception: It will not be information blocking if an actor does not fulfill a request to access, exchange, or use EHI due to the infeasibility of the request, provided certain conditions are met.

5. Health IT Performance Exception: It will not be information blocking for an actor to take reasonable and necessary measures to make health IT temporarily unavailable or to degrade the health IT's performance for the benefit of the overall performance of the health IT, provided certain conditions are met.

6. Content and Manner Exception: It will not be information blocking for an actor to limit the content of its response to a request to access, exchange, or use EHI or the manner in which it fulfills a request to access, exchange, or use EHI, provided certain conditions are met.

7. Fees Exception: It will not be information blocking for an actor to charge fees, including fees that result in a reasonable profit margin, for accessing, exchanging, or using EHI, provided certain conditions are met.

8. Licensing Exception: It will not be information blocking for an actor to license interoperability elements for EHI to be accessed, exchanged, or used, provided certain conditions are met.

PHYSICIAN CONCERNS Out of the many inquiries MIEC has received about the ONC Final Rule, most were concerned with how specially protected records, such as behavioral health and chemical dependency records, or sensitive records involving minors, can be appropriately protected under one of the allowable exceptions while still being made generally available under the Final Rule. The exceptions cannot be applied generally, but rather must be applied on a case-by-case basis if the requirements are met.

Since access to EHI no longer will depend on formal written requests, appropriate management of specially protected or sensitive information will depend on the prior location and

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labeling of EHI in the electronic health record. Many EMR systems allow for the separate labeling or filing of psychotherapy notes or records relating to a legal matter; additionally, clinicians can mark notes in various ways (example: EPIC users can include “dot phrases,” such as “/.blockshare” at the end of notes to mark them as not accessible).

For mental health providers, the American Psychiatric Association has information on its website7 about the ONC Final Rule, and the unique nature of mental health records and psychotherapy notes in the setting of enhanced access.

Additionally, in June 2020 the APA sent a letter to the National Coordinator for Health Information Technology requesting clarification on compliance by psychiatrists. Among the issues raised were the “Preventing Harm” and “Promoting the Privacy of Electronic Health Information” exceptions and the potential for misinterpretation of the scope of those exceptions. For example, the letter pointed out that physicians from many areas of practice incorrectly believe that HIPAA prevents them from sharing any mental health or substance abuse information with other providers. It was also pointed out that some providers could interpret these two exceptions as allowing them to withhold any part of the mental health record. For these reasons, the APA requested that the ONC develop training for providers on how to apply the exceptions in practice.

It is important to note that enhanced patient access to EHI does not change the doctor patient relationship, and it should not affect what is documented in the medical record; all medical care should be completely and accurately documented regardless of access. Rather, providers should rely on proper information management and application of the above exceptions to protect patients and their privacy when appropriate.

However, enhanced patient access to chart notes should cause physicians and other health care providers to reconsider and perhaps adjust how they document. For instance, certain clinical terminology may be negatively misinterpreted by patients (for example, “incompetent cervix”), and this could have an effect on the physician-patient relationship if the information is taken out of context. At a minimum, physicians should read their own notes and consider the perspective of the patients who will be reading them. Additionally, enhanced patient access should encourage physicians to have more discussions with patients about what is recorded in their chart, in an attempt to put information into the right context.

If you have any questions about the ONC Final Rule as an MIEC policyholder, please contact MIEC’s Patient Safety & Risk Management team at patientsafetyriskmgmt@miec.com. footnotes on page 17

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

OP-ED

OP-ED

Health Insurers Must Divest From Fossil Fuels

By Ashley McClure, MD, FACP, CMA Alternate Delegate for District IX

This article expresses the opinion of the author and does not reflect ACCMA policy.

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new campaign led by health professionals and health advocates is emerging to expose the health insurance industry’s dirty little secret: US health insurers collectively invest tens of billions of dollars into coal, oil, and gas companies. We know that exposure to pollution from the extraction, transport, and burning of fossil fuels costs approximately 200,000 lives each year (https://bit. ly/3fmGV7p) in the US and causes preventable sickness.

The climate crisis is further causing harm to public health.

The World Health Organization estimates climate change will cause an additional 250,000 deaths per year between 2030-2050, at a cost of two to four billion dollars a year. Climate change is projected to increase incidences of heat stress, food insecurity, asthma and respiratory diseases, mosquito-borne diseases like Dengue fever and malaria, the spread of water-borne diseases, and other severe health impacts.

The harms to human health do not affect the population equally. The burden of exposure to fossil fuels and the accompanying risks to human health fall disproportionately on communities of color. Fossil fuel infrastructure is sited overwhelmingly near communities of color, from oil drilling in California, to pipelines in the Midwest, petrochemical refineries on the Gulf Coast, and coal plants throughout the nation. These exposures contribute to higher rates of severe childhood asthma and death from cardiovascular and cancer-related illnesses among communities of color compared to whites.

ONC FINAL RULE (continued from page 16) Footnotes 1 https://www.healthit.gov/curesrule 2 https://www.hhs.gov/sites/default/files/righttoaccessmemo.pdf 3 https://www.healthit.gov/cures/sites/default/files/cures/2020-08/Health_Care_ Provider_Definitions_v3.pdf 4 https://www.healthit.gov/curesrule/resources/information-blocking-faqs 5 https://www.natlawreview.com/article/blocking-and-tackling-what-everyhealth-care-provider-s-legal-it-and-compliance 6 https://www.healthit.gov/topic/information-blocking 7 https://www.psychiatry.org/psychiatrists/practice/practice-management/ health-information-technology/interoperability-and-information-blocking

Health insurance companies display a real hypocrisy by investing in the industries that make people sick. It’s long past time for U.S. health insurers to join the over 30 insurers worldwide that have divested from fossil fuels.

In October 2020, 60 health and environmental organizations sent a letter (https://bit.ly/2UIIwuH) to the top ten US health insurance companies, calling on them to divest their assets in coal, oil, and gas. It was accompanied by a paper “Running Out of Time: Why Health and Life Insurers Should Divest From Fossil Fuels” (https://bit.ly/3fhFk2N) authored by Physicians For Social Responsibility and the Insure Our Future campaign.

Individuals and organizations who want to get more involved or hear updates on the campaign can sign up at https://bit. ly/2KrokMe. To listen to a webinar on the topic hosted by Physicians for Social Responsibility and The Sunrise Project, visit https://bit.ly/3qDmsR9.

If you are interested in publishing an Op-Ed in the ACCMA Bulletin, please contact Hannah Robbins, ACCMA Policy Associate, at hrobbins@accma.org or by calling 510-654-5383. Please note that all submissions must be reviewed and approved by the appropriate committee prior to publication.

ELECTION RESULTS (continued from page 12) California State Assembly Districts: AD 11: Jim Frazier received 64.7% of the votes AD 14: Tim Grayson received 70.3% of the votes AD 15: Buffy Wicks received 84.7% of the votes AD 16: Rebecca Bauer-Kahan received 67.4% of the votes AD 18: Rob Bonta received 87.6% of the votes AD 20: Bill Quirk received 56.9% of the votes

Contra Costa County Board of Supervisors: District 5: Federal Glover received 66.1% of the votes If you have any questions or want more information, please contact David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives at dlopez@accma.org or 510-654-5383.

ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

17

BYLAWS AMENDMENTS

BREAK BARRIERS, DISCOVER BOOSTERS, AND REACH YOUR OWN GOALS TUESDAY, FEBRUARY 2, 2021 6:00 PM – 7:00 PM

This webinar will provide an opportunity for you to pause for a bit and, for a change, to think about yourself, despite the remarkable slurry of uncertainties and challenges in which we find ourselves. You will be able to visit or re-visit your own purpose and develop ways to move ahead. To do this, we will explore your context, the Big Picture of culture and attitudes that shape society’s, hospitals’, and systems’ policies about physicians. Importantly, we will also look at barriers that can hold you back and — the good news — boosters that can propel you forward. Little steps can lead to large progress. Through discussions, reflection and conversation, plus answering some simple–yet-not-so-easy questions on your own, you will discover practical and achievable ways to replenish your energy, find opportunities, and reach toward your own goals.

at https://bit.ly/2ICusAy

FREE | Online Video Webinar

Linda Hawes Clever MD, MACP A recording of the webinar will be available following the meeting

Linda Hawes Clever, MD, MACP, is the founder of the nonprofit organization Its purpose is to assist health care professionals and others discover ways to lead healthy and fulfilling lives. She is a graduate of the Stanford Medical School and board certified in internal and occupational medicine. Dr. Clever is active at UC Berkeley and Stanford University, a member of the National Academy of Medicine, and the author of The Fatigue Prescription: Four Steps to Renewing Your Energy, Health and Life.

Please contact the ACCMA at (510) 654-5383 or the NCMS-SCMS at (707) 255.3622 for more information.

PHYSICIAN WELLNESS

ACCMA Physicians Take Steps Toward Wellness

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ince the ACCMA began sponsoring group psychotherapy sessions for East Bay physicians and medical residents in response to the stress brought on by the pandemic, one group of five physicians has met for six free virtual sessions with a vetted mental health professional and another group began meeting in mid-November. A physician in the first group praised the sessions in an anonymous post-session survey, “This is a terrific forum for physicians to share their experiences and stressors during Covid times.”

“Joining a group of strangers may sound intimidating at first,” the American Psychological Association notes on its website, “but group therapy provides benefits that individual therapy may not.

Psychologists say, in fact, that group members are almost always surprised by how rewarding the group experience can be.” The therapist who facilitated the first group, Cathy Jefferson, affirmed that the group session quickly became a virtual place that the physicians looked forward to coming. “Taking and protecting time for self-care and self-compassion through the confidential support of a peer group while juggling the demands of patients, family, and a continually challenging working world is a necessary recharge.”

She further commented that the physicians were very grateful for the time to be together and carved out their weekly session time to be free from distractions.

Another benefit of group therapy is that groups can act as a support network and a sounding board. Group members can help you with ideas and hold you accountable. Regularly talking with and listening to other physicians can help put your own problems in perspective. You may feel you are the only one struggling with stress, burnout, life/work balance, and problems at your practice.

GABRIELA BRONSONCASTAIN, PSYD (510) 520-5116 gabcastain@gmail.com www.drgabcastain.com

Peer groups can provide the open discussion to hear what other physicians are going through and to realize that you are not alone.

Thus, it is no surprise that the first sponsored group wanted to continue to meet on its own, after the six sessions, to support and care for one another.

Beyond the benefits of group support, group therapy sessions are led by vetted mental health counselors who can teach group members proven strategies for managing specific problems.

Indeed, one physician noted in the post-session survey that some valuable takeaways from the group therapy sessions were “selfhelp skills [and] reliance on feedback of others.”

Ms. Jefferson, the therapist for the first sponsored group, remarked how much facilitating the peer group discussions meant to her. “What an honor and a privilege it has been to facilitate a group of physicians whose predominant role in life is to provide care for others, under the most trying of times. I never expected the outcome would be so rewarding and how much it was needed.”

The ACCMA sponsors free group therapy sessions as part of our Clinician Wellness Program. Group therapy sessions are free to all East Bay physicians and medical residents, members and non-members. Small groups of three to six physicians meet virtually and privately, with a vetted psychologist or therapist who is experienced in working with physicians for six sessions.

Confidentiality is guaranteed; physicians contact the mental health professionals directly (see sidebar), and there is no charge.

Go to accma.org/Sponsored-Psychotherapy, or contact the ACCMA confidentially for immediate peer support or with questions at wellbeing@accma.org or (510) 654-5383, ext. 6307.

CATHY JEFFERSON, LCSW (415) 806-6336 cathyjefferson17@gmail.com www.cathyjefferson.com

ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

19

E/M CHANGES

E/M Changes Taking Effect January 2021 WILL YOU BE READY?

By Mary Jean Sage, CMA-AC

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here is a major change coming to new and established office visit codes in 2021, the first significant change since the development of the codes and the 1995 and 1997 Documentation Guidelines developed by CMS. These changes are CPT changes – these are the folks that develop and write the codes, not a specific payor. The changes have been essentially agreed to by CMS, but they are changes to the code descriptors and guidelines in CPT and will appear in the 2021 CPT book.

One of the primary goals of the change, other than simplification, is standardization. We know that commercial payors and CMS have a variety of documentation standards to support a level of E/M service. Beginning on January 1, 2021, CPT has standardized the documentation of the specific level of new and established Office or Other Outpatient Services, which should apply to all commercial and government payors. These changes are limited to codes 99202 thru 99215.

The changes are momentous. It is sure to change how office visits are documented. Some clinicians will find that the level of service increases and they are reporting more high-level visits.

Some clinicians will find the exact opposite. An added bonus is the Medicare payments for almost every E/M level will increase if the proposed payment rates become final. No matter the specialty, all practices need to prepare for this change.

These changes are discussed thoroughly in the on-demand webinar, "Getting Ready for the 2021 E/M Changes." This recorded webinar is available to ACCMA members and non-member - please find more information about this webinar at the bottom of page 22. In the meantime, here is an overview of the changes: • CPT® is changing the definitions and documentation requirements for new and established patient visits in 20201 – codes 99202 – 99215.

• Clinicians can select new and established patient visits based on time or medical decision making (MDM).

• Code 99201 has been deleted.

• Time will be defined as total time spent, including nonface-to-face work done on the day of the encounter, and will no longer require time to be dominated by counseling.

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• •

•

Visits will have a range of time, e.g., 99213 will be 20-29 minutes, 99214 will be 30-39 minutes.

There will be new definitions within MDM. The MDM calculation will be similar to, but not identical to, the current MDM calculation.

All other E/M services that are defined by the three key components (history, examination, medical decision making) will continue to use the 1995 and/or 1997 Documentation Guidelines, but the CPT® E/M panel is at work on other E/M codes for future years.

WHAT ABOUT HISTORY AND EXAM? In 2021, the history and exam must simply be medically appropriate. They are not factored directly into the E/M level, nor must they adhere to a specific type (i.e., problem-focused, expanded problem-focused, detailed, or comprehensive). However, they still need to be documented, but this means streamlined documentation, fewer cumbersome requirements to remember, and potentially more time spent on direct patient care. Physician documentation must accurately depict what occurred during the encounter and the physician still needs to be covered in the event of a lawsuit or post-payment recoupment.

MEDICAL DECISION MAKING There are currently four types of medical decision making recognized: Straightforward, Low Complexity, Moderate Complexity, or High Complexity. In 2021, these four types will remain.

However, physicians will use a “new and improved” MDM table that includes easy-to-understand requirements for each E/M level. This new MDM table is similar to, but not exactly the same as the current Table of Risk recognized by the current documentation guidelines.

With the new MDM table physicians can get credit for all these things: • Reviewing prior external notes from each unique source (must do it on the date of the encounter).

• Reviewing the results of each unique test, including imaging, lab, psychometric or physiologic data.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

E/M CHANGES

• •

Ordering each unique test.

Performing an assessment requiring an independent historian, defined by the AMA as an individual who supplements the information provided by a patient who is unable to provide a complete or reliable history (e.g., due to developmental stage dementia or psychosis) or because a confirmatory history is deemed necessary.

Examples include a parent, guardian, surrogate, spouse, or witness.

• Independently interpreting a test performed by another physician or other qualified health care professional (QHP). Note that the physicians and QHPs can only count this toward the MDM when they cannot report the service using another CPT code.

• Discussing patient management or test interpretation with an external physician or other QHP (i.e., someone who is not in the same group or who is in a different specialty or subspecialty, a licensed professional practicing independently, a hospital, nursing facility, or home health care agency), or another appropriate source (e.g., lawyer, parole officer, case manager or teacher). It does not include discussions with family or informal caregivers. Note that the physicians and QHPs can only count this toward the MDM when they cannot report the service using another CPT code. In other words, if you are going to bill for that service separately (with a CPT code), you cannot count it as part of your MDM. The new MDM table compensates physicians for complex MDM regardless of the time spent, as long as documentation supports medically necessary services. Currently, physicians are only compensated for a complex MDM when they also document a higher-level history and/or exam.

TIME-BASED BILLING Currently, CPT guidelines allow a physician to select an E/M level based on time only if they spend more than 50% of the visit counseling and/or coordinating care. Beginning in 2021, this requirement no longer applies to new and established patient visits. Instead, physicians can count the total time on the date of the encounter that may or may not include counseling and care coordination. Eligible time includes both face-to-face and nonface-to-face time that the physician personally spends before, during, and after the visit, as long as it is on the same day as the encounter. Staff time spent with or on behalf of the patient does not count.

The list of acceptable activities includes a variety of things such as:

• • •

•

• • • • •

(continued)

Care coordination (when not separately reportable).

Counseling and educating the patient, family, and/or caregiver.

Documenting clinical information in the electronic or other health record (must be on the same calendar day as the encounter).

Independently interpreting results (when not separately reportable [billable]) and communicating results to the patient, family, and/or caregiver.

Getting and/or reviewing separately obtained history.

Ordering medications, tests, or procedures.

Performing a medically appropriate examination and/ or evaluation.

Preparing to see the patient (e.g., reviewing tests).

Referring the patient to and communicating with other health care professionals (when not separately reportable).

The following time ranges have been assigned to the E/M services:

Code 99202 99203 99204 99205

Minutes 15-29 33-44 45-59 60-75

99212 99213 99214 99215

10-19 20-29 30-39 40-54

Physicians are not required to itemize their time. They should document the total time spent and summarize what they did during that time.

PROLONGED SERVICE Physicians will no longer report face-to-face prolonged services codes 99354 and 99355 or non-face-to-face prolonged services codes 99358 and 99359 with CPT 99202 – 99215 in 2021.

A new CPT code has been developed for Prolonged Services that may be added to either code 99205 or 99215. That code is 99417 and is described as “Prolonged office or other outpatient evaluation and management service(s) beyond the minimum required time of the primary procedure which has been selected using total time, requiring total time with or without direct patient continued on next page ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

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E/M CHANGES

(continued from page 21)

contact beyond the usual service, on the date of the primary service, each 15 minutes of total time (List separately in addition to codes 99205, 99215 for office or other outpatient E/M services).”

TIPS WORTH REMEMBERING 1. Avoid generic documentation: If a physician obtains and reviews medical records, they should document what specific records, from whom, and for which treatment dates. Do not just document “records reviewed”.

2. Describe diagnosis management: Simply selecting a diagnosis from a drop-down menu will not be sufficient to support managing that diagnosis. To get credit for diagnosis management in the new MDM table, physicians need to link each diagnosis with some type of action – a prescription, test, counseling, or some other type of workup. Stating that the diagnosis is managed by another provider does not count.

3. Tell the truth: Physicians are not required to itemize their time; however, their documentation must be an accurate depiction of services rendered. Be mindful of total time spent.

If a physician sees 20 patients a day and documents that they spend 35 minutes per patient, totaling approximately 12 hours, this exceeds a typical eight-hour workday and could be a red flag for a payer.

4. Don’t count services that are separately reportable: If a physician performs an ECG/EKG interpretation and report, they can’t apply that toward the E/M level because there are separate CPT codes for billing for those services (93000, 93005, and 93010).

5. Focus on social determinants of health (SDOH): Capturing SDOH via ICD-10-CM diagnosis codes (e.g., &59 for homelessness or Z59.5 for extreme poverty) may help support a more complex MDM and thus a higher-level

E/M code.

6. Always remember medical necessity: Medical necessity is still the overriding criteria for determining if an encounter is payable or not. It will be hard to justify 50 minutes on a patient with a sore throat.

NOW’S THE TIME TO GET READY Find a coding champion in our practice – e.g., coder or practice manager – to champion the education effort. This person can attend webinars or take online courses and provide staff members with need-to-know-education.

Contact your EHR vendor – ask what the vendor is doing to incorporate these new changes. In particular, how will the EHR’s code calculator incorporate time and MDM? How will the algorithm distinguish between outpatient office visits and other types of E/M service to which the 2021 change do not apply?

Look at your current documentation – does it support total time spent with patients as well as complex MDM? How does your current documentation map to various E/M levels using the new AMA guidelines? Now is the time to start documentation improvement efforts, if needed. Remember, it is not documented, it did not happen.

Mary Jean Sage, CMA-AC has many years of experience working with physicians and other healthcare professionals across the U.S. Mary Jean’s lecture engagements have included the AMA, many state and local Medical Associations, Specialty Societies, and Medical Group Management Associations. She is recognized for her expertise in coding, billing , healthcare compliance, and Medicare audit response. Visit learning.accma.org/recordings to access on-demand content recorded by Mary Jean.

GETTING READY FOR THE 2021 E/M CHANGES On-Demand Webinar | Visit learning.accma.org/Recordings

Will your practice be ready for the changes?

Join us for a walk-through of which E/M services will have changes in 2021; CPT’s new Table of Medical Decision Making; documenting the elements of MDM; and documenting time for new patient and established patient visits. Visit learning.accma.org/Recordings to access the on-demand webinar.

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E/M CHANGES

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OPERATION ACCESS

Operation Access: The Story of Dr. Nseyo and Latoya Maddox

By Operation Access

“T

Access, had known she needed surgery for a long time. Latoya had seen several other gynecologists before and felt ready for surgery but couldn’t find the right fit of treatment and doctor. Dr. Nseyo felt honored to be able to help her through OA. “Some patients have bad symptoms; Latoya was someone who we could take care of. Her case was challenging but working with another doctor, we helped her and gave her a better quality of life going forward.”

That she did! Latoya had a hysterectomy for fibroids, menometrorrhagia, and an enlarged uterus at Alta Bates Summit Medical Center in December of 2019. After surgery, she stated, “I have good hours and painful hours but I am getting stronger and healthier and I am extremely grateful for that.” Latoya says she can now take her dog for walks and participate in activities she could not before, due to the restrictions the pain created for her.

Latoya, a native of Oakland, works with her passion for dance and youth at Hip Hop for Change in Oakland. Her nonprofit provides at-risk youth with a safe place to congregate while sharing their love for dance and music. Latoya dealt with severe pain often, and in fact, while waiting for surgery with Dr. Nseyo, she visited the ER twice due to her pain.

Latoya felt good about her meetings with Dr. Nseyo. She felt she was given a lot of information and options which she had not been given before. This helped Latoya make the best decision for her, which made the surgery process less stressful overall. Once her treatment was concluded, Latoya sent OA the following message, “Thank you. All went well in my last appointment. I’m healed and feeling so much better. I am extremely grateful to you and everyone at Operation Access. I am returning to work tomorrow and I’m so happy to be able to do my job without being in pain, thank you!”

Operation Access strives to create a positive experience for patients by focusing on patient-centered care. The organization also aims to provide a rewarding experience for the volunteers by doing its best to make Latoya Maddox with her case manager and friend at Operation Access Volunteer Event in the process of volunteering seamless. Dr. February 2020. he best of both worlds!” is what Dr. Onouwen Nseyo said about volunteering with Operation Access (OA). “It is truly a privilege to not feel limited in the number of patients I can touch and improve their lives, I am so happy OA opened the door for me to do that.” An obstetrics and gynecology specialist, part of the Sutter East Bay Medical Foundation, and an ACCMA member, Dr. Nseyo joined the OA network of volunteers in early 2019.

Like many other volunteer surgeons, Dr. Nseyo wanted to become a doctor to serve the underserved. “I realized from college that people’s health trajectory is dependent on one’s social class. Health disparities have always motivated me to want to help people without access to healthcare, but I was looking for an opportunity to serve. Some of our patients are uninsured and when a partner mentioned OA, I realized it was a way for me to give back to the community. I was passionate about serving. It’s not just about surgery, because surgery is not always the answer; sometimes the patient just needs a gynecologist. Sometimes the patient has never talked to their gynecologist about their gynecological problems.

Sometimes that can be more satisfying than getting the surgical case, to just be a gynecologist and be able to provide the access.”

Latoya, a patient treated by Dr. Nseyo through Operation

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ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

OPERATION ACCESS

Nseyo summarizes her experience and why she finds the work with OA rewarding by saying, “It’s an incredible opportunity to give back. Graduating from residency, you wonder how you will do what you promised to do for people in need. I feel grateful to join a medical group where I am supported and who is also passionate to serve patients who otherwise could not access

VOLUNTEERING WITH OPERATION ACCESS As a physician, you likely practice medicine in order to help people but may find it difficult to treat those in your community who cannot afford care. Operation Access offers a solution. We’re like a local medical mission, providing seamless care coordination for people in need.

Since 1993, we have been arranging donated surgical and specialty care for low-income, uninsured, and unfunded adults in Northern California. Local community health centers refer patients to our program for specialty care, and we screen for eligibility and match patients with participating surgeons and specialists. We provide interpreters when needed, and, with our culturally responsive care coordination, help ensure patients arrive on time and ready for appointments.

Partner hospitals, ambulatory care centers, and ancillary provider groups such as anesthesia, pathology, and radiology, agree to waive charges for eligible patients.

VOLUNTEER OPPORTUNITY You are invited to join Operation Access to help those with limited access to care. As a volunteer physician, you determine the frequency of your participation and the types of cases you accept.

No lengthy sign-up process or paperwork is involved. We take care of the red tape and give you the opportunity to do what you do best— provide quality medical care with dignity and compassion.

CONTACT Please get in touch with us to learn more about how you can get involved. Call Angelica at 415733-0080, email angelica@operationaccess.org or visit https://www.operationaccess.org/

(continued)

healthcare day-to-day. Overall, OA staff is receptive and that helps when patients need ultrasounds or other work-ups. It has been a great experience! So far, some patients have needed surgery and only a couple did not, but it has been great to be an OBGYN to these women in any capacity, to learn from them and provide a service, so they feel they can learn and speak to a specialist and have things explained to them in a way they can understand. I can’t imagine not doing it. It is a great balance for what I do every day.”

NEW MEMBERS Russel Marc Nord, MD Orthopaedic Surgery Washington Township Medical Group Loton Robert Shippey, MD Hospitalist Alameda InPatient Medical, Inc. Benson W Yong, DO Internal Medicine Alameda InPatient Medical, Inc.

NEW RESIDENT MEMBERS Alameda Health System – IM Residency Program Alwalid Khalifa Ashmeik, MD Neha Jain, MD Kaiser Permanente NorCal Residency Program – PD Simran Kaur Behniwal, DO

To place a classified ad, go to www.accma.org > About Us > Advertise with ACCMA, or call our office at (510) 654-5383.

ACCMA members can place a classified ad for four months online and in two issues of the ACCMA Bulletin at NO CHARGE.

ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

25

OPERATION ACCESS

(continued)

Access the FREE On-Demand Recording at learning.accma.org/recordings

SCMS NCMS SOLANO COUNTY MEDICAL SOCIETY

NAPA COUNTY MEDICAL SOCIETY

HIPAA

CRITICAL UPDATES TO MAINTAIN COMPLIANCE CME Available

Review some of the most critical privacy and security standards in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule. In this one-hour webinar with expert practice management consultant David Ginsberg, you will receive important updates on current changes due to the COVID-19 emergency, risks associated with telehealth, who is covered, what information is protected, how you can stay secure in the Information Age, and how to avoid costly mistakes.

LEARNING OBJECTIVES: Security compliance: is our risk analysis sufficient?

Is our practice safe from ransomware?

Recent HIPAA enforcement actions and compliance reviews: what can we learn from them?

Understand basic privacy and security practices to require for telehealth-either from your home or office Understand what the HIPAA Enforcement Notice of Discretion covers during the COVID-19 Emergency.

Understand the HIPAA technical and cybersecurity risks associated with telehealth

PRESENTER: David Ginsberg is co-founder and president of PrivaPlan Associates, Inc. He has more than 30 years of experience in the health care industry with expertise in medical practice management and regulatory compliance. He is the official HIPAA advisor to ACCMA and the California Medical Association (CMA).

ON-DEMAND: https://bit.ly/37nNpiV Access the FREE on-demand recording by visiting the link above or going to learning.accma.org/recordings

Additional Information: For questions, contact Jennifer Mullins, ACCMA Education and Event Associate at 510-654-5383 or email jmullins@accma.org Accreditation Statement: The ACCMA is accredited by the California Medical Association (CMA) to provide continuing medical education Credit Designation Statement: ACCMA designates this live activity for a maximum of 1 hour of AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

COUNCIL REPORTS

OCTOBER 8, 2020 The meeting was called to order by Doctor Katrina Peters, President.

The Council received a presentation regarding the adoption of AB 890 from Dustin Corcoran, CEO of the California Medical Association (CMA), and Francisco Silva, General Counsel, CMA. Mr. Corcoran and Mr. Silva outlined the provisions of the bill, which grants nurse practitioners the ability to practice independently, and CMA advocacy efforts around implementation of the new law.

The Council approved the following Community Health recommendations: (1) That the ACCMA support efforts to coordinate among local grantees of the California ACEs Aware Initiative and that an ad hoc subcommittee of the Community Health Committee be formed to draw from and augment these local programs and ensure that East Bay physicians have access to comprehensive education and resources around ACEs. (2) That ACCMA communicate to its membership about the importance of encouraging patients to receive flu vaccinations this year.

It was announced that the 152nd ACCMA Annual Meeting on Thursday, November 5, 2020 will be held via Zoom from 5:30 p.m. to 6:30 p.m. to honor the outgoing ACCMA President, Katrina Peters, MD and to install the 2021 ACCMA President Suparna Dutta, MD and other incoming officers.

Mr. Greaves reported that the ACCMA Physician Leadership Program, directed by Hilary Worthen, MD, began on October 6, 2020. It consists of eight virtual sessions and registration goals were achieved.

The Council was informed about AMA activities related to COVID-19, including a letter regarding COVID-19 vaccines, urging the FDA to work closely with the physician community to develop a plan for further education and transparency surrounding COVID-19 vaccine candidates.

The Council was provided information about the MPFS proposed rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2021.

The Council was informed about COVID-19 local updates.

Both Alameda County and Contra Costa County are in the red tier as of September 22, 2020, indicating substantial risk.

The Council reviewed and discussed the Alameda Health System Labor Action. Employees began a five-day strike on October 7, 2020, citing the lack of proper isolation rooms for COVID-19 patients as well as insufficient PPE for the staff.

Ms. Lum presented the membership report. Membership is

down slightly from year-end 2019.

Ms. Lum discussed upcoming seminars and webinars.

There being no further business, the meeting was adjourned.

NOVEMBER 5, 2020 The meeting was called to order by Doctor Katrina Peters, ACCMA President.

Dr. Peters announced that her term as ACCMA President is concluding and therefore this is the last Council meeting that she will be chairing as President. Dr. Dutta will begin her term as ACCMA President on November 6 and will be chairing ACCMA Council meetings going forward.

Lubna Hasanain, MD provided an update regarding the ACCMA Clinician Wellness Program, including the sponsored group psychotherapy sessions, which are offered for free to all East Bay physicians, confidential support from peers, wellness webinars, physician peer group meetings & collegiality events, the Physician Leadership Program, and the East Bay Clinician Wellness Consortium. Members of the Council were invited to the upcoming meeting of the East Bay Clinician Wellness Consortium.

The Council discussed the draft CMA Unified Financing Policy for Health Reform. Mr. Greaves asked Council members to send additional comments to staff. Comments will be compiled into a letter, which will be reviewed and approved by the Executive Committee before being submitted to CMA prior to the December 10, 2020 deadline for comments.

The Council elected to cancel the December Council meeting and delegate authority to the Executive Committee to approve new applicants.

The Council discussed the actions taken by the Alameda County Board of Supervisors, which included asking for the resignation of all current Board of Trustee members from Alameda Health System and changing the qualifications to become a Trustee. The matter will be considered by the Medical Services Committee at their upcoming meeting.

Mr. Greaves gave an update on the plans to merge the Napa and Solano County Medical Societies, which will go into effect on July 1, 2021.

The ACCMA Bylaws changes that were recommended by the Bylaws Committee and approved by the Council are now up for approval by the general membership.

The ACCMA will be sending out a call for nominations for ACCMA committees. The Council was asked to help recruit new committee members. continued on page 29

ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

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ALAMEDA ALLIANCE

Medi-Cal Rx: California’s New Pharmacy Benefit System By: Scott Coffin, Alliance CEO

A

lameda Alliance for Health (the Alliance) is proud to serve over 270,000 children and adults in Alameda County. In this edition you will learn about Medi-Cal Rx, the new system of how Medi-Cal pharmacy benefits will be administered through the state’s fee-for-service delivery system, beginning on April 1, 2021, and what the Alliance has been doing to assist with a smooth transition.

In January of 2019, Governor Newsom issued Executive Order N-01-19, now known as Medi-Cal Rx, which tasked the Department of Health Care Services (DHCS) to transition all pharmacy services from the Medi-Cal managed care system into a state-administered fee-for-service benefit. In mid-November, the DHCS announced that due to ongoing challenges that the COVID-19 pandemic has presented, the transition time for full implementation of Medi-Cal Rx has been lengthened by three months and is now set to begin on April, 1 2021. The transition applies to all counties in California, and as of the spring of next year, services such as covered outpatient drugs, medical supplies, and enteral nutritional products will be carved out from the managed care system. The objective of this transition is to standardize the Medi-Cal pharmacy benefit under one delivery system, to improve access to pharmacy services, to apply statewide utilization management protocols to all outpatient drugs, and to strengthen California’s ability to negotiate state supplemental drug rebates with drug manufacturers.

Starting April 1st, 2021, the DHCS will work directly with Magellan Medicaid Administration Inc. (Magellan), the organization that was awarded a contract to manage the pharmacy benefit for Medi-Cal beneficiaries throughout the state including, most of our Alliance Medi-Cal members. Magellan will provide administrative services and support related to the pharmacy benefit, including claims management, prior authorizations, and utilization management services. Other services that will be provided by Magellan will also include pharmacy drug rebate administration, provider and member support services, and reporting services that assist with the administration of Medi-Cal Rx. This transition 28

will impact over 11 million people enrolled in Medi-Cal managed care, a majority of the nearly 14 million Medi-Cal beneficiaries throughout the state.

Over the last year, the DHCS has been working with stakeholders to implement a transition plan that will ensure that Medi-Cal beneficiaries that have existing prescriptions covered by their managed care plan will have continued coverage during a 180-day transition period. For the first 180 days, the DHCS will not require physicians to submit a prior authorization request to continue patients who are on existing medications. After the 180day transition period, Medi-Cal Rx will require all prescriptions to be on their Contracted Drug List (CDL) Any drug not on the CDL or within the quantity limit will need a prior authorization from Medi-Cal Rx. Additionally, they will ‘grandfather’ previously approved prior authorizations through its stated duration, (i.e. three to six months), but not to exceed one full year from the date of the prescription approval start date. While Medi-Cal Rx will be responsible for most administrative and support services, the Alliance will continue to be responsible for authorizations, denials, and appeals specific to physician administered drugs.

Most recently, the DHCS and Magellan launched a training on the Medi-Cal Rx portal for Medi-Cal prescribers and pharmacies. The training is available now through the end of the year and provides information on key functions such as prior authorization information and submittal instructions, beneficiary eligibility look up, and web claims submission, activities and inquiries. We encourage you to visit the DHCS Medi-Cal Rx website at https://medi-calrx.dhcs. ca.gov/provider for more information on how you can register and to obtain training instructions.

Throughout the DHCS-led stakeholder engagement process, the Alliance has attended and participated in various forums and workgroup meetings to understand how the implementation of their various strategies will impact our Medi-Cal members and provider partners. In addition to the information that the DHCS has shared, the Alliance will continue to keep our physicians informed and assist them with understanding how the

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

ALAMEDA ALLIANCE

pharmacy benefit changes will impact their practice by providing educational materials as well as making ourselves available to clarify any questions that may come up as we near the beginning of the Medi-Cal launch and throughout the transition period.

Recently, we have included information about the transition in the provider packet that goes out to our physician partners every quarter and will be including information in the Alliance provider manual. Additionally, the DHCS has mailed two notices explaining what Medi-Cal beneficiaries can expect when the transition begins, and will be sending out additional updated information about the new April 1st start date of Medi-Cal Rx. We encourage our provider partners to contact us with concerns they may have prior to the transition and to visit our website at www.alamedaalliance.org for the latest updates on

Practice & Liability CONSULTANTS Health Care Practice Management In a special arrangement with Practice & Liability Consultants, ACCMA members may purchase the following practice management kit at a reduced price: • Office Staff Personnel Policies and Procedures Manual New 2020 updates including COVID-19 policies Practice consulting services available.

Debra Phairas 461 Second Street, Suite 229 San Francisco, CA 94107 (415) 764-4800 Fax (415) 764-4802 www.practiceconsultants.net

(continued)

Medi-Cal Rx. Lastly, the Alliance will reach out to each of our Medi-Cal members with additional information on the transition at the end of February – 30 days before the transition, and will continue to post up to date information on the Alliance website.

As members of the local safety-net system, we remain committed to working closely with our provider partners to ensure that they have access to the information and resources they need to care for our members. To read the latest information on Medi-Cal Rx, please visit the DHCS dedicated website at https://www.dhcs. ca.gov/provgovpart/pharmacy/Pages/Medi-CalRX.aspx.

ABOUT ALAMEDA ALLIANCE FOR HEALTH Alameda Alliance for Health (Alliance) is a local, public, not-forprofit managed care health plan committed to making high quality health care services accessible and affordable to Alameda County residents. Established in 1996, the Alliance was created by and for Alameda County residents. The Alliance Board of Governors, leadership, staff, and provider network reflect the county’s cultural and linguistic diversity. The Alliance provides health care coverage to over 270,000 low-income children and adults through National Committee for Quality Assurance (NCQA) accredited Medi-Cal and Alliance Group Care products.

COUNCIL REPORTS (continued from page 27)

Ms. Lum reviewed upcoming webinars.

Dr. Kogan gave an update for the CMA Trustees report, stating that there was a vote to elect Sergio Flores, MD as the new Vice-Chair.

Dr. Wong reported on the ACCMA meeting with Congressman DeSaulnier, saying that the Congressman was very supportive and sympathetic to the legislative priorities that were discussed.

Ms. Lum gave an update on PPE distribution to medical groups. A form was provided for information.

There being no further business, the meeting was adjourned.

Put Your ACCMA Membership to Work! Go to www.accma.org > Membership, or call ACCMA at (510) 654-5383 for help.

ACCMA BULLETIN | NOVEMBER/DECEMBER 2020

29

CLASSIFIEDS

Tracy Zweig Associates A

Medical office suites available at Colby Medical Center, 3000-3010 Colby Street, Berkeley on campus at Alta Bates.

Newly refurbished common areas, best on-site parking in area.

Suites from approximately 500-4,500 sf. Contact Trask Leonard, Bayside Realty Partners, tleonard@baysiderp.com, 650-5332591 or 650-949-0700.

REGISTRY

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners Physician Assistants

Urgent Care + TeleHealth is searching for Staff Physicians to provide full-time or part-time staffing for our Urgent Care, located in Napa and Benicia.

Physician Criteria: • Must have a valid State of California Medical License with a current DEA. • Must have excellent communication and interpersonal skills and understand the importance of patient satisfaction.

• Be comfortable seeing a variety of primary care conditions from pediatrics to adults either in person or via telehealth.

• Able to perform minor surgical procedures (laceration repair, I&D of abscess, foreign body removal, etc.)

• Review and complete charting by end of shift.

• Our facility has a small pharmacy, X-ray suite, and performs CLIA-waived labs.

• X-ray over reads are provided by an offsite radiologist.

For further information or inquiry, contact Sherry Hartman, Manager, at 707-377-1005 or sherryh@telehealthuc.com.

Locum Tenens Permanent Placement Voice: 800- 919- 9141 or 805-6 41-9141 FAX : 805- 641 -914 3 jnguyen@ t r acyzw eig.com w w w.t r acyzweig.com

IN MEMORIAM DINO CACIOPPO, MD (1930–2020) earned his

bachelor’s degree from Kent State University before receiving his D.O. from the University of Des Moines and later his M.D. from the University of California. Dr. Cacioppo practiced surgery in San Leandro, where he was chief of surgery in three of its area hospitals: Humana Hospital, Laurel Grove Hospital, and Doctor’s Hospital. Dr. Cacioppo was passionate about aviation and enjoyed giving family and friends exhilarating rides in his Piper Seneca and DC3. Dr. Cacioppo was a member of the ACCMA for 39 years.

CARL JOSEPH MANI, MD (1934–2020) attended Loyola University of Los Angeles where he earned a degree in Philosophy. He then moved to Milwaukee, WI to attend Marquette University medical school before entering the United States Army Medical Corps, completing his internship and residency at Letterman Hospital in San Francisco as a Radiologist. Dr. Mani was a diehard fan of the Giants, Warriors and especially the 49ers. As Chief of Radiology at Summit

30

Hospital and later at St. Luke’s Hospital in San Francisco, Dr. Mani was a mentor to countless physicians. Dr. Mani was an ACCMA member for 50 years.

SUMNER MARSHALL, MD (1933–2020) was born and raised in Gloucester, MA, and graduated from Harvard College and Cornell Medical School. In 1961 he traveled to California with his wife, Hermine, to complete his Urology residency at University of California, San Francisco. While helping to raise three sons, Sumner practiced urology in Berkeley for the next 35 years. He was a talented surgeon with an inventive flair who published countless papers on clinical aspects of urology. For over 50 years, he was also a dedicated and beloved teacher to medical students at UCSF, where he received many teaching awards. After Sumner retired, he traveled the world with Hermine, and he loved capturing the essence of his experiences in detailed journal entries. Dr. Marshall was an ACCMA member for 49 years.

ALAMEDA-CONTRA COSTA MEDICAL ASSOCIATION BULLETIN

COUNCIL REPORTS

Helping People in Our Community Since 1996

A L A M E D A

C O U N T Y

www.alamedaalliance.org

(continued)

Alameda-Contra Costa Medical Association 6230 Claremont Avenue P.O. Box 22895 Oakland, California 94609-5895

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