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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> <img width=623 height=151 style='width:6.4895in;height:1.5729in' id="Picture_x0020_1" src="cid:image001.jpg@01D1FAE4.F8CCBDB0" alt="Description: Description: Description: Description: CAL/AAEM: California Chapter of the American Academy of Emergency Medicine"><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id=content><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>August 20, 2016<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>AB 72 wrongly rewards health insurance plans for carrying inadequate networks <o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="cmanet.org"><span style='color:#0000CC'>California Medical Association</span><span style='font-family:"Times New Roman",serif;color:#0000CC'><o:p></o:p></span></a></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>AB 72 (Bonta), a revised version of AB 533, would hamper physicians’ ability to effectively negotiate fair rates with health insurance plans by setting out-of-network payments at a statutory default rate. Because of this set rate, health insurance plans would be incentivized to drive down contracting rates and likely unwilling to sign fair contracts. By mandating in law that out-of-network providers are subject to the contracted rates of third parties, AB 72 sets up a framework whereby health plans are incentivized to carry exceedingly narrow networks. <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'>Description<o:p></o:p></span></b></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The Senate is expected to consider AB 72 as early as Tuesday, August 16, followed by the Assembly.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'>Talking Points<o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> • I am opposed to the current version of AB 72. To provide a better framework toward a comprehensive solution to the surprise billing issue, amendments are needed to complete the legislation. <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> • AB 72 needs to require health plans to provide in-network providers at in-network facilities. Stronger network adequacy laws ensure that health plans cannot use AB 72 as a way to drop contracts and carry narrower networks, which dangerously limit patient access to care.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> • The definition of “Average Contracted Rate” needs to be clearly defined to prevent manipulation and must take into account discounts currently provided for bilateral and multilateral procedures.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> • In-facility consultations should be arranged by the health plan. The health plan shall provide each facility with a list of an in-network specialist with privileges at the facility where services are needed to provide the consultation. <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'> • AB 72 sets out-of-network payments at the greater of 125 percent of Medicare or the average contracted rate. This statutory rate must be the exemption and not the rule; otherwise, it incentivizes narrow networks and will create downward pressure on the ability of physicians to sign fair contracts.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Legislators need to hear from you! We ask that you and your colleagues CALL, EMAIL or FAX your legislators, and urge them to oppose AB 72 unless amended!<o:p></o:p></span></p></div><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Please ONLY contact your legislator (click <span style='color:#0000CC'><a href="http://findyourrep.legislature.ca.gov/"><span style='color:#0000CC'>here</span></a></span> to look up which district you're in, if unknown). You can also download the <span style='color:#0000CC'><a href="cmanet.us1.list-manage1.com/track/click?u=145aa039e469fec82f515d867&id=21c9b28cc1&e=7040f4c7a9"><span style='color:#0000CC'>Senate and Assembly Roster with Counties</span></a></span> for your reference.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'>Sample Letter<o:p></o:p></span></b></p><p class=MsoNormal><b><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>A sample letter is available on the <span style='color:#0000CC'><a href="http://cmanet.us1.list-manage.com/track/click?u=145aa039e469fec82f515d867&id=c425ad6233&e=7040f4c7a9"><span style='color:#0000CC'>CMA website</span></a></span>.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Jeff Wells</span></strong><span style='font-family:"Arial",sans-serif'><br>Deputy Editor, CAL/AAEM News Service<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service<br><br></span><o:p></o:p></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Contact us at: <span style='color:#0000CC'><a href="mailto:calaaem.news.service1@gmail.com"><span style='color:#0000CC'>calaaem.news.service1@gmail.com</span></a></span><br><br>For more articles, visit our <span style='color:blue'><a href="http://www.calaaem.org/news_archives.php"><span style='color:blue'>archives</span></a></span>. <br><br></span><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><a href="mailto:somcaaem@uci.edu"><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0070C0'><a href="https://maillists.uci.edu/mailman/listinfo/calaaem"><span style='color:#0070C0;text-decoration:none'> </span><span style='color:blue'>unsubscribe</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'> from this list, visit our mail server.<br><br>Copyright (C) 2015. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span> <span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0000CC'><a href="http://www.calaaem.org"><span style='color:#0000CC'>http://www.calaaem.org</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.<br><br><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Follow CAL/AAEM on Facebook and Twitter:<o:p></o:p></span></b></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><a href="http://www.facebook.com/pages/CalAAEM/172577489479442?sk=wall&filter=12" target="_blank"><span style='color:black;text-decoration:none'><img border=0 width=28 height=28 style='width:.2916in;height:.2916in' id="Picture_x0020_6" src="cid:image002.jpg@01D1FAE4.F8CCBDB0"></span></a> <a href="https://twitter.com/#!/CALAAEM"><span style='color:windowtext;text-decoration:none'><img border=0 width=30 height=30 style='width:.3125in;height:.3125in' id="Picture_x0020_7" src="cid:image003.jpg@01D1FAE4.F8CCBDB0"></span></a> <a href="http://escholarship.org/uc/uciem_westjem"><span style='color:windowtext;text-decoration:none'><img border=0 width=112 height=30 style='width:1.1666in;height:.3125in' id="Picture_x0020_4" src="cid:image004.jpg@01D1FAE4.F8CCBDB0"></span></a><o:p></o:p></p><p class=MsoNormal style='background:#D9D9D9'><span style='color:black'><o:p> </o:p></span></p></div><br />
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