CAL/ACEP Needs You

CAL/AAEM News Service calaaem_news at yahoo.com
Sat Sep 6 22:26:27 PDT 2008





CAL/ACEP
Needs You

 

Source: California Chapter of the American College of Emergency
  Physicians ( http://www.calacep.org/
)

Date: September 2, 2008

 

 

We need your help to have Governor Arnold Schwarzenegger
sign SB 981 

(Perata), which seeks to solve the fair payment/balance
billing issue. The Governor's staff is recommending a veto, and a veto is also
being requested by HMOs and capitated medical groups.

 

The best chance to get SB 981 signed is for an emergency
physician (or a friend of an emergency physician) to contact the Governor
directly. If you or a friend of yours has direct access to Governor
Schwarzenegger, please call or email me immediately at (916) 325-5455 or elopez-gusman at calacep.org. The
signature/veto deadline is September 30. 

 

This bill is very important as it solves the fair payment/balance
billing issue in a fair manner (details below). HMOs and capitated medical
groups are opposed to SB 981 because it requires them to make a fair payment up-front,
rather than allowing them to pay whatever amount they choose, and force
emergency physicians to enter into expensive litigation to get paid fairly.

 

Most emergency physicians will not, of course, have a good
contact with Governor Schwarzenegger, but you will be able to help in getting
the bill signed. Look for emails in the next few days, and when they arrive, please
act on them immediately.

 

We have an uphill battle with the Governor.  But we've already won an uphill battle in the
Legislature, and we can win this fight as well.

 

Thank you in advance for your help!

Elena Lopez-Gusman

Director of Government Affairs

 

Quick Summary of SB 981-PerataOverall, CAL/ACEP made the
political calculation that eventually the State Legislature would prohibit "balance
billing".  Accordingly, we worked
with Senator Don Perata to develop a fair, compromise bill that would keep patients
from being balance billed but would provide fair payment to emergency physicians.  SB 981 is this compromise bill.

 

1.    Authored by
President Pro Tem Don Perata (D-Oakland), California's most powerful Legislator, and a
long-time friend of CAL/ACEP.

 

2.    Supported by
patient and consumer groups, including AARP, Health Access, Western Center
on Law & Poverty, CALPIRG, California Nurses Association, California Labor
Federation, and Teamsters.

 

3.    Opposed by HMOs
and their subcontracting capitated medical groups.

 

4.    SB 981 requires
HMOs and capitated medical groups to make an  "interim payment" for non-contracted
HMO patients at 250% of the Medicare payment rate of 01/01/2007, plus an
immediate 10% (approximately) cost-of-living increase (to bring the Medicare
rate up to the implementation date of the bill, 07/01/2009), plus annual cost-of-living
increases thereafter based on the medical professional services index of the
CPI.  It should be noted that the 01/01/2007
Medicare rate is 4% to 5% higher than the 01/01/2008 Medicare rate.

 

5.    After payment is
made at the interim rate, emergency physicians or HMOs and capitated medical
groups may seek a higher or lower payment through an Independent Dispute
Resolution Program (IDRP).

 

6.    IDRP is required
to use the "Gould Standard" to determine the "reasonable and
customary" value of the service.  The
Gould Standard is based on comparable charges and other, similar criteria.

 

7.    HMOs and
capitated medical groups may not downcode prior to IDRP.

 

8.    Medicare
standards are used for bundling issues.

 

9.    Emergency
physicians are prohibited from balance billing non-contracting HMO patients and
PPO patients regulated by DMHC.




      
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