Friday, February 23, 2018

OCMA Blog

Call to Action from CalOptima Regarding Duals Demonstration

Dear Orange County Physicians:

CalOptima is measuring physician interest in a direct contract model for the dual-eligible demonstration that will launch in Orange County in April, 2014.  If there are not enough physicians interested in the direct contract model, it may be difficult for the CalOptima board of directors to support the model.  See the "Call to Action" below that CalOptima issued to the physician community.  As always, if you have any questions or comments, please contact us.

 

Thomas C. Kockinis, MD                                                   Robert McCann, MHA

President                                                                           CEO / Executive Director


 


Thinking About the Duals Demonstration? 
We Want to Hear From You!


The time for you to respond is now! The CalOptima Board of Directors is exploring the interest level of a direct contracting option with CalOptima for Cal MediConnect (also called the Duals Demonstration). Based on the interest level of the Orange County physician community, the CalOptima Board may grant authority to make this new option available.
 
If approved, the direct network will be based on managed care principles, providing support for your patients who may be difficult to manage through: coordinated care, case management, physical and mental health coordination, as well as home and community-based support services.
 
We need to hear from physicians who are interested in contracting directly with CalOptima, as the window for measuring interest is narrowing. In order for the model to be viable, a substantial number of physicians need to indicate their desire to participate. Currently, we do not have enough physicians displaying an interest to proceed with this option.
 
Orange County is one of eight California counties selected to participate in Cal  MediConnect. With Cal MediConnect, Medicare patients who are 21 years of age or older receiving full Medi-Cal benefits will have the option to transition from fee-for-service Medicare to this Duals Demonstration no sooner than April 1, 2014.
 
If you are a provider interested in directly contracting with CalOptima for this demonstration, please contact our Provider Relations department at 714-246-8600 or providerservices@caloptima.org to let your voice be heard and receive additional information about your contracting options. 

 


ALERT: You May have Automatically been Contracted into an Exchange Plan

Open enrollment began October 1st for Covered California (California's Health Benefits Exchange). The OCMA has received many calls from members confused as to whether they are contracted to see these patients. 
  

Many doctors were automatically put into contracts, and are unaware that they are on the plan directory for exchange plans with payers. These physicians have to opt out of that part of their contract if they do not wish to participate in the Exchange. The easiest way to confirm your participation is by calling the provider relationship department of the three plans in Orange County who are contracted to see Exchange patients.  

  • Anthem Blue Cross:  (855) 238-0095
  • Blue Shield Of California:  (800) 258-3091
  • HealthNet:  (800) 641-7761

For additional questions about Covered California or any practice management issue, OCMA / CMA members may call OCMA Physician Advocate Mitzi Young directly at (888) 236-0267 or myoung@cmanet.org.


Notice: Due October 1: Employee Notices - Health Insurance Exchange

One of the provisions of the ACA requires employers to provide their employees notice of the new state health insurance exchange (Covered California). Regardless of whether or not your practice offers employees health insurance, employers subject to the Fair Labor Standards Act (FLSA) are required to provide notification of purchasing options and subsidies available through the Covered California health exchange by October 1, 2013 (model notices are available at www.marshhealthoptions.com).  Generally employers with one or more employees who generate sales of $500,000 or more annually are required to provide the notice. There is one notice for employers who provide their employees with health insurance and one notice for employers who do not provide health insurance to their employees. Since the FLSA applies broadly, most employers are subject to the requirement. 

A Department of Labor online compliance tool: http://www.dol.gov/elaws/esa/flsa/scope/screen24.asp can help employers determine whether they are covered by the law. 

MICRA ALERT: Trial Lawyers Start Voter Mail Program

The trial lawyers and their front group "Consumer Watchdog" are taking the MICRA battle up another notch. With the start of their direct mail campaign to registered voters, it is clear they are looking to score a victory this year. Below is a photo of their mailer including a "38 Is Too Late" story card and an ever-so-subtle "morgue toe tag." Over the top tactics are to be expected.

Your help is critical to our continued success. Share the details of the trial lawyers efforts with your colleagues. Also, donating to CALPAC to your fullest ability and asking your colleagues to donateCMA/OCMA membership is crucial, so please consider becoming a member to help us with this fight. If you are already a member, we sincerely thank you for your membership.

CMA and our MICRA coalition members at Californians Allied for Patient Protection (CAPP) are fully engaged. With increased legislative visits and the preparation of our own mail and updated materials, we are telling the full story of MICRA and its important role in maintaining access for all. We completed our field poll testing and just received the results. This crucial data will help guide our campaign and ensure we deliver the strongest defense of MICRA at both the legislative level and to the voters of California.

Share this email with others and follow up to join and donate. We don't win unless the physicians of California are united and committed to beating back the trial lawyers. You have the strongest possible message to urge your fellow physicians to join the efforts to protect MICRA. And have no doubt, the fight will get more intense over the coming days and months.

We will win this fight once again because MICRA is a nationally-respected best-practice with overwhelming bipartisan support that has worked successfully in California for decades and, if changed, would result in higher health care costs for every Californian. Your commitment and efforts motivate our incredible staff at CMA. Thank you for all you do and will do. We will be back to you shortly with an update on our latest efforts.



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