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CMS has temporarily stopped proposals from insurers that want to automatically enroll their commercial or Medicaid patients into their Medicare Advantage plans. This is now done by most insurers when patients turn 65. The seniors were expected to be enrolled into traditional Medicare but only learned of the switch when they got care. Present law allows this with approval by CMS. CMS must send a letter to the individual affected at least 60 days in advance of the switch and how to opt out. This has not happened.
CMS has released the MACRA final rule. This replaced the terrible sustainable growth rate which was never enacted. The idea is to get away for paying for fee for service and pay for value, whatever that is. The new rule will have a budgeted $20 million per annum to help small practices, under 15 doctors training and education on the program. The time elements were also lengthened. The rule is heavy on technology of which there needs to be changes in the usual EMR. CMS also wants to start reducing the administrative burden on physicians that are practicing in APMs. They will not be asked to justify their claims for an 18 month trial period. Watch for a huge exodus of physicians when this takes effect.
The California Governor has signed many healthcare bills into law. They include AB 72 which set a reimbursement rate of 125% of Medicare or the insurer's average contracted rate, which ever is higher, for the service provided a patient by an out of network physician in an in network hospital. Also he signed SB 42 which requires physicians to check a patient's prescription history in a state database before prescribing any potentially addictive drug. This is an unenforceable law. SB 586 mandates improvement in case management and coordination for children transferred from CHIP to Medicaid. SB 908 requires insurers to notify consumers of rate hikes the Department of Insurance or the Department of Managed Care deem to be unreasonable. SB 1075 requires observation units to maintain the same nursing requirements as standard nursing units. Brown also signed a bill to allow right to try experimental drugs for the patients who are terminal and are not helped by standard drugs. Top
The state of California has accused Dr. Arfa Babaknia, a Fountain Valley GP with sexual abuse and/or misconduct toward a female patient. He is accused of examining a patient for a urinary infection with no one else in the room and touched her genitalia without a medical reason to do so. Sounds like he said she said.
California Medical Board has accused Dr. Doanh Nguyen of gross negligence for prescribing excessively and to addicts to four people who died under his care. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the
information presented.