Mental Health is a Top Priority
By Albert L. Brooks, MD, ACCMA President
May is Mental Health Awareness
Month, and I wanted to use this month’s column to highlight some ACCMA activities that support the mental health of our members and the patients we serve.
ACCMA continues to offer support for physician members through sponsored psychotherapy sessions and confidential peer support from fellow physicians. Our Wellbeing Committee members have curated a list of experienced mental health professionals who have worked with physicians before, and ACCMA will cover the costs of up to four sessions for any East Bay physician seeking psychotherapy from these clinicians. For those who don’t want psychotherapy, but would value connecting with a supportive peer, you can also contact the ACCMA to be confidentially connected to a member of our Wellbeing Committee who can offer confidential peer support over the phone. This includes support for physicians undergoing litigation or Medical Board investigations.
Another important component of mental health is feeling connected to community. ACCMA offers many opportunities for
physicians to engage with one another and build community. We have started to offer more social events where physicians and their families can connect with colleagues around shared interests and activities. Some of these events are organized by the ACCMA staff while others are organized directly by ACCMA members themselves with financial support from ACCMA. You can find a list of upcoming events on the last page of the Bulletin or by visiting www.accma.org.
On the advocacy side, we are focused on a number of mental health related priorities. We are supporting AB 2164 to remove the requirement for physicians to disclose if they received mental health treatment when applying for a medical license. This may unintentionally dissuade doctors from getting the help they need and stigmatizes physicians who seek mental health services. ACCMA also sent a letter recently to the Department of Health Care Services urging changes to the new system for Medi-Cal youth and children to access mental health services, calling for the use of a clinically validated screening tool and for allowing physicians to directly refer patients rather than going through county health departments for additional screening. We also recently sent a letter to the FDA and DEA asking them to take immediate action to address the pervasive drug shortages for ADHD medications.
I hope these ACCMA resources and activities are meaningful to you, and that you are able to use Mental Health Awareness Month to reflect on optimizing your own mental health and the mental health of your patients.
This year’s ACCMA Annual Meeting will be unlike any other! Join us on Friday, November 15th for a “Galactic Gathering” at the Chabot Space and Science Center. The event will kickoff with a welcome reception at 6 PM, followed by a short program in the Planetarium at 7 PM, after which guests will have access to the run of the museum: exhibits, planetarium showings, the famous Chabot telescopes, and more.
ACCMA MEMBERS LOBBY LEGISLATORS IN SUPPORT OF PRIORTY ISSUES
Over 50 ACCMA members participated in CMA’s 50th Legislative Advocacy Day, held on April 10, 2024, in Sacramento. Attendees lobbied legislators in support of some of CMA's priority issues, including protecting historic investments in Medi-Cal, reforming prior authorization process, and requiring physician oversight of utilization review decisions made or assisted by a health plan’s AI decision-making tools or algorithms.
HEALTH PLANS DROP LAWSUIT CHALLENGING COVID-19 SERVICE PAYMENTS
The California Association of Health Plans (CAHP) has dropped its appeal in a lawsuit challenging the constitutionality of SB 510, a state law requiring health plans and insurers to reimburse health care providers for certain COVID-19 claims retroactive to the beginning of the pandemic. SB 510 remains in effect and health plans and insurers are legally obligated to comply with all its requirements, including its retroactive provisions and the payment of interest for claims that were not paid in a timely manner.
GOVERNOR’S HEALTH CARE FUNDING CUTS UNDERSCORE CRITICAL NEED TO PROTECT ACCESS TO HEALTHCARE BALLOT INITIATIVE
In his May state budget revise, Governor Gavin Newsom is proposing to redirect funds from the Managed Care Organization (MCO) Tax from Medi-Cal rate increases that were scheduled for implementation in the 2024-25 state budget, to the general fund to address the state's projected deficit of $27.6 billion for 202425. The revised budget proposes to maintain the rate increases that became effective on January 1, 2024, but have not yet been paid to providers. CMA will be pushing back on the Governor’s proposal and is sponsoring a ballot initiative in November 2024 to restrict the Legislature’s ability to use the MCO tax proceeds for anything other than increasing Medi-Cal rates and strengthening the physician workforce.
BLUE SHIELD CHANGES WILL AFFECT IN-PERSON CONSULTS AND SURGICAL PERIOD PAYMENT POLICIES
Effective July 14, 2024, Blue Shield will no longer reimburse for face-to-face consultation services, which includes telehealth consults (CPT codes 99242-99245 or 99252-99255). Additionally, Blue Shield will reduce reimbursement of certain office and other outpatient visit E/M services (CPT codes 92002, 92004, 92012, 92014 and 99201-99215) by 50% when appended with modifier 25 and billed with a minor surgical procedure code (0- or 10-day global period) by the same physician or physicians of the same group.
To find more information or to view full articles on any of these topics, scan the QR code, visit accma.org/Bulletin, or contact us at accma@accma.org or (510) 654-5383.
CMA SPONSORS BILL TARGETING AI IN UTILIZATION REVIEW
CMA is sponsoring the Physicians Make Decisions Act (SB 1120), which requires that adverse utilization review decisions be made by a licensed physician, rather than artificial intelligence (AI). In recent years, health plans have increasingly relied on AI to streamline the processing of claims and prior authorization requests. SB 1120—authored by Senator Josh Becker (D-Menlo Park)—requires licensed physicians to supervise treatment and coverage decisions made by algorithms.
WORKERS COMP MEDICAL FEE SCHEDULE UPDATE
The California Division of Workers’ Compensation (DWC) has published a notice that updates the Official Medical Fee Schedule, effective for dates of service on or after April 1, 2024. Additionally, DWC has posted a revised Table A which specifies the geographic-adjusted conversion factor for each California locality for anesthesia Services.
CONTROLLED SUBSTANCE DISPENSERS URGED TO CONTACT THEIR DATA SUBMISSION SOFTWARE PROVIDER REGARDING NEW CURES VERSION REQUIREMENT
Beginning August 1, 2024, all California dispensers of controlled substances will be required to report to CURES using version 4.2B of the American Society of Automation in Pharmacy (ASAP) format. As technical implementation of this update to data submission software may take considerable time, practices dispensing controlled substances are urged to contact their data submission software providers and confirm they are preparing for this upcoming ASAP version change.
NEW HEALTH CARE WORKER MINIMUM WAGE LAW EFFECTIVE JUNE 1
On June 1st a new state law will raise the minimum wage for employees of physician group practices with 25 or more physicians, urgent care clinics, community clinics, ambulatory surgical centers, and hospitals. CMA’s advocacy efforts amended the law to exempt IPAs and practices with 24 or fewer physicians and to phase-in the increases over several years. Practices are encouraged to review the new law to determine how the new law applies. Scan the QR code to learn more.
URGE YOUR LEGISLATORS TO SUPPORT ASSEMBLY BILL 2164
Urge your legislators to support AB 2164 to remove the requirement for physicians to disclose if they received mental health treatment to apply for a medical license. The licensure application for physicians and surgeons might unintentionally dissuade doctors from seeking mental health support. Take a few minutes to take action today by sending a message to your legislators (scan QR code below to easily contact your legislators). Your voice will ensure that physicians receive the necessary support to excel and deliver optimal care to their patients.
CHANGE HEALTH CYBERATTACK
The February 21st cyberattack on Change Healthcare resulted in nationwide outages affecting payors and physician practices. According to the AMA's most recent follow-up survey, physicians have suffered numerous administrative and billing hurdles. Please scan the QR code below to find several resources available to physicians impacted by this news.
MEDICARE PHYSICIAN PAYMENT SCHEDULE
CMS has updated its website to reflect the new Medicare Physician Payment Schedule conversion factor which is a result of the Consolidated Appropriation Act. CMS has now established the new conversion factor of $33.2875 for dates of service 3/9/24 through 12/31/24.
PRESCRIPTION DRUGS TARGETED FOR PRIOR AUTH REFORM
CMS has signaled that prescription drugs are a potential area of focus for prior authorization reform. CMS has recently implemented several meaningful prior authorization reforms to Medicare Advantage and Medicaid plans which will decrease delays in care and prevent inappropriate denials. To assist advocacy efforts, please share your story about the harms of prior authorization delays – both from your own experiences and practices, as well as from your patients.
ICD-10 CODE(S) REQUIREMENT TO AVOID MEDI-CAL CLAIM DENIALS
Prescribers who participate in Medi-Cal should include a valid ICD-10 code(s) on prescriptions. Effective April 30th, Medi-Cal Rx will implement claim utilization management (UM) edits for Code I diagnosis restriction (Reject Code 80) for members 22 and older. If the diagnosis requirement is not met, the claims submitted will be denied. Physicians should perform the steps outlined in DHCS guidance (scan QR code below to access guidance) if the drug prescribed is impacted by a Code I diagnosis restriction.
WANT TO THROW A PARTY? ACCMA’S GOT YOU COVERED
Are you interested in organizing a social event or group activity for ACCMA members and their families? The ACCMA is offering mini-grants of up to $500 to help fund member-organized and led events and activities that are open to all ACCMA members. Examples of recently funded events include a private hike, pickleball tournament, Zumba class, happy hour event, and more. Use the QR code below to see a list of upcoming events and submit an application.
ADVERTISING WITH ACCMA
Did you know that members can post classified ads online free of charge for 2 months? Take advantage of this benefit by contacting the ACCMA. Check out the current ads online now.
IN MEMORIAM: GARY NYE, M.D.
Doctor Gary Nye was a leader in psychiatry and an active member of the ACCMA and CMA for 53 years. Throughout his career, he was actively involved in the ACCMA Advisory Committee on Physician Well-Being (formerly the Physicians Advisory Committee), serving as chair for 37 years. He was an outspoken advocate for the maintenance of California’s physician diversion program and the subsequent creation of a physician health program. The CMA House of Delegates recognized his significant contributions and instituted the Gary S. Nye, M.D. Award for Physician Health and Well-Being that is awarded annually at the CMA House of Delegates meeting. He will be greatly missed by his family, friends, patients, and colleagues.
East Bay physicians since
ACCMA UPCOMING EVENTS
TIPSY PUTT & TACOS
5/30 at 5:30pm | Emeryville
HIKE AND SNACKS AT LAKE CHABOT
6/1 at 10am | Lake Chabot
COMMUNITY HEALTH COMMITTEE
6/13 at 6:30 pm | Virtual
HEALTH EQUITY COMMITTEE
6/20 at 6:30 pm | Virtual
MEDICAL SERVICES, TECHNOLOGY, AND QUALITY OF CARE COMMITTEE
6/25 at 6:00 pm | Virtual
ADVISORY COMMITTEE ON PHYSICIAN WELLBEING
6/27 at 6:00 pm | Virtual
LINDSAY WILDLIFE EXPERIENCE
6/29 at 1pm | Walnut Creek
ACCMA GOES TO THE BALLPARK: OAKLAND A’S VS. LA ANGELS
7/2 at 6:40pm | Oakland Coliseum
MEDICAL GROUP ADVOCACY SYMPOSIUM
8/8 at 8am | Convention Center, Sacramento
