MEMBERSHIP MATTERS

CMA Hosts Budgetary Breakthrough for Healthcare

“ Major players in California’s health care field have reached a deal on how they want the state to spend $19 billion in proceeds of a renewed tax on insurance plans plus the federal funds that go with it — a development that followed months of private negotiations. It’s a massive victory… They did it by meeting for two hours each week since November, debating spending details at the headquarters of the California Medical Association over lunch, where they filled the conference room whiteboards with calculations. Dustin Corcoran, the CEO of the medical association who chairs the coalition, said he’s even had dreams about the tax. “There was a lot of sausage making,” Corcoran said. “It’s not always pleasant or fun, but we landed in a spot we can be really proud of.”

The deal includes money to bolster struggling hospitals, ease workforce shortages and entice more specialists to see Medi-Cal patients. Three specialties will get a boost to their reimbursement rates: Primary care, OBGYN and some mental health care services will start being paid 87.5 percent of what the federal government pays them through Medicare. And $75 million will be used to create new residency slots for medical school graduates.

– Politico, June 24. Full story: https://www.politico.com/news/2023/06/24/ california-strikes-huge-deal-unlocking-billions-for-health-care-00103476

Governor Gavin Newsom released his revised 2023-24 state budget, proposing the reinstatement of the Managed Care Organization (MCO) Tax, which will result in $19.4 billion in revenue from April 1, 2023, through December 31, 2026, to help maintain and increase investment in the Medi-Cal program.

Over the past several months, the California Medical Association (CMA) has advocated to reinstate and increase the MCO tax, which expired late last year, to improve Medi-Cal access to care by raising physician reimbursement rates.

In a win for physicians and patients, the budget proposal released includes an increase to some Medi-Cal provider rates for the first time in more than two decades. Effective January 1, 2024, the budget proposal would increase provider rates to at least 87.5% of Medicare for primary care, maternity care and non-specialty mental health services. Starting in the 2024-25 budget year, the provider rate increases would be expanded to some additional health care services and specialists.

The rate increase announced is due in part to the proposed elimination of the 10% Medi-Cal provider cuts authorized as part of the health services trailer bill (AB 97) to the 2011-12 state budget, which CMA has long advocated to undo. CMA had filed a lawsuit in federal court (CMA et al. v. Douglas) to stop the cuts, but ultimately a three-judge panel of the 9th Circuit Court of Appeals court ruled in 2013 that the state could move forward with the rate cuts.

Despite the disappointing 9th Circuit ruling, CMA never stopped advocating for a reversal of these cuts, which have had devastating effects on access to care for California’s poorest and most vulnerable patients.

“The provider reimbursement rate cuts from 2011 have had a detrimental impact on patient access to care for more than a decade and I am very happy to see the Governor’s May revised budget, which will help us achieve justice and equity in access to care for Medi-Cal patients,” said CMA President Donaldo Hernandez, M.D. “It is more important than ever to address the underfunding of the Medi-Cal system that makes it difficult for many patients to get access to primary and specialty care when they need it.”

Gov. Newsom’s newly proposed rate increases will be an adjustment to base rates, and the California Department of Health Care Services has indicated it will direct managed care plans to pay providers at least these rates.

The rate increases will be paid for by Gov. Newsom’s updated plan to tax managed care organizations. In his May budget proposal, Gov. Newsom announced a commitment to invest additional funds in the Medi-Cal program to improve access and equity. The MCO tax, which allows the state to receive federal matching funds, had been in place for more than a decade and expired in December 2022.

“There is much more to be done,” said Dr. Hernandez. “CMA looks forward to working with the Administration and the Legislature in the coming weeks to seize this rare opportunity to make meaningful change in the lives of Californians by making timely access to health care a reality for all.” See more on page 29.

Free CME: Do Your Patients Know About ACEs? Join ACEs Performance Improvement Project

Adverse Childhood Experiences (or ACEs) are associated with some of the most common, serious, and intractable health conditions facing our patients. This performance improvement project is designed to improve patient and physician awareness on ACEs and toxic stress, and to study the impact of educational materials on patients’ understanding of ACEs and its health impacts.

Participating physicians will survey ten patients, distribute two educational flyers, survey ten more patients, analyze survey data, and reflect on resulting practice improvement. For information, see https://www.cmadocs.org/aces.

New DEA Education Requirement on Substance Use Disorders

The DEA has released guidance on the new one-time requirement for eight hours of training on the treatment and management of patients with opioid or other substance use disorders.

See the official DEA letter to registered practitioners for more details and SAMHSA for additional guidance and recommendations for core elements of the required training.

CSAM members should know they likely have already met the requirements. You do not have to complete this training if you:

• Hold Board Certification in addiction medicine or addiction psychiatry through the American Board of Medical Specialties, American Board of Addiction Medicine, or American Osteopathic Association

• Previously completed the DATA-2000 Waiver training to prescribe buprenorphine for opioid use disorder (aka X-Waiver)

• Completed education (8 cumulative hours), prior to December

29, 2022, related to the treatment and management of patients with opioid or other substance use disorders from accredited groups named in the guidance document

• Graduated in good standing from a medical (allopathic or osteopathic), dental, physician assistant, or advanced practice nursing school in the United States within five years of June 27, 2023, and successfully completed a comprehensive curriculum that included at least eight hours of training on the treatment and management of patients with opioid or other substance use disorders, including the appropriate clinical use of all drugs approved by the Food and Drug Administration for the treatment of a substance use disorder

For those that need training, CSAM has a new collection in its online education center that will help satisfy the requirements: https://cme.csam-asam.org/

Reminder: Medical board will no longer accept paper applications after June 1

Effective June 1, 2023, the Medical Board of California will no longer accept or process paper-based applications for a Physician’s and Surgeon’s (P&S) License. The paper application was removed from the medical board’s website on May 19. Except under limited circumstances, paper applications submitted on or after June 1 will not be processed.

Sfmms Meets With Elected Leaders

April/May/June 2023

Volume 96, Number 2

Editor Gordon L. Fung, MD, PhD, FACC, FACP

Managing Editor Steve Heilig, MPH

Production Maureen Erwin

SFMMS OFFICERS

President Heyman Oo, MD, MPH

President-elect Dennis Song , MD, DDS

Secretary Sarita Satpathy, MD

Treasurer Jason Nau, MD

Immediate Past President Michael Schrader, MD

SFMMS STAFF

Executive Director

Conrad Amenta

Associate Executive Director, Public Health and Education

Steve Heilig, MPH

Director of Operations and Governance

Ian Knox

Director of Engagement

Molly Baldridge, MPH

Senior Director, Advocacy and Policy

Adam Francis

2023 SFMMS BOARD OF DIRECTORS

Edward Alfrey, MD

Melinda Aquino, MD

Ayanna Bennett, MD

Julie Bokser, MD

Kristina Casadei, MD

Clifford Chew, MD

Esme Cullen, MD

Manal Elkarra, MD

Mihal Emberton, MD

Cindy Greenberg, MD

Gordon L. Fung - MD, Editor

Beth Griffiths, MD

Ian McLachlan, MD

Jason Nau, MD, Treasurer

Heyman Oo, MD, President

Sarita Satpathy, MD, Secretary

Michael Schrader, MD, Immediate Past-President

Yalda Shahram, MD

Neeru Singh, MD

Dennis Song, MD, DDS, President-Elect

Kristen Swann, MD

Kenneth Tai, MD

Melanie Thompson, MD

Matthew D. Willis, MD

Kristen Wong, MD

Andrea Yeung, MD

Helen Yu, MD

For questions regarding journal, including possible submissions, contact Steve Heilig: Heilig@sfmms.org

Additionally, SFMMS has met with SF Supervisors Aaron Peskin and Rafael Mandelman, as well as Marin County Supervisor Eric Lucan. SFMMS plans to meet with all SF and Marin County Supervisors in the coming weeks to discuss emerging health issues and build relationships for future advocacy efforts.