NEWSLETTER 
Volume 2, Issue 52 - December 30, 2022

Physician practices and medical groups are required to sign a template Data Sharing Agreement (DSA) by January 31, 2023.

Signing the agreement is one of the first steps in complying with California’s new Data Exchange Framework. The goal of the framework is to create a statewide data sharing agreement to expedite and expand the exchange of information among all health and human services organizations throughout the state.

The DSA is meant to serve as a contract between physician practices, hospitals, health plans, and other health care entities stating that they will make data available to one another upon request. The DSA lays out the parameters of that agreement and outlines what information needs to be exchanged, privacy and security standards, and permitted uses of data. 

A new California law that takes effect January 1, 2023, requires California physicians to provide patients with a written or electronic notice about the availability of the federal Open Payments database. It also requires physicians to post in their offices and on their websites a notice informing visitors about the Open Payments database, which can be used to search payments made by drug and medical device companies to physicians, physician assistants, advanced practice nurses and teaching hospitals.

Open Payments Database

Under federal law, drug and medical device manufacturers are required to report their financial interactions with physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” are reported to the Centers for Medicare and Medicaid Services (CMS) for publication in the public Open Payments database.

Open Payments data is published annually by June 30, and physicians are able to preview the data attributed to them during a 45-day, pre-publication review and dispute period that runs from April 1 to May 15. Physicians are encouraged to review the data attributed to them during the review period.

Physicians who believe their data contain discrepancies can initiate a dispute with the reporting entity. This gives the reporting entity an opportunity to correct the information before the data is made public. 

Disputes can be initiated until the end of the calendar year in which the record was submitted, but disputes initiated after the end of the review and dispute period will not be reflected in the initial publication. For more information, visit cms.gov/openpayments.

CSAP Co-Sponsored Legislation

CSAP was worked successfully in 2022 with Senator Eggman and others to get three bills into law. We are in constant communication with her and her staff about a new package of bills in 2023. 

SB 929 - Expands the Department of Health Care Services’ (DHCS) responsibility in current law to collect and publish information about involuntary detentions to include additional information.

SB 1035 - Allows the court to conduct status hearings with a person who is subject to an assisted outpatient treatment (AOT) order and their treatment team to receive information regarding progress and adherence to the treatment plan, including medication adherence. Requires the AOT program director to include specified information when filling an affidavit affirming the person continues to meet the criteria for AOT.

SB 1227 - Permits a second up to 30-days of intensive treatment period under the Lanterman-Petris-Short (LPS) Act for a person who is still in need of intensive services and the certification for an additional up-to 30 days has begun, as specified.

You can view CSAP's end of year bill matrix here. You can view the CMA's end of year bill report here.
 

Parity

Are health plans routinely disregarding SB 855’s mandate to arrange and cover initial and follow-up psychotherapy on an out-of-network basis in the event of network inadequacy? Unfortunately, yes. Is the California Department of Managed Health Care (DMHC) allowing health plans to terminate coverage for ongoing psychotherapy with out-of-network clinicians (initiated due to network inadequacy) when health plans ostensibly identify available network providers after treatment commences, despite the expiration of timely access limits? Also unfortunately, yes. Please rest assured that CSAP and its state legislative advocates are aware of these developments and have been invited by the sponsors of SB 855 (The Kennedy Forum) to meet with the DMHC in January. In the meantime, please forward any such unfortunate events to Paul Yoder.
 

Pharmacy

Thanks to those of you who have forwarded examples of outrageous denials and / or delays on medications at the larger pharmacy chains. Please keep sending any examples you have to Paul Yoder. With legislators and their staffs returning next week on January 3, an intensive education campaign in about to roll out.

Meanwhile, the cost of prescription drugs keeps going up: DMHC Report Shows Prescription Drug Costs Increased by $2.1 Billion Over Five Years.
 

Medicare and Medicaid - What About Medi-Cal?

Last week we recapped recent federal actions regarding Medicare and Medicaid. Many of you asked: is there potentially any hope in California for Medi-Cal rates?

In the short-term, the news is that - due to CalAIM payment reform - all Medi-Cal rates are being updated/increased and provided to counties for negotiation with vendors. They are not public or finalized, particularly by service type, but here is some information.

This may also be of interest to some of you - Webinar: CalAIM Screening and Transition of Care Tools. January 19, 2023, 3:00. This webinar provides an opportunity for stakeholders to learn about the Screening and Transition of Care Tools initiative, which goes live January 1, 2023, as part of California Advancing and Innovating Medi-Cal (CalAIM). The initiative is focused on developing statewide Screening and Transition of Care Tools for both adults and individuals under 21 years old (youth) for use by Medi-Cal Managed Care Plans and County Mental Health Plans. The webinar will include an overview of the purpose of the initiative, a review of final guidance and tools, and responses to frequently asked questions. Advance registration is required. For more information, please visit the Screening & Transition of Care Tools webpage. 

Lastly, CSAP and SYASL are hearing rumblings about a possible statewide initiative going on the November, 2024 ballot. We will keep you posted on any developments in this regard. In the meantime, expect the Governor's proposed 2023-24 State Budget to be austere.

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