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Volume 2, Issue 44 - November 4, 2022

AB 890 / Nurse Practitioner Regulations 

The AB 890 regulations have now moved to the full Board of Registered Nursing (BRN). California Business and Professions Code (BPC) Section 2837.105 requested that the Office of Professional Examination Services (OPES) complete an occupational analysis by January 1, 2023. This analysis has been completed and is located here. Under the section titled “Nurse Practitioner-Specific Reports” you can find the Occupational Analysis of the Nurse Practitioner Practice and Practice Specialties and seven (7) reports that review various national certification examinations for Nurse Practitioners.
SYASL's notes from this meeting are here. CSAP's letter to the BRN is here. The BRN Board meeting on November 14-15th during which the proposed regulations will be discussed again, which will most likely be an opportunity for public comment if any of you are interested. The agenda is here, the item is 6.1.

Notice of Proposed Regulatory Action 
Initial Statement of Reasons
Proposed Language


Here's an anonymized story printed here with the sender's permission. Sound familiar?

"Our group has always been insurance friendly, with contracts with nearly all of the major payors. Anthem is our largest payor. We have been a contracted provider, probably for at least 15-20 years.  They have never previously raised any issues about our care, or anything else.  But last year, they informed us that they were putting our group on “prepayment review,” in which they required that we send in medical records with every single claim.  They provided us with a portal for uploading records.  However, this portal was faulty, and eventually we had to instead print out and mail the records to them.  We literally wore out a fax machine and printer and had to hire additional billing staff to accommodate their demands.

Despite our sending in these records, they continued to deny essentially all our claims.  At the peak, we had over 10,000 outstanding Anthem claims, representing approximately $4 million in claims.  This naturally created significant financial issues for us, threatening to put us out of business.  We have had at least two of our psychiatrists leave the group due to this issue. A major primary care group was no longer able to refer to us, despite their very positive regard for clinical care. 

Among other issues, Anthem rejected many of our claims because they said that we were not documenting the “start and stop times” for add-on psychotherapy. As I believe you are aware, most psychiatrists bill for a combination of an Evaluation and Management service plus add-on psychotherapy.  Anthem, however, created a policy in which they required that we document a start and start time for the psychotherapy portion of the visit.  However, this was a fabrication.  The coding requirements do not require such documentation, and in fact do not require that the psychotherapy even be a discrete portion of the visit. 

To confirm our position, we spoke with Becky Howell from the APA’s practice management service. Becky strongly supported our position, which was supported by the very physicians who developed the coding requirements.  

Earlier this year, we started fighting back more forcefully.  For many months, Anthem refused even to sit down with us or even discuss the issues. Eventually, at considerable expense, we hired an attorney. Largely through his connections from suing Anthem on multiple prior occasions, he was finally able to get their attention. They agreed to meet with us, although maintained that their made-up policies were valid. However, over the course of a couple of such meetings, they suddenly conceded that we were right.  Actually, no, they never conceded we were right – they still insisted that their policies were correct but that they were making us concessions so that we would not have to document start and stop times for psychotherapy. Up until now, we assumed that the pressure from our attorney and from the APA was responsible for their change of heart, but maybe your efforts with the DMHC were what did it. 

About three months ago, they took us off prepayment review, a major relief. They are now paying most of our claims.  However, they still owe us quite a bit of money for the previously denied claims (which have been resubmitted up to eleven times).  There are currently still over 9,000 outstanding unpaid claims. We are working with our attorney now to try to negotiate a settlement with them for those claims. We have been told that this kind of practice is a standard operating procedure for Anthem and other healthcare insurers.  Although they are liable for interest penalties under the Know-Keane Act, they know that we cannot reclaim anywhere near as much as they denied.  We will no doubt have to settle the outstanding claims for somewhat less then full value. 

We understand now that other psychiatric groups have been similarly harassed. We would love to be put in touch with them. Also, we would be happy to work with any governmental entities – regulatory agencies, legislative staffs, etc."

If you want to be added to the list of doctors and physician groups who SYASL is connecting with the DMHC, email Paul Yoder. This is a fight, more fighters are welcome. CSAP doesn't endorse business, services, or products; however, if you want the name of a legal firm that might be able to help you and/or your practice, email Paul Yoder.

Governor Throws Down on Homelessness

Governor Newsom announced he rejected every local homeless action plan in the state. He is demanding more intensity when it comes to getting people off the streets and into homes. The Governor will hold the remaining funding for the third round of Homelessness Housing, Assistance and Prevention (HHAP) grants until further notice. Also, in a letter addressed to local leaders the Newsom administration stated they will convene a meeting on November 18, 2022, in order to discuss possible additional solutions to reducing homelessness. County Board Chairs will be invited in addition to Big City Mayors. 

It is our understanding that funding could be released sometime soon after 11/18, and that there won’t necessarily be a new formal process for this, but it may depend instead on how the discussion goes, i.e., “is the intensity manifest” as the Governor might say.

“Californians demand accountability and results, not settling for the status quo,” Governor Newsom said in a statement. “At this pace, it would take decades to significantly curb homelessness in California.”

This has caused quite a stir around the State. More to come next week.

CARE Court

As advertised, Senator Cortese held a virtual Town Hall on Thursday, November 3rd to discuss "CARE Court: A State Initiative to Address our Mental Health Crisis".

Judge Stephen Manley from the Superior Court of Santa Clara County was there. So was Uday Kapoor from the National Alliance on Mental Illness (NAMI). NAMI provided an overview of the legislation and Judge Manley discussed the role that courts will serve under this program. 

You can view SYASL's notes from this event here.

Riverside County (one of the first counties that must implement CARE Court) has put together a flow chart for how they see the program working upon implementation. You may view it here.

Homelessness Youth in San Bernardino County

The Assembly Select Comittee in Youth Homelessness in San Bernardino County held an inforational hearing: Engaging Youth to Drive the Development and Implementation of Homeless Services. The Committee discussed the status of youth in San Bernardino County, how youth are incorporated into the process, and expanding partnerships to address homeless youth. You may view the agenda here and SYASL staff notes from the hearing here 

APA / Federal Update 

APA News 
  • 79% of Americans view mental health as a public health emergency that merits attention from lawmakers, according to the latest Healthy Minds Monthly Poll from APA in association with Morning Consult. Nearly three quarters (71%) of those polled said they would vote for a candidate who promised to invest in mental health. Furthermore, 80% of those polled said they viewed the state of children’s mental health as a public health emergency. You can read more about Americans’ views on the state of mental health in our country, and see the full poll results here.
  • Around three-quarters of Americans believe that people incarcerated in prison or jail should have access to high-quality mental health care according to the Healthy Minds Monthly poll commissioned by APA and conducted by Morning Consult of 2,111 adults between Sep. 30 and Oct. 2, 2022. Americans are aware of the high prevalence of mental illness in our nation’s prisons and jails, but only one in five (20%) believe that those incarcerated are receiving the care they need. You can read more about Americans’ opinions on criminal justice and mental health here.
  • November Course of the Month – Advocacy for Anti-Racist Policies That Expand Equitable Access to Mental Health Care: The Role of the Psychiatrist
    This course aims to embolden participants in their paths to becoming clinician advocates – providing practical skill building on best advocacy practices, including tackling parity with an equity lens, actively working to recruit leadership and practitioners that represent the surrounding communities, expanding access to culturally-centered care, and more. Examples of effective actions individuals can take to support policy change, as well as resources available will be discussed.
     Click here to access the Course of the Month and sign up for updates about this free member benefit.
APA Assembly 

The Assembly will be meeting virtually November 5-6, 2022. DB/SA Executive Directors may attend virtually as guests of the Assembly. Please note that only members of the Assembly may address the Assembly, so guests are asked to mute their lines and turn off video.

Meeting Materials:
  1. Assembly Agenda 
  2. Assembly Schedule
  3. Assembly Meeting Booklet
  4. Report of Reference Committee #1:  Advancing Psychiatric Care
  5. Report of Reference Committee #2:  Advancing Psychiatric Knowledge and Research
  6. Report of Reference Committee #3:  Education and Lifelong Learning
  7. Report of Reference Committee #4:  Diversity and Health Disparities
  8. Report of Reference Committee #5:  Membership and Organization
  9. Assembly Action Papers (Original action papers, including APA Administration cost estimates and feedback)
CMA Update

Urge Congress to stop the Medicare payment cuts

Physicians are facing another round of Medicare payment cuts. Unless Congress acts by the end of the year, physicians face more than 8.42% in Medicare payment cuts in 2023 due to a confluence of statutory and budget neutrality payment cuts. 

If these cuts are allowed to take effect, these cuts will severely impede patient access to care due to the forced closure of physician practices and put further strain on those that remained open during the pandemic.

The California Medical Association (CMA) is asking all physicians to urge their Senators and Representatives to protect the nation’s Medicare patients by stopping the cuts.

Webinar on health care worker retention bonus application process

Earlier this year, the California Medical Association (CMA) worked with the Governor and legislature to secure $1.3 billion in the state budget to provide retention bonuses for California’s physicians and other health care providers. The retention bonuses, of up to $1,000, will be available to employees of hospitals, clinics that are 1206(l)s and affiliated with a hospital, or skilled nursing facilities and physicians who provide patient care in those facilities during the eligibility period, which ran from July 30 to October 28, 2022.  

The California Department of Health Care Services (DHCS) will be administering the health care worker retention bonus payments. DHCS has created a two-step process to receive a retention bonus.

In the first step, qualifying independent/solo physicians will need to register with DHCS. If you are a physician employed by a medical group or other eligible health care facility, your employer is required to apply on your behalf; therefore, you should not register/apply on your own. Contact your employer for more information. 

The registration portal is now open. The deadline to register is December 21, 2022, but we encourage you to do so as soon as possible to minimize delays.

In the second step, the application portal will open on November 29, 2022, and all requests for payment must be submitted by December 30, 2022. DHCS anticipates issuing payments in January 2023. 

Questions? CMA will be hosting a webinar on November 17, 2022, where DHCS staff will  provide an overview of and answer questions about eligibility and the registration/application process. You can see additional details and register here.

For more details on the process and what information is required,click here.  

Voting - a Powerful Tool to Achieve Health Equity

Compelling op-ed by two pediatricians - "Policy matters at all levels"

"As pediatricians, we cannot treat children equitably unless we fight to dismantle the systems of oppression and systemic racism that lead to disparities. The policies that govern our communities and health care system often make it impossible to provide the care that our patients deserve. On Nov. 8, we have the power to move our communities closer to health equity or continue to widen the gap." Read more

Looking to 2023

Race for Speakership drives tensions in Assembly races

“While it may be sooner than the Speaker was asking for, or wanted, Robert (Rivas) followed what we believe are the time-honored traditions of the house and was rebuffed,” said Assemblyman Jim Wood (Chairman of the Assembly Health Committee), whose district runs along the coast north of Santa Rosa. “ And that’s disappointing.” Will Jim Wood remain Chairman of Assembly Health if Anthony Rendon is still Speaker on December 5? More on the back story

SYASL Making the Rounds

Gathering Rumors, strategizing, forming alliances wherever possible. Busy week - met with Senator Wiener's staff, talked with the National Union of Healthcare Workers (NUHW) lobbying team, ditto the Steinberg Institute's advocates, and multiple conversations with the Department of Managed Health Care staff to help some of you very specifically with your health plan challenges. Last but certainly not least, the Governor's staff about homelessness and the severely mentally ill. Meeting next week with Stephanie Welch, the Deputy Secretary of Behavioral Health · California Health and Human Services Agency, as well as Senator Eggman's staff.


Worth a Read

CSAP is a cooperative effort between the Central California Psychiatric Society, the Northern California Psychiatric Society, the Orange County Psychiatric Society, the San Diego Psychiatric Society, and the Southern California Psychiatric Society.

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