By Wesley G. Bradford, MD, MPH
Health care reform implementation is finally here, and your academy has got you covered with all the latest news and helpful FAQs! The hot topic of the past few months is Covered California, the website run by the state where your patients can shop for competitively-priced health plans on a health insurance exchange. CAFP has a webpage completely dedicated to providing resources to family physicians and their patients.
Other significant aspects of the Affordable Care Act also went into place on January 1, 2014: patients can no longer be dropped by health plans when they get sick, plans cannot denied enrollment because of a pre-existing condition, and young adults can remain on their parents’ health plan until age 26. Subsidies are available for lower-income individuals and small businesses to purchase health coverage.
The Medi-Cal expansion will add 1-2 million newly eligible individuals, including more than 643,000 transitioned from the Low Income Health Program which has now ended. Adult dental, chiropractic and podiatric services are available to Medi-Cal members when provided by a federally qualified health center or rural health clinic (limited to two visits/month for chiropractic and podiatric services). The Coordinated Care Initiative (CCI) will move 456,000 dual-eligible (Medicare-Medi-Cal) patients, Medi-
Cal-only seniors and persons with disabilities into Medi-Cal managed care in 8 counties including Los Angeles by about April.
Healthy Families children have also been moved into Medi-Cal managed care (see DHCS website information on network adequacy assessments and monitoring reports). Medi-Cal beneficiaries will have expanded mental health benefits, including for substance use disorders.
Increased demand for primary care physicians and decreased misuse of emergency departments are expected. That is why it is more important than ever that we increase financial support for primary care residency programs to increase the number of slots in California. The Academy will sponsor legislation this year to do just that.
The other necessary action to ensure access to primary care is to appropriately value primary care services. The Academy has had some great victories on this front, but believes more should be done.
First, the Pathway for SGR Reform Act was signed into law, preventing a scheduled 24 percent Medicare payment reduction from taking effect in 2014. A 0.5% payment increase will be in effect through March 31 while federal legislators work toward a long term solution. A bipartisan plan is gaining steam in Congress that would shift payment to reward coordinated care, such as the Patient Centered Medical Home (PCMH). PCMH resources are available on CAFP’s website here, including tools to help you transform your practice. CAFP also has EHR Implementation Tools and information on the Medicare EHR Incentive Program available here.
Second, Medicaid payment rates have been increased to Medicare levels for primary care services (for two years, retroactive to January 1, 2013). Family physicians who participate in Medi-Cal must visit DHCS’s attestation portal and complete the downloadable form to attest that they are eligible.
CAFP’s legislative efforts this year will include making that primary care payment increase permanent and fighting to reverse the Medi-Cal cuts that went into effect recently after a lengthy court battle. CAFP is optimistic that this can be achieved due to the greatly improved economic forecast for California.
If you’d like to be involved in family medicine advocacy efforts, please contact Adam Francis at CAFP.
