CMA Council on Legislation Report –March 11 2021

Report: CMA Council on Legislation

By Dr. John Lam, CUA Pres-Elect & Rep to CMA

The following is a comprehensive summary of the CMA Council on Legislation meeting held  on March 11.

BELOW ARE 2 CRITICALLY IMPORTANT UROLOGY BILLS:
SB 225 & AB 1520 – PLEASE SCROLL DOWN TO REVIEW.

 

Dear Members and Colleagues

The California Medical Association (CMA) Council on Legislation chaired by Drs. Valencia Walker and Kelly McCue was held remotely via Zoom on March 11, 2021. Dr. John Lam represented the California Urological Association (CUA) as well as Dr. Peter Bretan, CMA President, were present as voting members to the Council. In addition, Dr. Robert Lurvey was present for the meeting.

The meeting started off with Yvonne Choong, Vice President for the Center for Health Policy at the CMA, giving a review of CMA policy on two topics, cost and affordability and single payer.

CMA House of Delegates deliberated on Health Care Affordability as a Major Issue topic with 4 major areas for reform in October 2018:

  • Addressing Utilization Through Improved Care Delivery
    • Care Delivery and Payment Reforms
    • Social Determinants of Health
    • Telehealth

 

  • Enhancing Competitiveness of the Healthcare Market
    • Reduced Competition among Plans and Insurers
    • Increased Hospital Market Concentration and Health Care Affordability
    • Achieving Integration without Increasing Consolidation

 

  • Reducing Administrative Burdens on Physician Practices
    • Credentialing
    • Eligibility and Billing
    • Prior Authorization
    • Quality Measurement and Reporting
    • Medical Records

 

  • Addressing Increasing Pharmaceutical Costs
    • Transparency – drug price setting, prices negotiated, formulary development
    • Pharmacy Benefit Manager (PBM) activities
    • Drug procurement efforts by the Department of General Services (DGS)
    • Enforcement of California’s Unfair Competition Law
    • Pharmaceutical manufacturers list prices and price increases
    • Market competition
    • Prescriber tools
    • 340B program
    • Price negotiations in the Medicaid Drug Rebate Program

Single Payer:
In 2018, Assembly Bill 3087 (Kaira) was introduced which would have established an untested and incomplete health care rate setting system in California. The bill would have established a government-run commission with eleven political appointees to set the prices that health providers (doctors, hospitals, optometrists, etc.) can charge for services in the commercial market. The bill would have based providers’ pricing off a percent of Medicare rates.

Governor Newsom released a proposed 2020-2021 state budget which included a proposal to create a new Office of Health Care Affordability in January 2020. This office would be charged with increasing price and quality transparency, developing specific strategies and cost targets for the different sectors of the health care industry, and financial consequences for entities that fail to meet these targets. In January 2021, Governor Newsome released a proposed 2021-2022 state budget which included a proposal to create a new Office of Health Care Affordability and Department of Health Care Affordability and Infrastructure.

CMA House of Delegates deliberated on Single Payer and Public Option as a Major Issue topic in October 2017, and adopted single payer/public option policy (MI-1B-17).

CMA will only consider a single-payer health care financing and delivery proposal, if the following elements, at a minimum, are in place:

  • Appropriations for the single-payer system shall not be subject to limitations, and an adequate level of funding (with appropriate inflation adjustments) should be guaranteed. There must be a clear path to ongoing financial support and viability;
  • Physicians must be provided a means to ensure payment through usual and customary charges as defined by the Gould criteria whether delivered downstream through fee-for-service, capitation, or other payment options;
  • Pluralistic payment options for all types of physician practices must be retained and physicians must maintain the choice of how to organized their practice;
  • Physicians must be permitted to collectively negotiate;
  • Benefit/coverage design decisions should be made by a scientific, apolitical body comprised primarily of physicians and updated in a timely fashion based on current information.
  • There should be basic benefit/coverage package outlined in the law that is developed with significant input from practicing physicians. These benefits should include, at a minimum, reproductive health, maternity, mental health, substance use disorder prevention and treatment, and preventive health services. Pharmaceutical services should be included. Appeals of adverse coverage decisions should be adjudicated by an independent medical review processed by practicing physicians of like specialty:
    • Patients are allowed to purchase supplemental coverage in addition to the “single” plan;
    • Access to care must be protected by ensuring there are mechanisms in place to address physician training, workforce shortages, capital investment, and infrastructure building;
    • Co-payments that promote effective care and appropriate utilization should be considered Co-payments should be a sliding-scale and waived for low-income individuals. Cost-sharing should not be applied to primary and preventative care;

SB 562 (Lara & Atkins, 2017) would have created the Healthy California Program to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit off all residents of the state. Failed in the Assembly. In October 2019, CMA formed Technical Advisory Committee to help guide CMA’s advocacy and efforts as they relate to the Healthy California for All Commission. In December 2019, state formed Healthy California for All Commission.

 

The following are two bills pending in the California State Legislature that are of specific interest to the California Urological Association:

 

SB 225 (Wiener)
Medical procedures: individuals born with variations in their physical sex characteristics.

NOTE: TIME SENSITIVE!!
THIS BILL IS GOING TO COMMITTEE ON APRIL 5 – CLICK HERE TO READ BILL
SEE BELOW HOW TO TAKE ACTION

Under existing law, the Medical Practice Act, certain procedures or treatments constitute unprofessional conduct, including, among others, the prescribing, dispensing, administering, or furnishing of liquid silicone for the purpose of injecting it into a human breast or mammary. Any violation of the law relating to enforcement of the Medical Practice Act is a misdemeanor, as specified. This bill would prohibit a physician and surgeon from performing certain sex organ modification procedures on an individual born with variations in their physical sex characteristics who is under 12 years of age unless the procedure is a surgery required to address an immediate risk of physical harm, as specified. The bill would make any violation of these provisions subject to disciplinary action by the board, but not criminal prosecution.

An Oppose Unless Amended position is recommended. SB 225 is similar to SB 201 from 2019 which deals with surgical delays for those born with differences in sexual development (DSD) or born intersex, defined broadly by the bill. SB 225 would prohibit a physician from performing certain procedures specific to the DSD community until the patient has reached the age of 12, unless the surgery is required to address and immediate risk of physical harm, as define in the bill. CMA should seek amendments that would modify the definition of DSD or those born with variations in physical sex characteristics, to only include the medical diagnoses of those born with DSD as determined by a physician working group. Additionally, CMA should seek amendments that would require a standardized consent form for all patients that require treatment. The consent form would ensure that all patients receive the same information about their diagnosis as anyone else in the state would. Any additional amendments should be synonymous with this goal of standardized information, consent, and practice across the state, this includes ensuring that treatments or procedures are done in facilities that can provide the patient with a multidisciplinary care support care team to help answer any questions.

SB 225 is a blatant attempt to legislate the practice of medicine and potentially endangers the physical and emotional health and future of the patient. The complex cases that arise from DSD births require individualized attention and must be evaluated by a multidisciplinary team on a case-by-case basis. This bill sets a one-size-fits-all approach to the treatment of a child born with DSD.

Ask: Change to Oppose position
Council voted: CMA position of Oppose unless Amended was upheld

Although we were not able get the Council to change their position to a straight Oppose position, this bill is still ultimately opposed by CMA. The proposed amendment to have a physician working group determine the diagnoses of DSD may allow for carve-outs of diagnoses such as Congenital Adrenal Hyperplasia or hypospadias. Senator Weiner has not been very flexible on amending previous versions of this bill so this would ultimately lead to CMA outright opposing this bill.

 

HOW TO TAKE ACTION – SB 225

Written comments or testimony can be provided directly to the Business & Professions committees by emailing the committee and For public comment and testimony, using the teleconference system, please refer to the committee website for the toll free number.

https://sbp.senate.ca.gov/

Click here for more info: https://cuanet.org/sb225/

Telephonic participation in committees is available during hearings by calling in during the public comment period. As is our normal practice, public comment will be accepted at the conclusion of each bill presentation.

To watch the livestream of the proceeding visit: www.senate.ca.gov

To listen only, but not testify, for this hearing in the Senate Chamber, please dial 1-888-251-2909 and use Access Code 7362831.

Teleconference Quick Tips

  1. Call the toll free number and enter the access code
  2. You will enter the ‘waiting room’ where you can listen but will be muted
  3. Mute the device you are watching the hearing on
  4. Listen to the hearing using the phone
  5. When prompted for your position dial 1-0 (one time only)
  6. Be patient and an operator will give you a line number, there can be a short wait
  7. Once you receive your line number, you are now in the queue
  8. Wait in the queue, the moderator will call your line number and unmute you
  9. You are now ready to address the committee

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AB 1520 is CUA SPONSORED LEGISLATION

AB 1520 (Levine)
Health care coverage: prostate cancer: screening.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires individual and group health care service plan contracts and health insurance policies to provide coverage for the screening and diagnosis of prostate cancer, when medically necessary and consistent with good professional practice. Existing law specifies that it does not prevent the application of deductible or copayment provisions for those services. Existing law requires an individual or small group health care service plan contract or health insurance policy to, at a minimum, include coverage for essential health benefits, which include preventive services, pursuant to the federal Patient Protection and Affordable Care Act.This bill would prohibit a health care service plan or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2022, from applying a deductible, copyament, or coinsurance to coverage for preventive care screening services for prostate cancer for an enrolled or insured who is 55 years of age or older or is 40 years of age or older and is high risk, as defined. This bill contains other related provisions and other existing laws.

A Support if Amended position is recommended. AB 1520 would prohibit a health plan or insurer from applying any patient cost-sharing to coverage for preventative prostate screenings for patients who meet specific criteria, including that the patient is “high risk.” CMA should seek an amendment that edits the definition of “high risk” to include if the attending/treating physician deems the patient high risk. This is to address the concern that screening services will be provided by the physician, however, the plan will deem the patient not high risk and require patient cost-sharing or not pay the physician for the service. This addition will provide the physician with the recourse necessary to counter that behavior. This position is consistent with CMA policy (407-99), which states that CMA continue to support legislation that would require medical necessity determinations be made by a clinical peer, and that “clinical peer” is defined as a physician in the same or similar specialty as typically manages the medical condition, procedure or treatment being reviewed. This position is also consistent with CMA policy MI-1B-17, which states “Co- payments that promote effective care and appropriate utilization should be considered. Co-payments should be on a sliding-scale and waived for low-income individuals. Cost-sharing should not be applied to primary and preventive care”This position is also consistent with CMA policy (515-96) which states that CMA 1) affirms as policy that health plans and insurance companies should provide coverage for all appropriate and necessary medical care. 2) CMA reaffirms as policy that the physician, not the health plan or insurance company, shall have ultimate authority in determining the necessity and appropriateness of medical diagnostics and therapy.

This bill was not extracted and therefore CMA’s position remains Support if Amended. We found this to be acceptable as the amendment being sought is that it edits the definition of “high-risk” to include that as determined by an attending/treating physician, which is address the concern that a plan will deem a patient not high-risk and require cost-sharing or not pay the physician for the service.

__________________________

 

Assembly Consent Calendar was approved minus extractions.
Extracted Assembly Bills:
AB 399 (Salas) – Workers’compensation.
Ask: Change to Support if Amended position
Council voted: CMA position of Watch was moved to Support if Amended

AB 412 (Reyes) – California Commission on Human Rights.
Ask: Change to Support if Amended position
Council voted: CMA position of Support was moved to Support if Amended

AB 552 (Quirk-Silva) – Integrated School-Based Behavioral Health Partnership Program.
Ask: Change to Support if Amended position
Council voted: CMA position of Support was moved to Support if Amended

AB 615 (Rodriguez) – Higher Education Employer-Employee Relations Act: procedures relating to employee termination or discipline.
Ask: Change to Support position
Council voted: CMA position of Watch was moved to Support

AB 653 (Waldron) – Medication-Assisted Treatment Grant Program.
Ask: Change to Support position
Council voted: CMA position of Watch was moved to Support

AB 797 (Wicks) – Health care coverage: treatment for infertility.
This bill would require every health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 2022, to provide coverage for the treatment of infertility. The bill would revise the definition of infertility, and would remove the exclusion of in vitro fertilization from coverage. The bill would delete the exemption for religiously affiliated employers, health care service plans, and health insurance policies, from the requirements relating to coverage for the treatment of infertility, thereby imposing these requirements on these employers, plans, and policies. The bill would also delete the requirement that a health care service plan contract and health insurance policy provide infertility treatment under agreed-upon terms that are communicated to all group contract holders and prospective group contract holders. Because the violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. This bill contains other related provisions and other existing laws.
Ask: Change to Watch position
Council voted: CMA position of Support if Amended was moved to Watch

AB 1131 (Wood) – Health information exchange.
Ask: Change to Support position
Council voted: CMA position of Oppose Unless Amended was upheld

AB 1204 (Wicks) – Hospital equity reporting.
Ask: Change to Watch position
Council voted: CMA position of Support was moved to Watch

AB 1465 (Reyes) – Workers’compensation: medical treatment.
Ask: Change to Oppose position
Council voted: CMA position of Watch was upheld

AB 1468 (Cunningham) – Prior authorization.
Ask: Change to Support if Amended position
Council voted: CMA position of Support was moved to Support if Amended

Senate Consent Calendar was approved minus extractions.
Extracted Senate Bills:
SB 221 (Wiener) – Health care coverage: timely access to care.
Ask: Change to Support if Amended position
Council voted: CMA position of Watch was upheld

SB 379 (Wiener) – University of California: contracts: health facilities.
Ask: Change to Oppose unless Amended position
Council voted: CMA position of Oppose was upheld

SB 492 (Hurtado) – Pregnancy-related death: data.
Ask: Change to Oppose position
Council voted: CMA position of Oppose unless Amended was moved to Oppose

SB 613 (Limon) – Maternal health: neonate medical wrap.
Ask: Change to Oppose position
Council voted: CMA position of Oppose unless Amended was moved to Oppose

SB 652 (Bates) – Dentistry: use of sedation: training.
Ask: Change to Watch position
Council voted: CMA position of Watch was moved to Oppose unless Amended

Respectfully submitted, John S. Lam, MD, MBA, FACS

MANY THANKS TO DR. JOHN LAM FOR HIS DILIGENCE AND TIME IN PROVIDING THIS EXCELLENT SYNOPSIS.