Legislative Alert: Urge Senator Leno to Oppose AB 533 September 4, 2015 Advocacy, CMA AB 533, health plan, legislative alert, network coverage 0 CMA is urging all SFMS members to contact Senator Mark Leno to urge a NO vote on AB 533. AB 533 was introduced by Assemblymember Bonta to prevent consumers from receiving surprise bills when the consumer seeks care at an in network facility. While CMA shares the same goal, the solution as envisioned by AB 533 would cause major problems to the health care delivery system much more significant than those it aims to solve. AB 533 would drastically change the current health care marketplace by transferring negotiating power to the health plans at the expense of physicians. The bill would require non-contracted physicians/providers to accept the “average contracted rate”—as determined by the health plan—when performing services in a contracted or “in-network” facility. In so doing, AB 533 would eliminate incentives for health plans to provide fair contract terms to physicians. AB 533 would also discourage hospital-based and on-call specialists from accepting PPO patients. SFMS/CMA is working with the California Society of Anesthesiologists, American College of Emergency Physicians, California Society of Plastic Surgeons, American College of Cardiology, California Society of Pathologists, California Radiological Society, and the California Orthopedic Association to derail this bill. We anticipate the bill to be heard early next week, however it is eligible to be considered on the Senate floor at this moment. Please join in on the advocacy effort and contact Senator Leno’s office. Additional bill information and talking points are included below. Senator Mark Leno (916) 651-4011 Senator.leno@senate.ca.gov Click here to send a letter or email to Senator Leno (login required). Talking Points In its current form, AB 533 drastically changes the current health care marketplace by transferring negotiating power to the health plans at the expense of physicians. This entire bill is based upon the “average contracted rate,” as defined by the plans, with no opportunity for the physician to verify such data. Inadequate networks will further be encouraged because the hospital-based specialists that are the focus of the bill are not captured in the state’s current network adequacy or timely access standards. The use of an “average contracted rate” means that what rate the Health Plan negotiates with physicians will have a direct impact on what the plan is obligated to pay non-contracting physicians. This incentivizes health plans to drive down contracted rates and carry narrower networks, because AB 533 creates a structure that places all the negotiating power in the hands of the plan and creates no punishment for health plans that carry inadequate networks. Comments are closed.
