Legislation on the Governor's Desk: Weigh in Now! September 22, 2011 Advocacy, CMA CMA advocacy, CMA Priority bills 0 Eight of SFMS/CMA’s priority bills have been sent to Governor Brown awaiting his signature or veto. Now is the time for the Governor to hear from you and your fellow physicians. Contact the Governor’s office today to alert Governor Brown and his staff about what these bills mean for the practice of medicine and the patients of California. How to Contact the Governor’s Office (916) 445-2841http://govnews.ca.gov/gov39mail/mail.phpOn the website, choose the bill number from the drop down menu and express your support or opposition based on the background and talking points below. SB 791 (Simitian) - Health care coverage: Mammograms Oppose This bill requires select women with a higher level of breast density (3 & 4 out of a 1-4 scale, about half of all women) to receive a notice about breast density and its impacts on imaging following completion of a mammogram. Language from this bill was moved from SB 173, which was held on the Assembly Suspense file. Despite ongoing conversations and meetings, the author denied all of CMA’s substantive amendments. As a result, the bill will pose significant costs to public programs such as Medi-Cal and Every Woman Counts. As many of our physicians have testified to in committee and commented to the press, there is no scientific evidence backing the merits of this bill. However well intentioned, we must urge Governor Brown to veto this costly legislation. In addition to the lacking of evidence and cost to the state, SB 791 has significant legal liability implications for physicians. CMA is working with other physician groups to secure a veto of the bill. Because the scope of who must receive the notice is so broad, it will lead thousands—and possibly millions—of women to believe that that their mammograms aren’t protecting them, and that they need expensive additional screenings (breast ultrasound and/or breast MRI) when it isn’t at all warranted, leading to substantial cost increases and unnecessary overuse of an already overburdened healthcare delivery system, causing delays in care and treatment to all patients. Although density is an emerging issue in mammography and the fight against breast cancer, the science is still out on this matter and no definitive protocols have been developed by the industry yet in response to this condition. Mammograms continue to be the gold standard method of detection. AB 210 (Hernandez) – Maternity Services Support This bill would require every group health insurance policy to provide coverage for maternity services for all insureds covered under the policy. This bill would become operative only if SB 222 is also enacted. The economic and social costs of restricting or delaying this access to women are intolerable. These insurance products are barriers to care, and any delay in prenatal care can result in poor outcomes for both the mother and her baby. When a pregnant woman is not insured for maternity coverage, her only option for affordable maternity care is Medi-Cal or AIM. AB 301 (Pan) – Medi-cal, Managed Care Support This bill would extend the existing carve-out for the California Children’s Services (CCS) program from Medi-Cal Managed Care. Children enrolled in the CCS program have some of the most complex and catastrophic of all health conditions, including congenital heart disease, spina-bifida, cancer, cleft palate, premature birth and cystic fibrosis, among others. CCS has maintained the current carve-out for over fifteen years because it is critical that these children have access to the high-quality specialty providers that they need. Forcing them to transition to another coverage model could disrupt their care and have potentially drastic effects on their health outcomes. AB 568 (Skinner) – Treatment of Incarcerated Pregnant Women Support This bill requires that inmates and wards in the custody of the California Department of Corrections and Rehabilitation (CDCR), CDCR's Division of Juvenile Facilities, and local correctional and juvenile facilities, who are known to be pregnant, shall not be shackled by the wrists, ankles, around the abdomen, or to another person, unless deemed necessary for safety, and if necessary for safety, be restrained in the least restrictive way possible. Using restraints that significantly limit a pregnant inmate's mobility, such as leg shackles, chains across the belly or shackling wrists behind the back can cause serious and undue health risks to the woman and her pregnancy. The vast majority of female prisoners or detainees incarcerated are non-violent offenders, and shackling them greatly increases their chances for physical harm if they trip or fall. Pregnant women have a different center of gravity. If she trips and falls while her ankles are shackled, chances are good that she will not be able to restore her balance and could suffer a terrible injury. AB 584 (Fong) – Worker’s Compensation Utilization Review Support This bill would require physicians performing utilization review in California workers’ compensation to be licensed in California. This bill clarifies current law and will provide for both enhanced access to care and quality medical review for injured workers in California. Decisions made to modify, delay or deny medical treatment must be done by healthcare providers that know and understand California’s rules and regulations with regard to utilization review. Physicians making decisions without any connection to California or knowledge of California-specific issues can lead to denial of care for many injured California workers. If an out-of-state physician makes errors or otherwise requires discipline, neither the Division of Workers Compensation nor the Medical Board of California has any jurisdiction to remedy the situation. There is no shortage of qualified California-licensed physicians to perform hands-on utilization review for cases involving California’s injured workers. Further, there is no need for any utilization review program to employ out of state physicians that could lead to inadequate or improper review of requests for medical treatment. SB 222 (Evans) – Maternity Services Support This bill would require every individual health insurance policy to provide coverage for maternity services for all insureds covered under the policy. This bill would become operative only if AB 210 is also enacted. The economic and social costs of restricting or delaying this access to women are intolerable. These insurance products are barriers to care, and any delay in prenatal care can result in poor outcomes for both the mother and her baby. When a pregnant woman is not insured for maternity coverage, her only option for affordable maternity care is Medi-Cal or AIM. SB 746 (Lieu) – Tanning Facilities Support This bill will protect young people from the health dangers of ultraviolet radiation by prohibiting anyone under the age of 18, without a prescription, from using indoor tanning facilities. Rates of skin cancer – including melanoma, the most serious form of skin cancer – continue to rise, even in young people. The use of tanning salons is a common practice among teenagers, especially females. The intensity of ultraviolet radiation produced by some tanning units can be 10 to 15 times higher than the midday sun. Doctors and public health officials have long recommended taking steps to minimize the sun's damage to the skin and eyes and warn about the dangers of tanning. Skin cancer can result not just from sunburn, but from regular tanning and exposure to ultraviolet radiation. The World Health Organization, the American Medical Association, the American Academy of Dermatology, and the American Academy of Pediatrics all support prohibiting access to tanning salons or artificial tanning devices by children. SB 866 (Hernandez) – Prior Authorization Standardized Forms Support The bill requires all plans, all insurers and physicians to use a standardized form when requesting prior authorization for prescription drug benefits. If a health plan or insurer fails to accept the prior authorization form or fails to respond to a physician within 48 hours, the bill would deem the prior authorization request granted. The bill would require the Department of Managed Health Care and the Department of Insurance to jointly develop the form with stakeholder input. The form cannot exceed two pages and must be electronically available and electronically transmissible. This bill will dramatically streamline and improve the prior authorization process for prescription drugs. Preauthorization policies lead to costly bureaucratic hassles that take time from patient care. Requiring physicians to ask permission from a patient's insurance company before performing a treatment or prescribing a drug can delay patient access to medically necessary care because of red tape and inefficiencies in the process. Physicians spend 20 hours per week on average just dealing with pre-authorizations. For example, every insurer uses a different form for each different drug. Studies show that navigating the managed care maze costs physicians billions. Comments are closed.
