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Monday Rx: CA Rise in Infections, Town Hall Series, Covid-19 Reimbursement, Testing and the Electronic Prescribing Mandate

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State Action on Rise in Infections

Gov. Gavin Newsom is expected to present a proposed $2.7 billion COVID-19 emergency response package today in Sacramento as part of his proposed 2022 state budget amid the surge driven by the Omicron variant, state administration officials said Saturday.

The Governor's proposed budget also calls for new legislation to put supplemental paid sick leave policies in place to help protect the state's healthcare workers, according to state officials.

The money from the emergency response package would be used to bolster testing capacity, accelerate vaccination and booster efforts, support frontline workers, strengthen the health care system and battle misinformation, officials said.

The package allocates a proposed $1.2 billion to bolster testing capacity by expanding hours at state testing sites, distributing COVID-19 antigen tests to local health departments and supporting the state's testing facilities. $583 million would go toward getting more Californians tested for COVID-19, among other things, while $614 million would be used to support healthcare workers and health care systems.

The package also allocates $200 million to enhance the state's emergency response and public health capacities, including staffing and information technology at the state's Department of Public Health, Office of Emergency Services and Emergency Medical Authority. $110 million would go to increase public health efforts at the California-Mexico border to keep migrants safe in various ways, including vaccinations. The funds would also be used to enhance contact tracing.

Over the last eight days, there have been nearly 250,000 positive cases of coronavirus reported in Los Angeles County, a record-breaking number that shows how fast the Omicron variant is spreading.

Moreover, with an average of nearly 115,000 people being tested each day over the last seven days, more than 20% of people are testing positive for the virus.

This spike is breathtaking but also expected, given the way Omicron earlier marched through South Africa, Europe and American cities such as New York. But there are some bright spots, including far fewer critically ill patients than during last winter’s surge. Those who are vaccinated and boosted generally are avoiding major illness.

Reimbursement for COVID-19 Clinics

We’ve received inquiries regarding HMO plans and if they are required to reimburse for COVID-19 testing and treatment. Several medical offices have shared that they have been operating clinics but have to turn away HMO patients as they are not contracted to care for them.

I’ve reached out to CMA for details on this issue. If you face similar challenges, please share directly with me by replying to this email.

US Health & Human Services Action on Covering Testing

As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th. The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for upfront by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs upfront and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

“Under President Biden’s leadership, we are requiring insurers and group health plans to make tests free for millions of Americans. This is all part of our overall strategy to ramp-up access to easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took office, we have more than tripled the number of sites where people can get COVID-19 tests for free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans who need them. By requiring private health plans to cover people’s at-home tests, we are further expanding Americans’ ability to get tests for free when they need them.”

Links: HHS Press ReleaseFrequently Asked QuestionsAdditional Details on the Requirements

If the medical clinic provides treatment to an uninsured patient, they can submit for reimbursement through HRSA. You can find more information here.

Expanding Healthcare Coverage Town Hall Series Continues

Following the successful initial town hall featuring CMA's CEO Dustin Corcoran, LACMA will host Dr. Sandra Hernández, MD, MPH CEO of the California Healthcare Foundation on February 8th.

Learn more and register here.

Electronic Prescribing is Here

Nine days into the new law making almost all prescriptions written in California to be transmitted electronically, physicians who have not yet implemented electronic prescribing in their practices, should begin the process now.

The electronic prescribing mandate was contained in a law passed by the California State Legislature in 2018. The bill (AB 2789) had a three-year delayed implementation to allow physicians and other prescribers the opportunity to select and implement an electronic prescribing platform. But the delay ends at the end of this year.

The law is partially based on the Medicare electronic prescribing for controlled substances (EPCS) requirement, which was also set to take effect on January 1st. The Centers for Medicare and Medicaid Services (CMS) has proposed in the 2022 Medicare Physician Fee Schedule to delay implementation of the EPCS requirement for an additional year, to January 1, 2023, but that does not have any direct effect on the state requirement. Much of the language of the requirement was copied straight from the federal regulations.

Unlike the Medicare requirement, however, the state mandate applies to almost all prescriptions, not just those for controlled substances. In that respect, the state mandate is much broader than the Medicare one and will affect many more physicians.

The California Medical Association (CMA) opposed AB 2789 when it was being debated in the legislature and offered the author possible amendments that would have created some accommodations in the law. But the proposed amendments were rejected, as the Legislature saw AB 2789 as just an extension of the Medicare requirements.

Understanding the Electronic Prescribing Mandate

As physicians approach coming into compliance with the electronic prescribing mandate, it is important to understand a few major facets of the law. CMA has based the following on conversations with many physicians over the past few months.

Exceptions:

The following types of prescriptions are exempt from the electronic prescribing mandate:

  • Controlled substances prescriptions for use by a patient who has a terminal illness.
  • E-prescribing is not available due to a temporary technological or electrical failure.
  • The prescribing physician is issuing a prescription to be dispensed by a pharmacy located outside California.
  • The prescription is issued in a hospital emergency department or urgent care clinic and either the patient resides outside California, the patient resides outside the geographic area of the hospital, the patient is homeless or indigent and does not have a preferred pharmacy
  • The prescription is issued at a time when a patient’s regular or preferred pharmacy is likely to be closed.
  • The prescription is issued by a veterinarian.
  • The prescription is for eyeglasses or contact lenses.
  • The prescribing physician and the dispenser are the same entity.
  • The prescription is issued by a prescribing physician under circumstances whereby the physician reasonably determines that it would be impractical for the patient to obtain controlled substances from an e-prescription in a timely manner, and the delay would adversely impact the patient’s medical condition.
  • The prescription that is issued includes elements not covered by the latest version of the National Council for Prescription Drug Programs’ SCRIPT standard.

If a physician believes that one of the above exceptions apply, they must document it in the patient record within 72 hours of filing the prescription.

Practice Exemptions:

While some specific prescriptions are exempted from the electronic prescribing mandate, there are no exemptions in the law for physician practices. CMA receives many questions from physicians about hardship exemptions, considerations for retired (or semi-retired physicians), low volume prescribers, physicians in safety net settings, and rural physicians. All of the above are subject to the law, and there is no provision in the law for a practice to request an exemption.

Enforcement:

Physicians who fail to comply with the law will be referred to the Medical Board of California. The Medical Board has published several physician communications outlining the requirements of the law but has not proposed any specific enforcement actions they might take.

An enforcement action by the Medical Board under this law would be triggered by a complaint. The most likely scenario is that a physician is referred to the Medical Board by either a patient or a pharmacist.

Importantly, the law does not create private right of action. That is, physicians cannot be sued for failing to comply with the law.

Product Selection and Implementation:

For physicians who have an electronic health record (EHR) system, implementing electronic prescribing may be as simple as turning on an embedded electronic prescribing module. Any EHR that is certified by the Office of the National Coordinator for Health IT (ONC) must have the capability to transmit prescriptions, including controlled substances, electronically. Physicians with an EHR should contact their vendor for more information.

For paper-based practices, selecting the right technology platform will be a little more complicated. A stand-alone electronic prescribing system (that is, not tied to an EHR) will likely be much cheaper and easier to implement than a complete EHR system. Most paper-based practices will likely look to one of these systems.

While CMA does not endorse any particular electronic prescribing system, there are a few recommendations for physicians who are in the market. First and foremost, if the practice does any prescribing of controlled substances, the system must have the ability to do EPCS and query the CURES database. Not all commercially available systems can do both of these, so practices should ask prospective vendors before investing in a system.

Also, practices should strongly consider electronic prescribing systems that are connected to the SureScripts network. SureScripts is the largest electronic prescribing network in the country. Vendors on their certified product list will give physicians and patients the largest number of pharmacies from which to choose.

CMA Resources:

To help physicians make this transition, CMA has developed the following resources, available only to CMA members:

  1. CMA Frequently Asked Questions: California’s Electronic Prescribing Mandate
  2. Webinar: Preparing for California’s Electronic Prescribing Mandate (archived; available for on-demand viewing)

CMA members are also always welcome to call the CMA Member Helpline at (800) 786-4262 to request one-on-one assistance.

Confirmed360 Offers VIP Packages

Upcoming Opportunities:

LA Playoff Football at SoFi Stadium

  • Dates: January 2022 TBA
  • Location: SoFi Stadium – Inglewood, CA
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Email lacma@confirmed360.com to inquire and join the waitlist.

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  • Game Date: February 13, 2022
  • Party & Event Dates: February 4th – 13th
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  • Description: The biggest Las Vegas show of the year! Adele’s much-anticipated residency is the toughest ticket on the strip, Confirmed360 has you covered.

To request info or book an experience, email lacma@confirmed360.com or visit confirmed360.com/lacma.

The Healthcare Burnout Symposium

We are proud to partner and support 2022 The Healthcare Burnout Symposium. Join healthcare leaders from around the country who address the multiple facets of the burnout crisis and share how to increase the well-being of our physicians, nurses, and administrators.

  • Understand the far-reaching consequences of burnout
  • Discover strategies for burnout prevention and mitigation
  • Learn how to identify burnout in yourself and others

January 24 - 26, 2022 at the Hyatt Regency San Francisco, CA.

Register here.

#MondayMotivation

"Character cannot be developed in ease and quiet. Only through experience of trial can the soul be strengthened, ambition inspired, and success achieved."

Gustavo Friederichsen

Chief Executive Officer

Los Angeles County Medical Association

“If it matters to our LACMA members, it matters to me.”

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