Looking back at its legislative successes for 2005, the California Medical Association has much to celebrate. The association won many battles, including eliminating several scope of practice bills and protecting Medi-Cal provider reimbursement rates and the MICRA cap.

But the CMA lost its struggle to bolster the Maddy Emergency Medical Services Fund and to pass a reintroduced Medi-Cal liens bill.

Here is a look at the top bills passed and vetoed, and the issues the CMA plans to work on in 2006.

Legislative Wins

Medi-Cal Provider Reimbursement (AB 1735-De La Torre and Aghazarian)
This bill addresses the recently overturned injunction the CMA got two years ago to prevent the state from cutting Medi-Cal reimbursement rates by 5 percent. Sponsored by CMA, AB 1735 blocks implementation of Medi-Cal cuts retroactively or in the current year. Signed by Gov. Arnold Schwarzenegger

Protection from Unfair Payment Practices (SB 634-Speier)
This CMA-sponsored bill extends many of the current protections afforded to providers in Department of Managed Health Care-regulated plans to products regulated by the Department of Insurance. These protections include disclosure of the fee schedule and payment rules the insurer uses to pay contracted providers and a prohibition against unreasonable claims deadlines. Signed by Gov. Arnold Schwarzenegger

Legislative Losses

Increased Fines for ER/Trauma Care Funding (SB 57-Alarcon)
This legislation would have allowed a county board of supervisors to raise fines and forfeitures on criminal offenses and traffic violations by $2 for every $10 of the base fine. The increase in revenues would have gone toward local Emergency Medical Services Funds, also referred to as Maddy Funds, which reimburse physicians for uncompensated ER care.

The bill would have also established dollars for the expansion of pediatric trauma reimbursement and services. The author estimated that this bill would have generated about $60 million annually. Vetoed by Gov. Arnold Schwarzenegger

Medi-Cal Liens (SB 399-Escutia)
This bill was a reintroduction of SB 494 (Escutia) from 2004, which was vetoed by the governor. It would have restored a physician’s ability to obtain a lien for the cost of medical services provided to a Medi-Cal recipient, if the injuries were caused by a third party, such as in the case of an auto accident. Vetoed by Gov. Arnold Schwarzenegger

Issues for 2006

Fairness in Contracting Act (AB 598-De La Torre)
This bill is intended to increase access to care by establishing new protections to ensure fair and reasonable contracting between healthcare providers and managed care plans. Proposed protections include prior regulatory approval of standardized form contracts, contract renewal on a yearly basis and the clear delineation of contractual amendments. Held in Assembly Appropriations Committee (two-year bill)

Silent PPO Reform (AB 757-Chan)
This bill would ensure that PPOs are no longer “silent” by, among other things, forcing transparency of profits and forcing PPOs to seek the provider’s affirmative permission before selling his/her name to another payer.

This bill would also ensure that a provider would not be forced to participate in any product or business line that is materially different from the underlying agreement, as it relates to increased workload imposed on the provider or decreased benefits conferred on the provider. Held in Assembly Appropriations Committee (two-year bill)