CMS champions issues important to physicians and patients while defending medicine’s interests
by Emily Bishop, Program Manager, CMS Division of Government Relations
Featured in the January-February 2020 Colorado Medicine Colorado Medicine.
The 2020 legislative landscape is already shaping up to produce a challenging session for physicians. It’s not without opportunity, however, with several CMS-authored bills, impressive goals in the public health arena, and ample opportunity for physicians to have a seat at the table.
COMPAC has been meeting diligently with key legislators throughout the session to continue friendly relationships and gain early supporters of key issues. Your generous support of COMPAC makes this work possible and will be even more crucial during the 2020 election season.
The following issues will be top priorities in the Second Regular Session of the 72nd General Assembly, convening Jan. 8 and adjourning May 6.
Delayed credentialing can compromise patient access to care by delaying in-network availability of crucial providers. CMS has identified, through consultation with partners and other stakeholders, that insufficient incentive for health plans to process a health care professional’s credentialing application in a timely manner is hindering access and opening patients to financial risk when compelled to access out-of-network providers.
CMS has found a solution, however, authoring a bill to require timely and transparent credentialing processes. The legislation would require health care plans to adhere to strict deadlines regarding the process and load times. It would also require plans to treat applicants as a participating provider in certain circumstances for the purposes of payment, prescribing, referrals and prior authorization. CMS worked closely with the Colorado Chapter of the Medical Group Management Association (CMGMA) to draft this legislation and is excited about the benefits to both patients and providers of a streamlined credentialing process.
“CMGMA is delighted to work with CMS in developing meaningful bills that will provide much needed reform and transparency,” said CMGMA Legislative Liaison Eric Speer, MBAHA, FACMPE. “The credentialing act will help providers expedite the ability to see patients, and consequently give Coloradans more access to care.”
Workers’ compensation arbitration
The CMS Workers’ Compensation and Personal Injury Committee worked closely with stakeholders to develop an arbitration bill, which CMS will be running in the 2020 session. Some payer-provider agreements contain arbitration clauses that prevent providers from using the Division of Workers’ Compensation’s streamlined Medical Dispute Resolution Process. CMS is concerned this weakens the workers’ compensation system and discourages providers from participating. It also hurts the interests of injured workers. This bill would allow stakeholders to better utilize the division’s dispute resolution process and would eliminate the high costs and long wait periods often associated with arbitration. WCPIC Committee members see this as an opportunity for fairness in dispute resolution that would benefit both providers and patients.
The opioid crisis
“Addressing Colorado’s opioid crisis is [a] priority heading into 2020,” said Senate President Leroy Garcia, D-Pueblo. “We made great strides last year on addressing addiction through pilot programs, but we still have work to do toward bridging gaps in treatment for our communities.”
Generally, physicians should be in favor of the slate of draft bills from the Opioid and Other Substance Use Disorders Interim Study Committee this year, which is building on two prior years of work on this issue. The 2020 bills address prevention, harm reduction, criminal justice system reform, treatment and recovery.
“The interim study committee has made substantial gains in areas that state government can impact, thanks in no small part to our strong partners in the provider community,” said Sen. Jack Tate, R-Centennial. “Our goal this session is to consider ways to improve access to prevention services and treatment for substance use disorders, and support criminal justice response. As always, we need to hear from providers about how proposed legislation will affect your patients and practices.”
CMS is particularly focused on the proposed prevention bill, part of which requires carriers to cover on the same tier as opioids alternative pain treatments such as acupuncture and physical therapy. Benzodiazepines are expected to be added to the mandatory PDMP check. CMS continues to work with partners to enhance the ability to integrate PDMP with electronic health records and health information exchanges, while decreasing the cost of doing so.
Health care cost and quality
CMS anticipates cost reform to be another hot topic in the coming session and is prepared to advocate for the importance of quality and network adequacy in all cost reduction efforts.
“One of the most pressing issues our state continues to face is finding affordable care, particularly outside the Front Range,” says Senate President Garcia. “We’re committed to bringing down health care costs and increasing access and quality of care for all Coloradans, especially rural communities.”
State health insurance option
CMS has been an active stakeholder in the public option process from the start: the Work Group on Health Care Cost and Quality submitted a proposal to the Division of Insurance and Department of Health Care Policy and Financing this summer and has convened meetings to discuss the state’s proposal several times since. Following many interactions with state leaders, the draft proposal neither sets physician rates nor requires physician participation in the plan.
The CMS Board of Directors voted to support the State Health Insurance Option proposal, with recommendations for improving the plan. Once the proposal is drafted into bill form, the Council on Legislation will take a close look to determine CMS’s final position.
The governor’s office has thanked CMS and the physician community for a constructive and collaborative approach to this issue so far.
Threats to liability
According to sources, the No. 1 issue for trial lawyers in 2020 will be to erode the corporate practice of medicine doctrine that makes it difficult for a health system or professional corporation to be sued for a physician’s negligence.
This push would expand the potential value of a lawsuit by targeting the deep pockets of large hospitals and physician groups, and could result in those systems and groups eroding a physician’s independent medical judgment.
An attack on the noneconomic damages cap is always in the trial lawyers’ arsenal. Reportedly, should the narrowing of the corporate practice of medicine fail to get off the ground, the trial lawyers may shift their resources toward caps. CMS, in partnership with COPIC, is gearing up to once again defend the stable liability climate from liability increases of any kind.
Working for you
“The Colorado Medical Society, through its CMS Board-appointed Council on Legislation (COL), is uniquely prepared to evaluate, discuss and take positions on state legislative and ballot issues,” said COL Chair Kim Warner, MD. “The COL is comprised of representatives from specialty, county and component societies to comprehensively assess proposed legislation and take positions on behalf of the House of Medicine. The Council has, over the years, represented the physician view on such important legislation as scope of practice, liability reform issues, credentialing, opioids, physician wellness, health care quality, cost and access, and many more.”
The team of professional advocates at CMS works hard on behalf of the members to pass meaningful, workable health care legislation in Colorado. Surveys show advocacy is ranked as the first priority for a majority of our members across the state. Physician involvement and participation is necessary for success on all of the issues that face organized medicine as we head into the 2020 session.
Consider getting involved by contacting email@example.com or visiting our website, www.cms.org/membership/explore.