Managed Care & Insurance Committee Updates
[UPDATE] From CalChiro’s Managed Care & Insurance Committee Regarding January 2020 Meeting
January 23, 2020
The Managed Care & Insurance Committee held its monthly meeting
to discuss health plan issues and initiate the scheduling of
meetings with stakeholders including legislative staff/consultant
members, Surgeon General of California, and health plan
representatives. Discussion regarding coalition building to add
strength and numbers to issues of concern in 2020 was
entertained.
The Governor has created two entities – Health California for All
Commission, and the Office of Health Care Affordability. CalChiro
representatives will attend meetings and participate in
public-policy discussions for both entities. It is anticipated
that information hearings on the expansion of the Essential
Health Benefits definition will occur in the next several months.
It is not yet certain if provider groups will be invited to
submit oral testimony, but certainly CalChiro will be available
in that regard and certainly will provide written testimony. The
expansive definition is important as CalChiro will advocate for
the inclusion of doctors of chiropractic as a category of
provider – particularly in the Covered California program.
CalChiro has received from members issues related to E/M code
use, adjudication of claims of Medi-Cal beneficiaries
(particularly in those members whose benefits are managed by a
delegated entity), access to doctors of chiropractic by children
(typically under 4 years of age), and adjudication of 3rd party
liability claims.
As always, documentation received by CalChiro members related to
denial of claim submission, or issues that appear discriminatory
are welcomed by the association.
[UPDATE] From CalChiro’s Managed Care & Insurance Committee Regarding Advocacy Activities for 2020
January 9, 2020
The Managed Care & Insurance Committee (MCIC) will continue its
advocacy activities with stakeholders that either manage services
provided by doctors of chiropractic, regulate the health plan
industry, as well as other public policy decision-makers.
Currently, we have request letters to Cigna and Blue Cross on a
variety of issues related to coding and denial language of
services, and Blue Shield on the delegation to ASH for services
providers to select Blue Shield PPO markets. It should be noted
that according to Blue Shield, not all PPO plans will be managed
by ASH, and therefore, those Blue Shield-contracted providers
should retain their contract status. There remain several
outstanding issues from 2019 related to ASH policy/procedures,
and we will engage with their leadership on these matters,
including some provider confusion related to the Blue Shield/ASH
delegation issue.
As we have noted previously, the MCIC will continue our meetings
with stakeholders regarding Covered CA. Recently, the Governor
created the Health
California of All Commission. CalChiro will be in attendance
at each meeting and offer information relative to the inclusion
of the chiropractic profession’s participation in crafting health
care policy. Of interest is several of the commission members,
legislative appointees, and ex-officio members have a long
history with CalChiro, including presentations to CalChiro
conferences and meetings as well as assisting in legislative
activities.
January is a particularly challenging time of year related to
full service health plans and the delegated entities that manage
certain benefits. These challenges include, but are not limited
to eligibility determination and verification of benefits,
including deductibles. As we have stated previously, CalChiro
cannot advocate on behalf of each provider. However, certainly if
a global issue is identified that adversely effects all CA-based
doctors of chiropractic, CalChiro should be notified and we can
initiate discussion with the health plan, or its’ delegated
entity. If resolution is not available at that level,
presentation of documents and in-person meetings with regulatory
personnel will be scheduled.