CMS Board report

Tuesday, July 01, 2014 12:40 PM

Kate Alfano, CMS contributing writer

CMS Board moves forward on multiple policy fronts

The Colorado Medical Society Board of Directors met on Friday, May 16, to conduct business integral to the success of the society and its members and take action on a host of issues, including maintenance of licensure, proposed clarification of the Affordable Care Act’s 90-day grace period provision, a potential strategic partnership to help with the transition to value-based care and opioid prescribing and dispensing.

Maintenance of licensure

Brent Keeler, MD, chair of the CMS Committee on Maintenance of Licensure (MOL), addressed the board. The House of Delegates created the MOL committee in 2011 and charged its members to develop a Colorado-specific MOL framework.

The committee recommends that licensees who are current with MOC requirements of the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) should be considered to have satisfied CME requirements. All other physicians with an active license under this proposal will be required to fulfill 50 credits/hours of accredited or certified category 1 CME that is relevant to his or her practice during each two-year renewal cycle. The board approved these specifications and will send the proposal to the House of Delegates for consideration at the annual meeting in September.

90-day grace period

CMS Immediate Past President Jan Kief, MD, presented information on a rule proposed by the Colorado Department of Insurance to clarify the reporting stipulation in the 90-day grace period that was not addressed in the federal Affordable Care Act. Patients who receive federal subsidies to purchase health insurance plans through the state health insurance exchange have a 90-day grace period for non-payment of premiums. During the first 30 days the health insurer must pay for claims as if the patient were eligible, but in the last 60 days they can suspend claims. If the patient’s coverage is cancelled after 90 days because of non-payment of premiums, the insurer may deny all suspended claims for services furnished during the 31-90 day time period. That could leave physicians on the hook for collecting payment for services and imperil access to care.

The ACA requires that the carrier notify the patient’s physician and other health care providers when a patient enters into the second and third month of the grace period, but the notification requirement does not indicate when such notification must be made. Kief testified before the DOI on May 1 that the proposed regulation should include language that will ensure providers receive eligibility information from health insurers in a timely manner, and in a manner detailed enough so that providers can anticipate any potential problems. Click here to read more about this issue.

ACO/network opportunities and physician support

The board agreed to move forward to explore a potential collaborative relationship with a company that would offer practice tools, resources and solutions to enable CMS members to succeed in accountable care and other payment initiatives. Such a relationship could also involve an ACO or other network arrangement with CMS. The board referred the issue to the CMS Committee on Physician Practice Evolution.

Opioid policy

The board heard a presentation by Lynn Parry, MD, on opioid prescribing and dispensing. The four provider licensing boards – regulating dentists, physicians, nurses and pharmacists – proposed a joint policy on this issue and requested comments from stakeholders. With previous approval by the executive committee, CMS provided comments and revisions that were well received by the four boards.

CMS strongly recommended that the policy not be interpreted or published as a “rule” to maintain flexibility; a rule has the force and effect of law. Rather, it should be written as a “policy,” which acts as guidance. CMS supports a policy that is helpful to prescribers and dispensers without establishing legal or disciplinary grounds for action followed by increased prescriber education. CMS also expressed concern that the proposed policy does not differentiate between chronic, non-malignant pain; cancer-related pain or palliative/hospice care; or short-term acute care situations. CMS recommended that the policy be limited to chronic non-malignant pain or clearly delineate between guidelines for the three types of pain.

Learn more

The Board also took important positions concerning workers’ compensation, the gainful employment requirement, the CMS policy manual, scope of practice, and the CMS strategic plan refresh. Click here to read a complete summary of the meeting.