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Oregon Carrier Advisory Committee (CAC) Minutes
Oregon Medical Association Headquarters
5210 SW Corbett Avenue
Portland, Oregon97201
9:00 – 11:00 A.M., Saturday, October 14, 2006
Attendees:
Members and alternates
William B. Baer, M.D., Ophthalmology, CAC Co-Chair
Alan F. Barker, Pulmonary Medicine
Nels Carlson, M.D., Physical Medicine and Rehabilitation
Len Christie, M.D. Cardiology
Joy Conklin, Oregon Medical Association
Kathleen Farrell, D.O., Geriatrics
Craig Fausel, M.D., Gastroenterology
David E. Gannett, Jr., M.D. Radiation/Oncology
Donald Giles, M.D., Managed Care Organization, Regence BCBS
Ronald A. Gilson, M.D., Family Practice
Kris Harvey, Oregon Medical Group Management Association
Terry Harvey, Beneficiary Representative
Nathan Kemalyan, M.D., General Surgery
Angela Kendrick, M.D., Anesthesia (teleconference)
Thomas Kruse, M.D., Dermatology (teleconference)
Richard A. LaFrance, M.D., Neurology
Gregory J. Landry, M.D., Periperhal Vascular Surgery
Candace McKanna, M.D., Psychiatry
Ruth Medak, M.D., QIO, Acumentra Health
Walter Shafer, M.D., Medicaid Medical Director
Hugh Sowers, Beneficiary Representative
John Stiger, D.O., Osteopathy
Elizabeth Stone, M.D., Plastic and Reconstructive Surgery
Cynthia Strawn, O.D., Optometry
Ted Tosterud, Clinical Laboratory
Jenn Webster, Oregon Medical Association
CMS:
Kenneth Fink, M.D. Chief Medical Officer, Seattle Regional Office
Barb Riley, RN, Seattle Regional Office (teleconference)
GUEST:
Marc Gosselin, M.D., Radiology, OHSU
Kenneth Rhoads, M.D., FACC, Epic Imaging-Cardiac
Noridian Administrative Services staff:
Marie Gray, CPC, CMD Assistant)
George Waldmann, M.D., Contractor Medical Director, (), telephone 503-944-8810, fax 503-944-8814
Lori Weber, Education
Observers:
Jeff Ladwig, Amgen
John Schlatter, TAP Pharmaceuticals
David Thomas, Novartis
Paul Voss, Allergan
1.Call to Order
Dr. Baer called the meeting to order at 9:00 AM.
- Introduction of members and guests
Dr. Baer asked CAC members to introduce themselves.
- Approval of minutes of the June 17, 2006 meeting
The minutes were approved as submitted.
- Administrative Reports
CMS – Kenneth Fink, M.D.
Dr. Fink reported on a new Medicare campaign, “My Health, My Medicare.” Thepurpose of this campaign is to help beneficiaries with the following:
- To be more proactive in their health care
- Take full advantage of their Medicare benefits
- New prescription drug coverage and
- Preventive care benefits
Medicare will also be promoting a new web site Beneficiaries will have access to personalized information regarding their Medicare benefits. When they register, they will be able to:
- Review claim status (excluding Part D claims),
- Order a duplicate Medicare Summary Notice (MSN) or replacement Medicare card,
- View eligibility, entitlement and preventive services information,
- View enrollment information, including prescription drug plans,
- View or modify their drug list and pharmacy information,
- View Part B deductible status, and
- Access online forms, publications and messages sent by CMS.
He gave a brief update on Physician Voluntary Reporting Program. Currently, there are about eighty-five hundred physicians that have signed up to submit data for this program. The program’s initial 16 quality measures can be found at Providers may register their intent to participate at
He also reported on the Open Enrollment for Medicare Part D and the new drug formulary finder toolavailable next week. Beneficiaries who wish to change prescription drug plans are encouraged to sign up before December 8 in order to have coverage by January 1, 2007.
Part A – There is no report for Part A. Dr. Bernice Hecker, Noridian Part A Medical Directorwas unable to attend.
OregonState Medicaid - Walter Shafer, M.D.,Medicaid Medical Director
Dr. Shafer reported that the name of thestate agency that administers Oregon Medicaid has been changed toDivision of Medical Assistance Programs (DMAP). This change makes all the agency names consistent. The Division’s financial status is relatively stable at present, as new enrollment has been very close torecent projections. CMS has approved reductions in benefits in the following areas: vision benefits (routine exams and glasses), restorative dental services, a limitation on over-the-counter medication coverage, and a limitation of in-patient hospital coverage to 18 days per person per year.
QIO –Ruth Medak, M.D., Medical Director
Dr. Medak reported that Acumentra Healthcontinues to work with the Medicare QIO contract, the Medicaid contract for Oregon and Washington,and will be venturing into Quality and Care Oversight.
- She provided a handout relating to the Home Health Project, including Beers Criteria for potentially inappropriate medication use in older patients. She asked members to review the information from this pamphlet in order to assist their patients in medication management.
- There will be a Care Management Program conference on Friday, October 27, 2006,7:30 a.m.–1:00 p.m. (additional afternoon sessions for DOQ–IT participants). The conference will benefitOregon medical practices engaged in implementing and optimizing electronic health records (EHRs).
- Reviewers are needed in nearly all areas. It is critical that excellent reviewers participate. These are mainstream physicians, respected by their peers, who reflect the standards if the community. The goal is to have 3 or 4 such reviewers represent each specialty group.
NAS – George Waldmann, M.D. Contractor Medical Director
Dr. Waldmann referenced several articles on Medicare listed in the agenda that CAC members might find interesting. He also listed three new articles in the handouts that he provided with his PowerPoint presentation of the 2007 Update.
Dr. Waldmann reported that the question has been raised in some states as to why non-CAC members are allowed to attend CAC meetings. He then asked the CAC members in attendance to vote on whether non-members should continue to attend CAC meetings. The members then voted to allow non-members to continue attending the meetings.
There are 109 additional draft LCDs listed as additional handout. These are policies that are currently in effect but have been slightly revised to provide uniform wording and additional diagnoses as allowed in the states of Montana and Utah, which CMS recently awarded to Noridianfor the administration of their Medicare contracts.
Dr. Waldmann briefly went over the WIC data for the five draft LCDs.
Dr. Waldmann asked for assistance in recruiting members to fill the vacancies listed in the agenda appendix for the Oregon CAC.
Local Coverage Determinations:
a) Allergen Immunotherapy
b) Allergy Testing
c) Genetic Testing
d) Multidetector Computed Tomography of the Heart and Great –Dr. Kenneth Rhoads
gave a PowerPoint presentation and offered comments for this policy. Dr. Marc Gosselin
also offered comments for this policy and submitted a PowerPoint presentation for email distribution to all OR CAC members.
e) Plastic Surgery
f) Handouts of additional draft LCDs Policies
Dr. Waldmann thanked all members who offered comments and also thanked the guest presenters and requested that comments be submitted in writing or by email. The comment period ends on December 5, 2006. LCD comments must be submitted in writing and mailed to the following designated address:
Contractor Medical Directors, Policy Development, Medicare Part B
Noridian Administrative Services, LLC
901 40th St., S, Suite 1
Fargo, ND58103-2146
Comments may also be emailed to:
NAS Provider Education—Lori Weber
Ms. Weber gave a brief overview of the following topics:
- Upcoming Online Workshops for office staff
- The next NAS Ask the Contractor teleconference is November 16, 2006
- Toll free number is 888-423-3272
- NPI Numbers
- CERT request – respond timely
- ListServe- sign up for the weekly email
The next Oregon CAC and Open Public Meetings scheduled for 2006 and 2007 are:
CAC Part B Open Public Meeting Ask the Contractor Teleconference
February 24January 9, 2007November 16, 2006
June 16 Participants must pre-register
October 13and request the teleconference number.
- Meeting adjourned at 11:00am.
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George Waldmann, M.D.Date
Contractor Medical Director
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