7/31/2019 Payers & Providers California Edition Issue of August 16, 2012

1/6

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Eacolhar

1> Auiux 2612

O*Ja`c`lnkFvaporualhvrk~`horu,ekjy`xm

xmo hoxa`cu kn pkr o~olx# kr eacc-=99) 28=*25>6# o}x, 5, @x y`cc bo

vbc`umoh `l xmo Eacolhar uoex`kl#uvaeo vorj`xx`li,

Eac`nkrl`a Oh`x`kl

Xyk Joh`*Eac jalaioh earo vcalu `lUkxmorl Eac`nkrl`a ma~o calemoh ajb`x`kuo*moacxm `l`x`ax`~ou bkxm mkvo y`cc mocv goov ac`h kl r`u`li moacxmearo ekuxu,

C,A, Earo Moacxm Vcal `u nkeuoh klrohe`li lloeouuarp ~`u`xu xk joh`eacuvoe`ac`uxu# ym`co xmo @lcalh Ojv`ro MoacxmVcal yalxu xk boxxor jalaio emrkl`eeklh`x`klu uem au h`aboxou,

C,A, Earou Yob*bauoh oEklucx vkrxacacckyu xmo moacxm vcalu vr`jarp earo alhuvoe`acxp vmpu`e`alu xk h`roexcp ekjjl`eaxoy`xm`l klo alkxmor# `lech`li xmo umar`li knvmkxku alh kxmor hkejolxax`kl, Xmax vorj`xujkro xmkrkim vax`olx o~acax`klu vr`kr xkjag`li a ronorrac xk a uvoe`ac`ux,

V`ckx vrkdoex xoux`li kn xmo vcaxnkrjroheoh ronorracu `l ukjo uvoe`acxp eaxoikr`ou

bp au jem au 8=/, Xmaxu a u`il`ealxjklop*ua~or# eklu`hor`li al lloeouuarp

ronorrac eal ekux au jem (1?6 lkx `lech`lialp hvc`eax`~o xouxu xmax j`imx keer,

@x jkro oau`cp vorj`xu eklucxax`kl y`xmalh oheax`kl nrkj xmo uvoe`ac`ux# ua`h Uad`hAmjoh# C,A, Earou h`roexkr kn moacxm @X alh`llk~ax`klu,

Ackli y`xm xmo hovckpjolx kn xmo vkrxac#abkx 5?6 h`i`xac eajorau ma~o bool uolx xkC,A, Earo vrk~`horu l krhor nkr xmoj xk xagovmkxku kn xmo`r vax`olxu eklh`x`kl alh uolhxmoj kl xk xmo roco~alx uvoe`ac`ux,

Ax xmo uajo x`jo# xmo vkrxac y`cc acuk mocvuvooh v uvoe`acxp ronorracu nkr C,A, Earoolrkccoou ymk looh uem a ~`u`x# aeekrh`li xkAmjoh,

Xmo oEklucx vkrxac calemoh oarc`or xm`uyoog y`xm eklloex`klu xk C,A, Earouhorjaxkcki`ux alh lorkcki`ux loxykrgu axuo~ol h`nnorolx u`xou xmrkim xmo eklxp, Bkxmuvoe`acxp valocu roeo`~o a m`im ljbor knvax`olx ronorracu# aeekrh`li xk Amjoh,

Bp xmo olh kn xmo poar# oEklucx `uo}voexoh xk bo a~a`cabco xk acc C,A, Earouvoe`ac`uxu ~`a ?5 ec`l`e u`xou `lech`li accec`l`eu kvoraxoh bp xmo Cku Aliocou EklxpHovarxjolx kn Moacxm Uor~`eou, HMU `u avarxlor l xmo vrkdoex# ackli y`xm xmoEkjjl`xp Ec`l`e Auuke`ax`kl kn Cku AliocouEklxp# xmo Moacxm Earo C,A, @lhovolholx

Vraex`eo Auuke`ax`kl alh JohVk`lxJalaiojolx,C,A, Eklxp HMU acuk knnoroh acc

oleklxor haxa nrkj > j`cc`kl vax`olxu x mauxroaxoh ax `xu nae`c`x`ou nkr `luorx`kl `lxk xmooEklucx upuxoj# jag`li `x jkro oaup nkrloxykrg vmpu`e`alu xk vcc v ekjvcoxojoh`eac m`uxkr`ou kn xmo`r vax`olxu,

oEklucx olabcou kr vr`jarp earovrk~`horu alh uvoe`ac`uxu xk ekjjl`eaxo

Auiux 10*21

3:!7=+EH?50(!O6(51/-!N0>?+0!I699(A!M=6!@5"/=610!

7+9?;510?+!+0>!@+0!D?6%5!F=+H/61(!G?99!%+/=61!/5!>?F"((!!7C(!+0>!5/=61!F5(/J(+8?0%!/160>(!?0!=6+9/=F+16!>69?861*A!

L))KJLVV$A!79?FQ!3616!;51!!=6+9/=F+16!

>69?861*!?0!1"1+9!+16+(A79?FQ!3616!;51!+!O6(51/-!,+9E!@H1?0%(A!U6G!

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79?FQ!3616!;51!6# o}x, 5 xk krhor

KR EC@EG MORO

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7/31/2019 Payers & Providers California Edition Issue of August 16, 2012

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Ga`uor Vorjalolxo rovkrxoh a bujv uvyarh`l ro~oluo alh olrkccjolx nkr xmo oeklhquarxor olh`li Dulo 56# bux `x k~oracc lox`lekjo ya hkyl bp 22/,

Ro~oluo nkr xmo Kagcalh*baoh mkv`xacalh moacxm vcal kvoraxkr roaemoh (12,>b`cc`kl nkr xmo quarxor# uv >/ nrkj xmo (11,0b`cc`kl `l ro~oluo rovkrxoh hur`li xmo oeklhquarxor kn 2611,

Xkxac lox `lekjo ya (?18 j`cc`kl#ekjvaroh xk (>>5 j`cc`kl nkr xmo poar*aikquarxor, Ga`or vkgovorkl Cara Hllaxxr`buxoh xmo h`v xk xmo krial`tax`kl`l~oxjolx,

Kur lkl*kvorax`li `lekjo ekjo nrkjkur `l~oxjolx vkrxnkc`k alh ekl`x kn abrkah arrap kn}oh `lekjo alh oqu`xpvrkhuex, Xmoo aro ubdoex xk xmo ~kcax`c`xp

Vaporu . Vrk~`horu Vaio 2

Xkv Vcaeojolx,,,Bkxxkjcouu Vkxolx`ac

Ah~orx`uo Moro

-=99) 28=*25>6# o}x, 2

@l Br`on

Ojvckpor Irkuv JkroNkeuoh Kl Yocclo

@leolx`~o

A loy xuhp bp Akl Moy`xxeklecuho xmax jalp ojvckpor

irkuv aro rocp`li kl `leolx`~o xkiox xmo`r ykrgor xk varx`e`vaxo lyocclo vrkiraj,

Xmo ur~op bp xmo @cc`lk`*baohAkl kn acjkx 2#666 ojvckpor y`xmjkro xmal 2 j`cc`kl ykrgoreklecuhoh xmax ?1/ vrk~`ho`leolx`~o xk ojvckpoo ymkvarx`e`vaxo l vrkiraj joalx xk`jvrk~o xmo`r moacxm alh yocclo,Alh ajkli xmko# ?0/ knnor jklop`leolx`~o xk xmo`r ojvckpoo# uvnrkj 59/ `l 2611,

A xkxac kn ?=/ ack knnor kjonkrj kn leolx`~o xk xmo`r ojvckpooymk ekjvcoxo c`noxpco jkh`eax`klvrkiraj# uem a xk qu`x jkg`li kr

`jvrk~o xmo`r h`ox,Xmo haxa xrklicp uiiox xmax

bu`loo aro xrp`li xk iravvco y`xm`leroa`li moacxmearo ekx ake`axohy`xm h`oao uem a ahucx kloxh`aboxo# ym`em ` acjkx acyapc`lgoh xk kbo`xp,

Ojvckpor glky xmax o`imxmoacxm boma~`kr# `lecuh`li r`guem a caeg kn vmp`eac aex`~`xp alhna`curo xk ekjvcoxo roekjjolhohvro~olx`~o erool`li# hr`~o 1?emrkl`e eklh`x`kl xmax coah xk m`imorjoh`eac ekx alh leroaoh aboleonrkj ykrg# a`h Uxovmal`o Vrklg# aec`l`eac moacxm jvrk~ojolx coahorAkl moacxm alh bolox h`~``kl,

Mkyo~or# kjo h`eklloexboxyool ojvckpor alh ojvckpooroja`l olxrolemoh, Acxmkuim jkroxmal =6/ kn xmko rj ur~opohuvvcp a quox`klla`ro xk xmo`rojvckpoo xk quorp xmoj abkux xmo`rk~oracc moacxm# noyor xmal 16/ knnoral leolx`~o xk h`roexcp ahhro xmorovklo xmax aro uvvc`oh,

Eklx`loh kl Vaio 5

LOYU

JOOX PK_R NOCCKY ROAHORU

Looh xk vrkjkxo a eklnoroleo; Pkur bralh; Vaporu .Vrk~`hor!uo*ja`c c`x nkr acc oh`x`kl ` a~a`cabco nkr pkurjargox`li looh, Roaem kux xk jkro xmal 12#666moacxmearo vrkno`klac ymk roah kur vubc`eax`kl, EacEca`ro Xmapor ax -=99) 28=*25>6# o}x, 5 kr o*ja`c mor axeca`roxFjekc,ekj,

h`roexcp alh jalaio a vax`olx lkl*uriolxlooh y`xmkux a naeo*xk*naeo ~``x# alh ealmkrxol xmo ya`x x`jo n a voe`ac`xavvk`lxjolx ` loohoh# a`h Aco}alhor C`#J,H,# em`on o}oeux`~o kneor kn xmo HMUajbucaxkrp earo loxykrg, Uanoxp Lox Eklloex# a Loyvkrx Boaem*baoh moacxmearo knxyaro rj# uvvc`oh xmoknxyaro nkr bkxm xmo v`ckx vrkdoex alh xmobu`chkux, Xmo ekx kn hovckpjolx ya abkux(1,? j`cc`kl# aeekrh`li xk Amjoh,

Ax @OMV# abkux ?#666 olrkccoo y`xmh`aboxo ma~o olxoroh `lxk a ~`xac `iljkl`xkr`li xocomoacxm vrkdoex lxolhoh xkboxxor jalaio h`oao uem a h`aboxo,

@OMV olrkccoo y`cc bo abco xk uoocoexrkl`e ho~`eo xk jkl`xkr alh iaxmoricueko co~oc# luxr`x`klac `lxago alh kxmor~ar`abco, Xmo jkl`xkr eal `lxornaeo y`xmocoexrkl`e iaxoyap `lxaccoh ax xmo kneo kn>66 vrk~`hor `l @OMV loxykrg alh bouvckahoh `lxk a Yob vkrxac,

Xmo earoi`~or eal ox ralio y`xmacarj kl x xmax y`cc auxkjax`eaccp lkx`np-xmoj) `n xmo vax`olx haxa ` kux kn ralio almkvonuccp a~k`h al OR ~``x# a`h Brox Jkroh`roexkr kn jargox`li nkr NkraEaro# xmoLoyburp Varg*baoh rj xmax vrk~`h`lixmo marhyaro alh jkl`xkr`li or~`eo xk@OMV,

^ar`ku xuh`o uiiox xmax xmo ekx knxroax`li uljalaioh h`aboxo ` jkro xmalo`imx x`jo m`imor xmal goov`li `x ulhoreklxrkc,

Al @OMV vkgovorkl hoec`lohekjjolx abkux xmo vrkdoex# ap`li `x ya x`l x l`x`ac xaio alh yo aro ykrg`lixmrkuim vrkeoo,

C,A, Earo vrk~`ho jalaioh earo xkabkux 1 j`cc`kl Joh`*Eac# UVH alh MoacxmpNaj`c`o olrkccoo `l Ck Alioco Ekulxp,@OMV vrk~`ho xmo ajo ek~oraio xk abkux?86#666 c`~o `l R`~or`ho alh alh UalBorlarh`lk Ekulx`o,

O*Ua~~p -Eklx`luoh nrkj Vaio Klo)

@l~oxjolx H`v M`x Ga`or Oarl`liLox @lekjo Hkyl Hkubco H`i`x Nkr Quarxor

alh uexuax`kl `l xmo jargox# a alp`l~oxjolx ykuch bo# Hull a`h `l al o*jaNkr xmo oeklh quarxor# xmo Hky Dklou @lho` hkyl 2,?/ alh xmo Uxalharh . Vkkru@lho} ` hkyl 5,2?/ kur `l~oxjolx xolhxk j`rrkr xm`,

Bp eklxrax# kvorax`li `lekjo ya uv=,1/ nkr xmo quarxor# roaem`li (828 j`cc`kl#ekjvaroh xk (506 j`cc`kl nkr xmo oeklhquarxor kn 2611,

Ga`or ma volx (1,> b`cc`kl kl eav`xac`l~oxjolx hur`li xmo rx macn kn xmo poar# unrkj (1,8 b`cc`kl hur`li xmo rx macn kn 2611Xmo pxoj ma kvoloh 15 loy alh

rovcaeojolx mkv`xac alh 9? joh`eac kneobu`ch`li k~or xmo vax ~o poar,

Upxojy`ho olrkccjolx iroy bp =9#666`leo xmo xarx kn 2612# alh ` lky 0 j`cc`kl,

7/31/2019 Payers & Providers California Edition Issue of August 16, 2012

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!"%"(/!.)-!$.!'!$.!#*!,+*61(!2!,158?>61(!,"#9?(=?0%-!447

Vaio 5Vaporu . Vrk~`horu

Cklior ACKU!$

Ah~orx`uo Moro

-=99) 28=*25>6# o}x, 2

$Nkr kr ahu# lkx pkr mkuv`xac

@l Br`on

HJME Xagou Eklxrkc KnHolxac Vcal

Xmo Hovarxjolx kn JalaiohMoacxm Earo mau uo`toh xmo auuoxukn al Areah`a*bauoh holxac vcal,

Xmo HJME acuk avvk`lxoh aekluor~axkr nkr Ajor`ealMoacxmIarh Ekrv,# ym`em acukkvoraxou au EolxaIarh HolxacVcal, @x vrk~`hou bkxm ekjjore`acalh Holx`*Eac ek~oraio, XmoHJME xkkg aex`kl kl Ai, 16,

Aeekrh`li xk HJMEhkejolxu# Ajor`eal MoacxmIarhmah na`coh xk ja`lxa`l unn`e`olxeav`xac u`leo 2660# alh mah a xkxaceav`xac hon`e`olep kn jkro xmal(866#666 `l Aiux 2611, Xmo vcalacuk na`coh xk joox j`l`jjxali`bco lox oq`xp roq`rojolxu,@l Jarem# `x jox vku`x`~o eaum nckyroq`rojolxu klcp bp na`c`li xk vap

`xu `luraleo alh eav`xax`kl noou xkvrk~`horu,Olrkccjolx `l xmo vcal mau

xjbcoh nrkj jkro xmal 28#666xmroo poaru aik xk couu xmal 19#666caux uvr`li,

Xmo vcal acuk na`coh xk jagojklxmcp rovkrxu xk xmo HJME#ym`em xmo aiolep roq`roh abkx apoar aik,

Ga`uoru NarjoruJargoxu Xkv ?6

Ga`uor Vorjalolxo# ym`em mauolekraioh xmo irkyxm kn narjoru

jargoxu au a yap xk vrkjkxo moacxm`orc`nouxpcou# mau roeolxcp kvoloh xu ?6xmjargox lax`kly`ho,

Xmo caxoux jargox u bo`likvoraxoh kxu`ho kn Ga`uoru Kagcalhmoahqarxoru yoogcp,

Ga`uor mau acuk kvoloh jargoxuxmrkimkx Eac`nkrl`a alh l Km`k#Jarpcalh# Maya``# Kroikl alhJarpcalh,

Yo aro xmr`ccoh xmax kr jargoxuaro xmr`~`li alh o}valh`li# ua`hVrouxkl Jar`li# J,H,# a Ga`uorvmpu`e`al ymk mocvoh ekleo`~o xmovrkdoex abkx a hoeaho aik,

LOYU

Eac`nkrl`a Yaxem# Aeeklxabco mau roxa`lohU`xr`eg Alh Ek,# a Cku Aliocou vbc`e rocax`krj glkyl nkr `xu er`u`u VR aejol,

Acc joh`eac loeouu`xp hoe`u`klu axAeeklxabco Moacxm Earo aro jaho bp ac`eoluoh Eac`nkrl`a vmpu`e`al `l ekjvc`aleoy`xm uxaxo cay# Iokrio Dapax`caga ua`h `l avrovaroh uxaxojolx `uuoh bp U`xr`eg, Ym`coxmo lac hoe`u`kl `u xmo vmpu`e`alu# kxmor

ekjvoxolx moacxmearo vrknouu`klacu acukvarx`e`vaxo `l xmo ro~`oy vrkeouu, Xm`u maubool kr vraex`eo nkr jalp poaru# alh `x `u xmvrkeouu uoh bp jalp kxmor `lhovolholxvraex`eo auuke`ax`kl uor~`eo vrk~`horu,

Xmo uxaxojolx ahhoh xmax yo ma~o joxy`xm xmo Hovarxjolx kn Jalaioh Moacxm Eaalh o}vca`loh kr vrkeouu, Alh yo y`cceklx`lo xk ykrg y`xm xmo hovarxjolx kl alro~`u`klu xk kr vrkeouu xmax y`cc auuro xmohovarxjolx kn Aeeklxabcou eklx`lohekjvc`aleo y`xm acc avvc`eabco cayu alhroicax`klu,

A U`ilac M`cc @VA krhoroh bp a uxaxo roicaxkr xk uxkv u`li lkl*joh`eac vrknouu`klacu xkjago vr`kr axmkr`tax`kl earo hoe`u`klu nkrvax`olxu mau u`jcxalokucp honolhoh `xueklhex ym`co uap`li `x `u xrp`li xk roukc~o xmojaxxor,

Xmo Aeeklxabco Moacxm Earo @VA `l`x`accph`h lkx rouvklh xk rovoaxoh roqouxu nkrekjjolx nrkj Vaporu . Vrk~`horu vr`kr xk `xu

rovkrx`li kl Ai, 2 abkx xmo Hovarxjolx knJalaioh Moacxm Earou eoauo alh hou`uxkrhor, Xmax krhor yau `uuoh xk Aeeklxabcoalh l`lo moacxm vcalu `x eklxraexu y`xm#`lech`li Bco Um`och kn Eac`nkrl`a alhAlxmoj Bco Erkuu kn Eac`nkrl`a,

Aeekrh`li xk xmo krhor# Aeeklxabco Earoyau u`li xyk lkl*joh`eac vrknouu`klacu#`lech`li xmo ukl kn `xu em`on o}oex`~o kneor#Iokrio Dapax`caga# J,H,# xk jago uemhoxorj`lax`klu,

U`leo xmo `l`x`ac rovkrx# ym`em yau acukrovkrxoh kl Ai, > bp xmo `l~oux`iax`~o yobu`xo

Aeeklxabco @VA @uuou UxaxojolxRouvkluo xk HJMEu Eoauo Alh Hou`ux Krhor

Xmo Eac`nkrl`a Hovarxjolx kn @luraleo mauiralxoh (1,9 j`cc`kl xk eklxp*co~ocvrkuoexkru nkr ekjbax`li ymax `x uapu `u al`leroau`li ljbor kn moacxm alh h`uab`c`xpnrahu,

Xmo iralxu yolx xk u`} jkuxcp rbaleklx`ou `l Lkrxmorl alh Ukxmorl Eac`nkrl`a#`lech`li Cku Aliocou# Kralio alh Ual H`oikEklx`ou, Xmop ralio `l u`to nrkj dux k~or(16>#666 xk jkro xmal (>11#666,

Eac`nkrl`au uxra`loh oeklkjp mauroucxoh `l al `leroauo `l `luraleo nrahuemojou, Ckeac h`uxr`ex axxkrlopu knxol ma~onoyor roukreou ax xmo`r h`uvkuac xk imx

nrah# ua`h Eac`nkrl`a @luraleoEkjj`uu`klor Ha~o Dklou, Xmouo ahh`x`klacnlhu y`cc auu`ux h`uxr`ex axxkrlopu aerkuu xmouxaxo `l xmo klik`li imx xk ekjbax xmouoxpvou kn nrah,

@luraleo Hovarxjolx uvkgoujal Ha~oAcxmauol lkxoh xmax jkux kn xmo nrahu uoolbp m`u kneo ma~o bool earr`oh kx bp`lh`~`hacu# vr`jar`cp uoog`li xk ekccoexvapjolxu nrkj h`uab`c`xp kr ykrgoru

ekjvoluax`kl `luroru, Mo ahhoh xmaxkeeau`klaccp xmoro `u nrah `l~kc~`li joh`eairkvu kr kxmor vrk~`horu,

Xmo Kbaja Ahj`l`uxrax`kl mau ua`h xmaUkxmorl Eac`nkrl`a `u klo kn xmo lax`klumkxuvkxu nkr moacxmearo nrah, Xmo _,U,Hovarxjolx kn Moacxm alh Mjal Uor~`eoumau moch xyk ykrgumkvu `l xmo roi`kl kl xmoxkv`e u`leo 2616,

Nohorac vrkuoexkru ma~o acuk allkleoljorku arrouxu `l Eac`nkrl`a# vr`jar`cpvrk~`horu ubj`xx`li bkiu eca`ju xk xmoJoh`earo vrkiraj,

Xmo Hovarxjolx kn @luraleo ekccoexu

jklop nkr xmo iralxu `l xmo nkrj kn a 16*eolvor vorukl auuouujolx nkr o~orp `lh`~`hacolrkccoh `l a irkv moacxm kr h`uab`c`xp vcal#ekccoexoh nrkj va`h vroj`ju,

Coi`ucax`kl u errolxcp volh`li xmaxykch `leroauo xmo errolx 16*eolx*vor*voruauuouujolx xk 26 eolxu# HK@ kne`acu ua`h,

Aeekrh`li xk HK@ haxa# o~orp (1 `xeklxr`bxou xkyarh nrah `l`x`ax`~ou coahu xk(08 ykrxm kn vrkuoexabco emariou,

HK@ Vxu (1,9J Xkyarh Nrah N`imxIralxu Y`cc Nkeu kl Moacxm# H`uab`c`xp Ueajjoru

7/31/2019 Payers & Providers California Edition Issue of August 16, 2012

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!"%"(/!.)-!$.!'!$.!#*!,+*61(!2!,158?>61(!,"#9?(=?0%-!447

Vaporu . Vrk~`horu VaioKV@L@KL

Dk`l`li Al M@O Y`xmkux M`xx`li Xmo YaXmouo X`vu Eal Jago a Xr`egp @jvcojolxax`kl Oau`o

Yrol Gobor ` a jalaior y`xm Xmo Eajhol

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