CONTACTS 

SUBJECTS
Medicare Coinsurance 20% Patients Self-refer Clinical Trials Kaiser

4003 -
4003 -    ..
4004 - Summary/Objective
4005 -
400501 - Follow up ref SDS 8 0000. ref SDS 7 0000.
400502 -
400503 -
400504 -
400505 -
400506 -
400507 -
400508 -
400509 -
400511 -  ..
4006 -
4007 -
4008 - Progress
4009 -
400901 - Clinical Trials Public Policy Medicare Law Physician Referral
400902 - Public Policy Medicare Law Physician Referral Clinical Trials
400903 -
400904 - Called for Catherine, following up the call last week on 070927,
400905 - ref SDS 8 KA5J, and the letter to Lee at CMS on 071002. ref SDS 9 KA5J
400906 - Catherine's voice mail said she is traveling this week, and left a
400907 - number for James Mayhew...
400909 -                   ..
400910 -                  410 786 9244  /
400912 -  ..
400913 - Called James.
400915 -  ..
400916 - Explained background from the record on 070830. ref SDS 4 0001
400918 -  ..
400919 - James requested an email to study Millie's case for issuing clarifying
400920 - CMS guidance on clinical trial policy and procedures.
400922 -  ..
400923 - James wants Kaiser's specific explanation for clinical trials.  This
400924 - was reviewed on 070927. ref SDS 8 166L
400925 -
400926 -     [On 071004 letter to James at CMS submits background for reviewing
400927 -     clinical trial coinsurance referral issue. ref SDS 10 KA5J
400929 -  ..
400930 - "Medigap" issue is presented on page 4 in Kaiser's documents for
400931 - Senior Advantage, shown on 070927. ref SDS 8 1F6L
400933 -  ..
400934 - Legal duty for doctors to prescribe needed treatment for covered
400935 - Services, e.g., chemotherapy for oncology services, is shown in
400936 - Section 2 of Kaiser's Senior Advantage EOC reviewed on 070927.
400937 - ref SDS 8 WS6M
400939 -  ..
400940 - Clinical trials are discussed on page 68 in Kaiser's Senior Advantage
400941 - documents. ref SDS 8 1F92
400943 -  ..
400944 - There are 16 issues arising from Kaiser's failure to perform required
400945 - services, including clinical trial support in this case, and are
400946 - presented on 070927. ref SDS 8 WU6M
400948 -  ..
400949 - Research on the Internet shows...
400951 -  ..
400952 - James has a CMS presentation on drug costs....
400953 -
400954 -              http://rds.cms.hhs.gov/presentations/national_conference_DayTwo.pdf?cache=n
400956 -  ..
400957 - This could serve as a model for a presentation at Kaiser and UCSF on
400958 - coordinating referrals for clinical trials, including resolving
400959 - payment issues.
400961 -  ..
400962 - He gave another presentation to the Health Care Compliance Association
400963 - (HCCA) on 060910 Medicare Prescription Drug Part D...
400964 -
400965 -              http://www.hcca-info.org/StaticContent/06PartD.pdf
400967 -  ..
400968 - James work product shows generoous references to statutory and
400969 - regulatory authority, which is needed in this case, per review on
400970 - 070917. ref SDS 6 4Q3I
400971 -
400972 -
400973 -
400974 -
4010 -

SUBJECTS
Complex Case Management Balance Patient Needs Medicare Law CMS Contr

9303 -
9304 - 1009
930501 -  ..
930502 - Called Jullin Kwok....... 415 744 3572.
930504 -  ..
930505 - Left message for Jullin per Mark's call yesterday on 071002,
930506 - ref SDS 9 LD5L, following up contact from Catherine Windfield Jones
930507 - with CMS responding to a call on 070917. ref SDS 6 SY6K
930508 -
930509 -
930511 -  ..
9306 -
9307 -
9308 - 1703
9309 -
930901 - Communication Coordination Referral Management CMS Kaiser UCSF
930902 -
930903 - Follow up ref SDS 9 LD5L.
930904 -
930905 - Jullin returned the call to CMS from this morning, per above.
930906 - ref SDS 0 O69R  She got a message from Mark asking Jullin to review
930907 - the letter sent to Lee yesterday. ref SDS 9 Q66M  Jullin advised that
930908 - Lee faxed to her (Jullin) the letter sent to CMS yesterday, 071002,
930909 - ref SDS 9 KA5J, and following up telecon with Lee at CMS last week on
930910 - 070927, ref SDS 8 KA79, and also following up discussion with Mark
930911 - yesterday. ref SDS 9 LD5L
930913 -  ..
930914 - Jullin plans to read the fax she received from Lee, and call back with
930915 - comments on Kaiser's legal duty to pay for prescried treatment, noted
930916 - in the letter to Lee. ref SDS 9 OY4Q
930918 -  ..
930919 - Discussed the opportunity for Jullin to expedite review and facilitate
930920 - understanding complexity by reading the letter on 071002 online,
930921 - rather than the printed fax version which she received from Lee.
930922 - Jullin asked why reading email online makes understanding the case
930923 - faster than reading a printed version?
930925 -  ..
930926 - Explained benefits of instantaneous precision access for verfication
930927 - and expanding span of attention to discover context of work history,
930928 - objectives, requirements, and commitments. ref OF 13 PX6J
930929 -
930930 -        [On 071006 Knowledge Management practices explained and
930931 -        demonstrated for Paula at Kaiser MCRC unit in order to
930932 -        facilitate review making sense of complex issues in a complex
930933 -        patient history. ref SDS 11 EX8K
930935 -  ..
930936 - Jullin will request the email sent to Lee on 071002, ref SDS 9 KA5J,
930937 - in order to make a thorough review of the payment dispute between
930938 - Kaiser and UCSF in Millie's referral for treatment on clinical trial,
930939 - summarized by case study on 070830. ref SDS 4 LQ5I
930940 -
930942 -  ..
930943 - 16 Issues Matrix Patient Kaiser UCSF CMS Medicare Complex Management
930944 - Complex Management Balance Patinet Needs Medicare Law CMS Kaiser UCSF
930945 -
930946 - Jullin indicated Millie's case presents very complex problems
930947 - involving CMS contract mangement, Medicare law and regulation, Kaiser
930948 - medical obligations, UCSF billing procedures, oncology and clinical
930949 - trial practice, and obviously for Millie's health care, shown by 16
930950 - issues arrising from Kaiser's failure to pay for care after the doctor
930951 - prescribed needed treatment, as set out on 070927. ref SDS 8 WU6M
930953 -  ..
930954 - Jullin's assessment today aligns with Doctor Rugo's letter issued at
930955 - UCSF on 070906, and saying Medicare rules in Millie's case are very
930956 - complicated. ref SDS 5 I49K  Earlier on 070823 Bob Schwartz with the
930957 - UCSF Accounting Department also described the case as very
930958 - complicated.  Case study on 071020 shows medical professionals view
930959 - Millie's case as very complex. ref SDS 1 T25H
930961 -  ..
930962 - Jullin advised that she will try to respond sometime next week to
930963 - issues in this case listed on 070927, ref SDS 8 WU6M, cited in the
930964 - letter to CMS on 071002. ref SDS 9 OY4Q
930966 -  ..
930967 - Upon further discussion, Jullin indicated that she would call back on
930968 - Friday, 071005, to report progress in her review, and present a work
930969 - plan to follow up.
930970 -
930971 -        [On 071006 Paula called Kaiser MCRC received fax from CMS with
930972 -        letter to Lee on 071002, ref SDS 11 Z87L, suggesting Jullin
930973 -        sent the fax.
930975 -         ..
930976 -        [On 071009 Jullin called and said she submitted the letter to
930977 -        CMS on 071002, along with 50 pages she printed of citations in
930978 -        the letter, for "research" on whether Medicare Senior Advantage
930979 -        managed care supports physician and self referrals; her
930980 -        understanding is that Medicare law prohibits physician
930981 -        referrals, ref SDS 12 EX5J; Jullin did not say that she sent
930982 -        the letter on 071002 to Paula at Kaiser. ref SDS 12 LT7J
930984 -         ..
930985 -        [On 071010 received letter from Paula notifying Kaiser's MCRC
930986 -        unit converted Millie's letter to CMS on 071002 into a request
930987 -        for appeal of a Kaiser "determination" which Millie has never
930988 -        received. ref SDS 13 TH8L
930990 -         ..
930991 -        [On 071029 CMS policy manager plans review of 16 issues arising
930992 -        from Kaiser to pay for prescribed treatment. ref SDS 14 6N8R
930994 -  ..
930995 - Jullin's review in CMS San Francisco office will complement James'
930996 - work, per above. ref SDS 0 I34O
930998 -         ..
930999 -        [On 071029 Jullin Kwok CMS contract manager for Kaiser Medicare
931000 -        account planning to submitt written response to issues arising
931001 -        from Kaiser's failure to pay for prescribed treatment.
931002 -        ref SDS 14 VO6F
931003 -
931004 -
931005 -
931006 -
931007 -
931008 -
9311 -