Big Changes in Store for Academic Medicine?
The financial pressure on academic medical centers has never been more intense than it is now, according to Mark Laret, CEO of UC-San Francisco Medical Center and outgoing chair of the Association of American Medical Colleges. The association, representing 141 medical schools across the country, held its annual meeting over the weekend in San Francisco.
“We have tried to use clinical income to make up for budget losses [that used to support medical schools],” Laret said. “And now that NIH (National Institutes of Health) budgets have flattened, that’s putting more pressure on, too, and increasingly we’ve had to use clinical income to support research, as well.”
In the recent past, Laret said, academic medicine has absorbed the decline in financial support for medical schools and research, but that’s changing, he said.
Healthy Families Notices Sent, Now Federal Approval Needed
The state late last week sent 415,000 notices to inform Healthy Families participants they will need to switch to Medi-Cal managed care plans on Jan. 1.
At the same time, almost two dozen organizations, including the California Medical Association, sent a letter to lawmakers and state health officials asking for a delay in the conversion for 880,000 children in California.
The 60-day notices went out on Thursday and Friday last week, according to officials at the Department of Health Care Services. That officially starts the clock ticking on the Healthy Families transition.
New Name, New Website for Exchange
California consumers will be able to get a strong picture of Covered California, the newly named package of health insurance offerings from the Health Benefit Exchange when the state launches a new website next month, according to exchange officials.
“We’ve been targeting the new website by the end of this year, but I’m optimistic we’re looking at Dec. 1 for the launch of that,” said Oscar Hidalgo, director of communication and public affairs at the exchange. “We might take a pause for stakeholder input, because we always like to run things by stakeholders before going public, but we’re hopeful it will be online at the start of December.”
The Covered California brand name and logo, chosen at Tuesday’s exchange board meeting, will be highlighted in the new site.
Exchange Picks New Name: Covered California
The California Health Benefit Exchange board voted Tuesday to adopt a new name for the health insurance coverage it will offer starting January 2014 — Covered California.
The decision comes after months of work. In August, the long list of potential names was winnowed to about a dozen possible names — including CaliHealth, CalAccess, Wellquest, PACcess and Covered California. The list alos included unusual trademark names such as Ursa, Healthifornia, Eureka, Beneficia, Cal-Vida and Condor, as well as the crowd favorite, Avocado.
After designing logos, holding focus group meetings and running trademark searches, that list was cut down to four finalists in September: Ursa, Eureka, CaliHealth and Covered California. Trademark concerns emerged around Ursa and CaliHealth, and those names were dropped, said Chris Kelly, who made the final name presentation to the exchange board.
Payments Delayed to CBAS Centers
California centers that offer adult day services are having trouble getting reimbursed for services provided to Medi-Cal beneficiaries under the state’s new Community Based Adult Day Services program launched on Oct. 1.
“We are not getting paid. And I don’t know when we will get paid. I’m not expecting anything at this point,” said Manooch Pouransari, who runs the Grace Adult Day Health Care center in Santa Clara.
“My experience is similar to many other centers,” he said. “We haven’t been told who to bill, where to bill, how to bill. And we found the same thing on their side, the MCOs (managed care organizations), they don’t know any of that, either.”
Assembly Committee Examines State’s Moves to Medi-Cal Managed Care
The Assembly Committee on Health last week asked for a progress report and assurances from Department of Health Care Services officials that the state was not only ready to move many Medi-Cal beneficiaries into managed care, but also ready to evaluate the process.
“The purpose of this hearing is to focus on what’s happening with the outcomes and evaluations of our various transitions,” said the new chair of the Assembly Committee on Health, Richard Pan (D-Sacramento).
“There are four major transitions in California — the SPDs [seniors and persons with disabilities], the dual eligibles project [also known as the Coordinated Care Initiative, or CCI], taking our Healthy Families program into managed care and taking our rural communities into managed care, as well,” Pan said. “So there is certainly a lot of movement going on.”
State Initiates Expedited Hearing Process for Adult Day Services Appeals
When the Department of Health Care Services launched its new Community Based Adult Services plan at the start of October, more than 2,000 people who had been denied services were still waiting for their eligibility appeal hearings.
Now DHCS officials say almost all of what is now a total of 2,500 eligibility appeals will be heard by Department of Social Services’ administrative law judges by the end of November.
That means roughly 2,000 cases will have been heard in just over two months — almost 200 administrative law hearings a week.
State Makes It Possible to Opt Back In to Managed Adult Day Services
Next week, the state’s new Community Based Adult Services program will be withdrawn from about 5,000 Californians who are eligible for the program because those people chose to opt out of Medi-Cal managed care — which is a requirement for receiving CBAS services.
State officials said some of those 5,000 people, many of whom are eligible for Medicare, may have opted out under false assumptions about Medi-Cal managed care. Many physicians and beneficiaries are under the impression that beneficiaries would have to give up their doctor, or that their doctor would somehow lose out on Medicare payments — and those false assumptions have led to some of those opt-outs, state officials said.
“We are concerned that some people may not be fully aware of the ramifications of their decision to stay in fee-for-service,” said a DHCS press release. “We believe that some of them have received erroneous information that suggested their move to managed care would affect their ability to continue seeing their Medicare primary care physician.”
How to Deal With Remaining Millions Uninsured
Health care experts gathered in Sacramento this week to take on the thorny issue of what to do about the estimated 3.1 million to 4 million Californians who will remain uninsured after five years of implementation of the Affordable Care Act.
The symposium, held on Monday and sponsored by the Insure the Uninsured Project, focused on what to do about the new estimate of uninsured in California.
Last month, the UC-Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research issued a joint report, “After Millions of Californians Gain Health Coverage under the Affordable Care Act, Who Will Remain Uninsured?”
Premium Reduction Approved for State High-Risk Coverage
Change is coming for the 5,823 current enrollees in California’s Major Risk Medical Insurance Program, and it’s change they’re going to feel in their pockets.
Premium rates are about to go down to match the rates paid in the similar federal program, the Pre-Existing Condition Insurance Plan.
The Managed Risk Medical Insurance Board, which oversees the state plan, voted last week to adopt the new premium rate cut that was made possible by a new state law.