Including PACE in Dual Eligible Options
Legislators are about to weigh in on one detail of the state’s dual-eligible pilot program known as the Coordinated Care Initiative: An Assembly bill calling for the inclusion of a popular program for Californians at-risk of nursing home care is up for a vote on the Senate floor.
AB 2206 by Toni Atkins (D-San Diego) would require the Department of Health Care Services to include PACE — the Program of All-Inclusive Care For The Elderly — as one of the alternatives to Medi-Cal managed care in the eight counties where the CCI pilot is starting.
The bill cleared its last committee obstacle, the Senate Committee on Appropriations on Monday, on a 7-0 vote. It has now been introduced on the Senate floor and a floor vote on it is expected soon.
Nearing Consensus on Dense Tissue Bill
In case you missed it, yesterday was the day to ask people if they’re dense. The Legislature last session officially approved Aug. 8 as Are You Dense Day. Not surprisingly, the occasion yesterday marked the reintroduction of a bill that would notify women if their dense breast tissue might interfere with mammogram results.
SB 1538 by Joseph Simitian (D-Palo Alto) has passed the Legislature before despite opposition from provider groups. Last year the governor vetoed it.
“Dense breast tissue can appear white in a mammogram, and cancer can appear white in a mammogram,” Simitian said at yesterday’s Assembly Committee for Appropriations hearing.
California’s LIHP a Big Success
The Low Income Health Program, launched 20 months ago, already has more than 400,000 Californians signed up. Health care experts gathered in Sacramento yesterday to discuss one of the successes in California’s health reform effort.
“We hear about a lot of issues people have, but the issue that rises to the top is the LIHP,” said Agnes Lee, health policy advisor to the Assembly speaker’s office.
“Among the doom and gloom of the state budget, there is a bright spot out there. LIHP is one of those rare examples of an innovative, forward-thinking program … and this is something the nation is definitely looking at, as something significant,” Lee said at yesterday’s conference, “Low Income Health Program: Evolution,” sponsored by the Blue Shield of California Foundation.
Appropriations Committee OKs Oral Chemo Bill
The Senate Committee on Appropriations yesterday approved AB 1000 by Henry Perea (D-Fresno), which requires insurers to cover oral chemotherapy medication.
“It’s a big day for cancer patients in California,” Assembly member Perea said. “We’ve been working on this since the beginning of last year, and it’s been a hard fight, the insurance companies have come out firing at it.”
Overall, it was a busy day for the Appropriations committee and the Legislature, which returned from summer recess yesterday. The current session only lasts for the next few weeks, before going on final recess — so the legislative docket will be full this month. The Legislature has until Aug. 31 to pass all bills for the year.
Exchange Maps Out Plan for Next Year
The state Health Benefit Exchange board finalized and submitted its request to federal officials for a $196 million Level 1.2 establishment grant — essentially mapping out the exchange’s plans over the next year.
Exchange executive director Peter Lee made the announcement at the board’s July 19 meeting in Oakland.
“We have submitted our establishment funding grant, what we call our Level 1.2 grant, to ensure our continued building of our state-based exchange,” Lee said. “The funding request itself is a demonstration of the partnership that is so vital to the success of the exchange.”
State Delays Not-for-Profit Requirement for Adult Day Centers
The Department of Health Care Services extended the not-for-profit deadline for potential providers of the Community Based Adult Services program.
Organizations providing adult day health care services now have until Jan. 1, 2013 to become not-for-profit, a new stipulation by the state to be eligible to receive Medi-Cal funding. The previous deadline was July 1, 2012.
The six-month delay in establishing not-for-profit status was done, in part, because the state will need a substantial number of former Adult Day Health Care providers to become CBAS providers.
First We Need To Agree on the Problem, New Jersey Doc Says
Jeff Brenner, a physician in Camden, New Jersey, is deeply frustrated by the health care system in America.
“The bulk of federal debt is health care,” Brenner said. “It’s 18% of the economy, and we’re exploding on a sea of debt. And it’s the system itself. It’s the system and the rules we’ve made. The system is headed for crisis and the question is, how fast will it get there.”
“The problem is, we don’t have a common agreement about what’s causing the problem, so we can’t bend the cost curve if we don’t agree on the problem,” said Brenner, founder and executive director of the Camden Coalition of Healthcare Providers.
Insurers Must Pay Rebates, Cover Women’s Services
Nearly two million California consumers and small business owners will get money back on their health insurance premiums this month because of new federal and state statutes requiring insurers to use at least 80% of their premium dollars for patient care. For employers with more than 51 covered employers, the threshold is 85%. Insurers will return almost $74 million in California.
Another Affordable Care Act requirement goes into effect today ensuring women receive eight types of preventive and diagnostic care in their health coverage, including breastfeeding support services.
The California rebate average of about $65 per person might not be much individually, but it could mean quite a bit to small-business employers, according to Anthony Wright, executive director of Health Access California.
DHCS Director Douglas Rejects Another Judicial Decision
Toby Douglas, director of the Department of Health Care Services, has rejected another proposed decision by an administrative law judge over an appeal of eligibility for the Community Based Adult Services program. According to stakeholders, it is the first rejection based on eligibility criteria.
Douglas earlier had rejected — or “alternated” as it’s known in the appeals system — two other proposed decisions based on the legal question of whether the department had the right to reverse face-to-face assessments of eligibility by nurses. After a Department of Social Services administrative law judge issued a proposed decision that DHCS did not have that right, Douglas disagreed, and rejected those proposed decisions.
In a more recent case, Douglas rejected an appeal based not just on the singular legal question but on the merits of the individual case, according to Elissa Gershon, a Disability Rights California attorney.
Access, Clinic Finances, ED Overuse All Major Concerns for CMA
With health care reform and the state’s cutbacks and reorganization of its health care system, the practice of medicine in California is about to undergo major changes. California Medical Association officials have serious concerns about some of those changes.
“Yes, we are in a budget crunch, and yes, money is tight,” said Doug Brosnan, an emergency department physician and a member of the CMA’s board of trustees. “But there is suffering. Patients are suffering because they lack access to basic services.”
Brosnan was part of a group of CMA officials who met with reporters on Friday in Sacramento to talk about California’s recent spate of budget cuts to health programs and the outlook for reform after the Supreme Court’s decision to uphold most of the Affordable Care Act. CMA officials said they are concerned about the state’s efforts to reorganize existing services — such as the duals demonstration project, or the shift of 873,000 children from the Healthy Families program to Medi-Cal managed care.