New Location for Patient Advocate and DMHC

The Legislature on Friday approved AB 922  by Bill Monning (D-Carmel), which expands the work of the Office of the Patient Advocate, providing a single source to help people with all of their health insurance questions when major health care reform changes come into play in 2014.

The bill raised some eyebrows with a late amendment, one that moves the Department of Managed Health Care to a different agency.

The question of where the Patient Advocate position would be housed is politically charged. Originally established in the Business, Transportation and Housing agency, with its expanded role in the Affordable Care Act, OPA clearly needed to be more closely allied with a government agency that deals with the health care reform law.

The question was: Would that move be to the Department of Insurance, which regulates part of the health insurance market, or to the Department of Health and Human Services, which is coordinating the state’s reform effort?

The decision was complicated by the fact that the Patient Advocate office is part of the Department of Managed Health Care, which also oversees health insurance regulation in California.

This bill originally had the OPA moving to HHS. The late amendment to the bill moved the whole DMHC agency along with it.

“It is a little odd,” Anthony Wright of Health Access California said, “that the big sister is following the little sister over to another agency.”

But, according to Wright, it’s a better fit than Business, Transportation and Housing.

“Part of the benefit of the Knox Keene Act is that it actually focuses on health, on getting people access to care, that it goes beyond a pure business function,” he said. “The [BT & H] agency secretary gets up in the morning, and what they’re thinking about is how can we get the administrative tools to build more roads, build more housing … rather than a secretary who wakes up thinking about getting health care to people who need it.”

The big question in the debate has been whether or not it might be an even better fit to have the Department of Insurance taking over the health insurance part of the health reform equation. With the DMHC moving to HHS, that may be a move that is now less likely.

The Department of Insurance had no comment on passage of AB 922, or its amendment.

“Under the current scheme,” bill author Monning said, “you have 8 or 10 different numbers in the state people can call, and it can be confusing.  Under federal reform, we’re required to have an ombudsman in place, and this bill does that, so anyone can access the office and be given informed advice.”

Aligning the Patient Advocate within HHS, and also bringing DMHC into HHS, will help with coordinating information and presenting it properly, especially in dealing with communities with language issues, Monning said.

“If you tried to duplicate that in different agencies,” Monning said, “it would be duplicative, costly and bureaucratic. The OPA is not designed to take any regulatory authority away from anywhere. I think it actually will facilitate getting people to the right place, including the Department of Insurance. It will, in fact, get them to the complaint line if that’s what they need.”