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Access at Issue in Provider Cut

A new Assembly bill would exempt one type of skilled-nursing provider from state-imposed Medi-Cal reimbursement cuts. The 10% reduction is being challenged in federal court and has not taken effect.

The new bill, AB 900 by Assembly member Luis Alejo (D-Salinas), would exempt hospital-based, acute-care skilled nursing facilities from the cut. Other providers could be included in the legislation, but so far the bill deals only one kind of provider.

Hospital-based skilled-nursing facilities were singled out because the cuts will affect them more than other Medi-Cal providers, according to Jan Emerson-Shea, vice president of external affairs for the California Hospital Association.

The challenge here is that the cut to us has been portrayed as 10%, but it is really 25% or even 30%, and those acute-care, distinct-part nursing facilities are the only providers getting that kind of cut,” Emerson-Shea said. “For some reason, these cuts are based on rates in effect in 2008 and 2009. So it actually comes out to be a 25 or 30% reduction.”

Since the state recently said those cuts would be retroactive to June, 2011 and state officials would ask providers to repay that percentage, some providers could be looking at 45% reimbursement reductions over a four-year period, Emerson-Shea said.

That would be untenable for hospital-based skilled nursing facilities, she said. If those sites had to close — particularly in rural areas — that could create a serious access problem for the state.

“These are usually frail, elderly people with more complex conditions. They are not patients who can be cared for in the nursing home down the street,” Emerson-Shea said. “A lot of freestanding nursing facilities just don’t have the capability to handle these patients. So where can they go? That brings up serious concerns about access to care.”

According to Norman Williams, deputy director of public affairs for the Department of Health Care Services, it is department policy not to comment on pending litigation or legislation. However, he did say access is an important goal for the department.

“DHCS is committed to ensuring adequate access to quality health care for Medi-Cal members,” Williams wrote in an email response. “The various rate reductions approved by the federal Centers for Medicare & Medicaid Services were supported by extensive analyses conducted by DHCS. The findings showed that the approved reductions would allow California to continue to meet federal standards requiring an adequate level of access to care for members.”

Williams pointed out that DHCS has amended policies when access becomes a clear issue. “In cases where the proposed rate reductions were not supported by the analyses, the amount of the reductions was either decreased or eliminated,” he wrote.

Emerson-Shea said she has repeatedly brought up access concerns to state health care officials and she has not been satisfied with the response.

“The administration keeps asserting there are enough of these beds across the state,” she said. “There may be enough beds in Los Angeles, but someone from Plumas County can’t go to Los Angeles. The state’s taking a broad-brush approach, and that doesn’t ensure access across the state.”

AB 900 is scheduled to be heard in the Assembly Committee on Health on Apr. 30.

Related Topics

Capitol Desk Medi-Cal