Inauguration Pomp, Some Substance

On Monday, the first day of the new legislative session included lots of inauguration pomp and a little substance to liven it up.

Insurance Commissioner Dave Jones (D) used the occasion of his second-term inauguration to announce a regulation to limit narrow networks and push insurers to provide timely access to care.

Gov. Jerry Brown (D), in contrast, had a relatively brief mention of health care in his inaugural speech.

“Two years ago California embraced the Affordable Care Act, dramatically increasing its health insurance coverage under the Medi-Cal program. The state will enroll 12.2 million people during this new budget year, a more than 50% increase,” Brown said.

“Providing the security of health coverage to so many Californians who need it is the right thing to do. But it isn’t free. Although the federal government will temporarily foot much of the bill, new state costs — now and more so in the future — will run into the billions.”

Sounding a note of fiscal concern does not bode well for health care requests from the Legislature in the coming budget negotiations. Brown announced he will submit a budget proposal Friday.

Insurance Commissioner’s Emergency Regulation

The emergency regulation issued Monday by Jones was designed to address concerns about narrow networks — particularly the concerns over the new insurance offering of exclusive provider organization (EPO) plans.

EPO plans have no out-of-network benefits, Jones said, and the Department of Insurance has fielded numerous complaints from consumers about them, he said.

“Health insurers’ medical provider directories have been inaccurate, misleading consumers into signing up with a health insurer for access to a doctor, specialist or hospital only to learn that these medical providers are not actually a part of the health insurer’s network,” Jones said in a release.

“Consumers have been forced to pay huge out-of-network charges when their health insurer fails to provide adequate medical providers in their network or when care is provided by out-of-network providers without even informing or asking the consent of the patient,” he said. “This emergency regulation is necessary to make sure that health insurers establish and maintain adequate medical provider networks to meet the health care needs of their policyholders, to make sure medical provider directories are accurate, and to stop the practice of surprising consumers with huge charges for out-of-network providers who provide care without the patients’ consent or foreknowledge.”

For more on the new emergency regulation, see today’s California Healthline article.

Medi-Cal Children’s Panel Meets

The Medi-Cal Children’s Health Advisory Panel on Monday had its inaugural meeting.

Last year the Legislature passed AB 357 by then-Assembly member Richard Pan to ensure the continuation of the advisory board on children’s issues within Medi-Cal.

When the panel met yesterday for the first time, the head of the Department of Health Care Services was there to voice his support of the advisory board.

“Hearing everyone’s background here, that is enormously powerful,” said Toby Douglas, director of DHCS. “This panel is a tremendous value to the department and the state.”

Many of the stakeholder groups that engage with state health officials tend to have more input from consumer advocacy groups. That is welcome and valuable, Douglas said, but there also is a need for the provider input the state will get from the new panel.

“We have had a lot of stakeholder engagement over the years, but what we don’t have as much in the department is what you bring here, the real-life experience,” Douglas said. “Where you stand is with the kids you see every day, so bringing what you’re seeing every day, that is going to be very important to the department.”

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