Latest California Healthline Stories
Managed Care Tax Decision Left Until New Budget Proposal Arrives
Distrust ran high yesterday during part of a budget subcommittee hearing when the subject turned to reinstitution of a managed care organization tax.
The MCO tax instituted in 2009 had the singular distinction of being embraced by the ones being taxed because the money was matched by federal dollars and was used to support the Healthy Families program. In the long run, health insurers made their money back and the state had more federal dollars in its coffers.
The MCO tax expired in December. The Brown administration wants to keep it going with one big difference: Since the state eliminated Healthy Families, a transition that started in January and runs through the end of this year, the governor would like to put the MCO tax money into a rainy-day fund for the state.
Committee Votes To Repeal Medi-Cal Cut
Assembly member Luis Alejo (D-Watsonville) got a grand total of seven seconds to speak at Tuesday’s Assembly Committee on Health hearing before he was interrupted.
“AB 900 eliminates the 10% Medi-Cal reimbursement rate cuts for all Medi-Cal providers … ” Alejo started to say.
“Move the bill,” said committee member Roger Hernández (D-West Covina). And before Alejo could speak again: “Second!” said Assembly member V. Manuel Pérez (D-Coachella).
That set the tone at Tuesday’s hearing, which saw a unanimous, bipartisan approval of Alejo’s bill.
Home Services Workers Balk at Regulation
The Assembly Committee on Human Services yesterday voted to approve a bill designed to register and regulate home health care workers.
“An unknown number of independents operate without any oversight or regulation in California,” said Gary Passmore, who sits on the board of directors at the California Congress of Seniors. “AB 1217 requires both the owners and aides of the organization to pass a background check and meet basic licensure standards. … And it requires all home care aides … to be certified.”
The bill also would publish the names of workers and their occupational data on a public website, a feature that raises privacy concerns for Jennifer Gabales, director of policy, advocacy and public affairs for CAHSAH, the California Association for Health Services at Home.
Study: Insurers Are Palliative Care Innovators
Six major health insurers in California are expanding access to palliative care by providing more specialized case management and opening up the hospice benefit beyond its Medicare boundaries, according to a new study expected to be released today.
The study, “A Better Benefit: Health Plans Try New Approaches to End-of-Life Care,” is accompanied by a second paper in today’s scheduled release: “End-of-Life Care in California: You Don’t Always Get What You Want.” The two papers are funded and published by the California HealthCare Foundation, which publishes California Healthline.
The study of the six largest health plans was based on interviews with stakeholders and with health plan directors, as well as reviews of published studies and academic reports, to determine the extent of palliative care alternatives at those plans.
Money to Be Made, Saved with Biosimilars?
A heated fight has developed over legislation to regulate a biotech development that hasn’t yet hit the U.S. market. On Wednesday, the state Senate Committee on Health will take up the topic of biosimilars and the surprisingly robust debate they’ve sparked.
“Legislation like this is a typical brand ploy,” said Brynna Clark, senior director for state affairs at the Generic Pharmaceutical Association, at a Senate Business and Professions committee hearing earlier this month. “It is being pushed by companies who stand to lose $60 billion in patent [expirations]. They don’t have a compelling interest to allow competition to the marketplace.”
That’s the opposition to the bill. Now a proponent:
“Quite frankly, I am shocked at the insensitivity that has been shown to patients during this debate,” said Eve Bukowski, vice president for state government affairs at the California Healthcare Institute, a not-for-profit research and advocacy organization. For cancer patients like Bukowski, who might need biosimilars treatment and who want their physician to be informed about a change in medication, she said, “Are our opponents really suggesting this is too much to ask? … Really?”
Legislature OKs First Special Session Bills
The Assembly and Senate yesterday voted to approve two similar bills that would reform the individual health insurance market and ban pre-existing conditions as a reason for denying health insurance.
They are the first bills from the special session on health care reform to pass legislative floor votes.
The bills now must pass a procedural vote by both houses of origination before heading to the governor’s desk. The governor’s office has expressed support for the bills, so both are expected to be signed into law.
No Diversion of Mental Health Money
A Senate budget subcommittee last week rejected a plan to divert roughly $34 million a year for mental health services to a CalWORKs (California Work Opportunity and Responsibility to Kids) fund.
The California Department of Finance wanted to redistribute realignment money so half the funds currently going to mental health services would instead be shared equally between mental health and CalWORKs starting in 2015-16.
“The realignment funds going into the CalWORKs maintenance of effort subaccount are capped at $1.1 billion, at which point any additional funds, or growth over that amount, are routed to the mental health subaccount,” said Judy Bowman from the Department of Finance, at last week’s Senate Budget Subcommittee for Health and Human Services hearing. “This … would adjust that structure so that those growth funds … would instead be split evenly between the mental health subaccount and the CalWORKs maintenance of effort subaccount.”
Committee OKs ‘Culture Change’ Spending
A new bill aimed at changing the culture of long-term care in part by redirecting nursing home penalty fees passed a surprisingly controversial hearing yesterday before the Assembly Committee on Health.
AB 973 by Assembly member Sharon Quirk-Silva (D-Fullerton) would direct roughly $150,000 a year in state penalty funds collected from long-term care facility violations to be used to “change the culture” at nursing homes, Quirk Silva said.
” ‘Culture change’ usually makes you think, well, what is that?” Quirk-Silva said. In this case, she said, “Culture change means looking at a shift in how we operate in our nursing homes, toward a more person-centered change in our long-term care facilities.”
Autism Families Directed to Regional Centers
Department of Health Care Services director Toby Douglas testified yesterday that some Healthy Families participants will probably lose a type of autism service in the transition to Medi-Cal managed care plans.
The service — applied behavioral analysis — is still covered by Medi-Cal, Douglas said, but in a different way. Families with an autistic child will need to reapply for the service through the state’s regional centers, where eligibility criteria are stiffer. Some children who qualified in Healthy Families may not be eligible under new guidelines, officials said.
Douglas testified yesterday before the Assembly Budget Subcommittee on Health and Human Services. His disclosure rubbed a number of legislators the wrong way.
Complaints, Specialty Services at Issue in Healthy Families Transition
State health officials said some of the official numbers may be a little low in monitoring the transition of children from Healthy Families to Medi-Cal managed care plans.
At last week’s meeting of the Managed Risk Medical Insurance Board, MRMIB executive director Janette Casillas said that, having overseen the Healthy Families program for so long, she sees some anomalies when looking at recent transition-monitoring numbers from the Department of Health Care Services.
“My observation in reviewing the monitoring is that the data appears to be understated,” Casillas said, referring to the low number of complaints and grievances DHCS has reported it received during the transition. Casillas said the few complaints received by the department could mean the bulk of complaints are going elsewhere.