Latest California Healthline Stories
Attorney: Decision Overdue In Suit Challenging Medi-Cal Disabled Cuts
A federal judge is “about to decide” a case with large ramifications for the developmentally disabled community. William McLaughlin, an attorney representing The Arc of California, a national disabled-rights group, said a final ruling from U.S. District Court judge Morrison England is coming “any time now.”
In a Jan. 24 hearing, McLaughlin argued for a preliminary injunction to halt the rate reductions. He contends a decision is overdue.
“We have not obtained any injunctive relief so far,” McLaughlin said, though a federal judge had issued a stay for a period of time. That stay was lifted by Judge England in August, which means providers have been absorbing the cuts since then. And not very well, McLaughlin said.
Bill Aims To Reverse 10% Provider Rate Reduction
Assembly member Luis Alejo (D-Salinas) yesterday said he wants to undo the 10% Medi-Cal provider reimbursement rate cut passed by the Legislature in 2011. The across-the-board reductions were challenged in a lawsuit still pending in federal court and have not taken effect.
California lawmakers in 2011 faced a huge budget shortfall, and this particular cut was made to save the state an estimated $50 million a month, health officials say. Physicians and other providers of Medi-Cal services have been leery of this further reduction, when California already ranks near the bottom in the nation in Medicaid reimbursement rates.
Alejo said he will expand AB 900 — a bill originally designed to reverse rate reductions to one small group of providers — to include all providers affected by the 2011 cut. That includes physicians, pharmacists, hospitals and ambulance services, he said.
“We want to really take a step back and look at the 10% cut to all providers,” Alejo said. “Medi-Cal providers in California already have some of the lowest rates in the country. We are ranked 47th in the nation right now, even before that cut.”
New Bill Proposes Insurer Fee to Expand Residencies
An Assembly committee yesterday approved a plan to provide a major boost to California’s physician-training residency programs by generating roughly $100 million a year with a $5-per-covered-life fee to be imposed on health care insurers.
The new bill is one of several legislative efforts to address a provider shortage in California that’s likely to intensify when the Affordable Care Act is implemented and Medi-Cal is expanded starting in 2014.
AB 1176, co-authored by Assembly member Raul Bocanegra (D-Pacoima) and Assembly member Rob Bonta (D-Oakland), would expand the number of resident physicians in California by an estimated 1,000 with the expectation that new physicians would remain in California and practice in the underserved areas where they fulfilled their residency training.
Pre-Existing Conditions Bill Up for Final Vote
The Senate Committee on Appropriations yesterday unanimously approved ABX1-2 by Assembly member Richard Pan (D-Sacramento), the bill to ban pre-existing conditions as a means of denial for health coverage. It now heads to the Senate floor for a final confirmation vote.
The bill already passed the Assembly, so Senate confirmation would be its ticket to the governor’s desk. Brown Administration officials have said they support the bill.
It’s the first of the set of bills in the special health care legislative session to reach the final vote stage.
Advocates Push for Expansion Compromise
The Legislature last week moved two key components of the special session bills on health care reform. SBX1-2 by Sen. Ed Hernandez (D-West Covina) and ABX1-2 by Assembly member Richard Pan (D-Sacramento) passed through committees of the opposite house. Bothbills make changes to the individual health insurance market.
The Assembly Committee on Health approved SBX1-2, and it’s now going to Appropriations; and ABX1-2 moved through the Senate Committee on Health on its way to Senate Appropriations. Both bills were approved in floor votes in their own house so they are nearing final approval.
Also last week, a Senate floor vote unanimously approved SBX1-3 by Sen. Hernandez, the bridge plan to help people move from Medi-Cal to the exchange more easily. That bill now moves to the Assembly.
Step Forward for Oral Chemotherapy Bill
The Assembly Committee on Health approved a bill Tuesday that would require health insurers to provide oral chemotherapy therapy to their members with a maximum out-of-pocket $100 co-pay per prescription. Another version of AB 219 by Assembly member Henry Perea (D-Fresno) passed the Legislature last year, but was vetoed by the governor.
“This bill would ensure cancer patients have affordable access to the most appropriate cancer treatment covered by insurers,” Perea said. “When the governor vetoed a similar bill last year, he encouraged me to work with his administration to design a policy that will work for California. AB 219 represents a new strategy to make oral chemotherapy affordable.”
According to Perea, even a fully insured patient can spend $5,000 a month on oral chemotherapy medication, while intravenous treatments are covered by a small co-pay, no matter what the drug costs. So he wants to spread the cost over the entire insured population.
The Assembly Budget Subcommittee on Health and Human Services yesterday approved the settlement over cuts to In-Home Supportive Services. The agreement reduces the severity of the cut from the original 20% proposal to its current 8% cutback.
“While we don’t celebrate any cuts,” said Frank Mecca, executive director of the County Welfare Directors Association of California, “we are in favor of the settlement agreement.”
“Eight is better than 20,” said Holly Mitchell (D-Los Angeles), chair of the subcommittee.
Assembly Bill Would Keep Adult Day Program Going
It was a watershed moment for state officials and senior health advocates in March, 2012 when California launched the Community Based Adult Services (CBAS) program, borne of a lawsuit settlement. It was an effort that calmed political waters and dealt with the 35,000 frail and elderly Californians who had been part of the eliminated program for adult day health services.
Yesterday, the Assembly Committee on Health took up the subject again, in the form of AB 518 by Assembly member Mariko Yamada (D-Davis).
The bill would codify the CBAS program, ensuring that it cannot be dropped when state health officials eventually renew the federal waiver that spawned it.
Physician Assistant Bill Clears First Hurdle
The Senate Committee on Business and Professions approved SB 352 by Sen. Fran Pavley (D-Agoura Hills), a bill designed to allow physician assistants and other providers to oversee work by medical assistants.
“MA’s are only allowed to do basic medical tasks, but if a physician’s not there on-site, then the MA can only do clerical work,” Pavley said. “Under this bill, a nurse practitioner, midwife or physician assistant can supervise them, without a physician being on the premises.”
Pavley made it a point to say the bill doesn’t change what medical assistants are allowed to do, or even what physician assistants or nurse practitioners are allowed to do.
Groups Calling for Pause in Transition
Children’s advocates last week called for a pause in the transition of kids from the Healthy Families program to Medi-Cal managed care. At a legislative hearing Thursday, advocates said the state had promised a relatively seamless transition of 860,000 children to managed care, but that gaps in coverage have already occurred — with the more-difficult phases of the transition yet to come.
The outcry was prompted, in part, when the families of an estimated 207 children who were receiving autism services through the Healthy Families program recently were told their coverage had to be stopped because of the state’s Healthy Families transition.
“From the beginning, we’ve heard assurances that there would be no loss in coverage for children, but we’re seeing it now,” said Serena Kirk, senior policy associate at Children’s Defense Fund California. She said the state’s monitoring effort isn’t working as well as it should be because it didn’t deal with the problems of these 200 families until they’d already been refused services.