Latest California Healthline Stories
Anthem, Jones Spar Over Premium Rate Hikes, Reinsurance Fee
California Insurance Commissioner Dave Jones yesterday said a recent rate submission by Anthem Blue Cross was “unreasonable” and took particular issue with Anthem’s plans to charge a reinsurance fee which Jones said forces small businesses to pay for a 2014 fee a year early, in 2013.
Anthem Blue Cross officials said Jones’ numbers are off and that the reinsurance fee is a benign and standard business practice which has been used for many years without complaints from government or advocates.
“I’ve concluded that the rate increase imposed by Anthem Blue Cross on its small employers customers is unreasonable,” Jones said. He said the average rate increase of 10.6% is not justified given the data submitted to the Department of Insurance by Anthem.
More California Kids Need Sealant, Study Says
A national study released today by the Pew Center on the States, part of the Pew Charitable Trusts, grades every state’s level of adherence to a basic preventive dental procedure for children — the application of dental sealant. California earned a “C.”
Dental sealant is vital for children, particularly for youngsters who don’t get regular dental care, according to Bill Maas, policy advisor to the Pew Children’s Dental Campaign.
“The most cavity-prone area is the molars, and the top surface of the teeth, and that’s what sealant helps protect,” Maas said. He said providing sealant is a simple way to reach a large number of at-risk children. “In places where we know there’s a concentration of [at-risk] children,” he said, “we can bring that to them very efficiently.”
How Can Hospitals Thrive in Future?
The first step in dealing with complex financial and care issues faced by community hospitals is to get people engaged and talking about them, according to the organizers of tomorrow’s online “Future of the Hospital” game. People will compete to present the most cogent and worthwhile ideas for improving hospitals in California and the nation.
Starting tomorrow morning and running for 24 hours, the Institute for the Future is putting on an online forecasting competition to prompt possible solutions for community hospitals with a discussion involving as many people as possible. The event is co-sponsored by the California HealthCare Foundation, which publishes California Healthline.
“As federal funding for hospitals nationwide dwindles, so does our ability to access basic care in hospitals,” said Jean Hagan, an executive producer for the Institute for the Future. “Our emergency medical system is over-burdened, underfunded and fragmented. The statistics are frightening.”
State Delays Adult Day Center Not-for-Profit Requirement
The requirement that adult day health care centers become not-for-profit operations has been delayed at least a year, according to Department of Health Care Services officials.
A Dec. 31 letter to centers caring for the frail and elderly population in the Community Based Adult Services program said “DHCS has decided to postpone until further notice and no sooner than January 1, 2014, the implementation of the requirement restricting CBAS providers to Non-Profit legal status.”
About two thirds of California’s 250 adult day centers are for-profit entities, according to state officials. Putting as many as 186 centers through the complexity of a not-for-profit conversion was a little too much for the state and the centers, according to Jane Ogle, deputy director for DHCS.
CMS Meets Deadline for Approving Healthy Families Transition
Tight up against the end-of-year deadline, CMS officials on Dec. 31 granted approval of California’s plan to move 860,000 Healthy Families children into Medi-Cal managed care programs.
Federal officials asked for changes to the transition plan, including more frequent monitoring and evaluation of the transition to better ensure children are able to access primary care physicians under the new plan.
The first phase of the transition started Tuesday, Jan. 1.
Sonoma Center Facing State Sanctions
The California Department of Public Health took a major step this week toward decertifying and revoking the license of the intermediate care facility at Sonoma Developmental Center.
The Sonoma facility, which serves 290 people with intellectual disabilities, is expected to appeal the state action.
The original survey in July by the Department of Public Health found 57 deficiencies, and four instances of immediate jeopardy to residents. The facility had two three-month periods to correct those problems. According to CDPH officials, time is up.
State Plans Retroactive Payment Rate Hikes
The good news for primary care physicians is the federal program to raise Medicaid reimbursement rates starts Jan. 1.
The bad news is Medi-Cal providers in California may have to wait several months to retroactively receive the higher payment.
California health officials have to wait for federal approval of a state plan amendment, which will take time, said Norman Williams, deputy director of public affairs for the Department of Health Care Services.
Healthy Families Set for January Transition
State health officials have made it clear that the first phase of the Healthy Families transition to Medi-Cal managed care will go on as scheduled, beginning Jan. 1. Children’s health advocates say they will do everything to support that effort while still keeping a careful eye on its progress.
The first phase of the transition will move about 415,000 children into Medi-Cal — almost half the 860,000 children enrolled in Healthy Families. The transition is dependent on federal approval by CMS within three weeks.
“We have said consistently that the state isn’t quite ready yet,” said Wendy Lazarus, the founder and co-president of The Children’s Partnership, a national not-for-profit children’s advocacy group based in Santa Monica. “So, yes, it would be good if CMS reached the same conclusion.”
Time Running Out To Opt Back In to Adult Day Program
About 4,400 frail and elderly Californians who qualified for Community Based Adult Services opted out of the managed care program to remain in traditional fee-for-service care. Less than three weeks remain for them to change their minds.
On Dec. 31, the state Easy-Way-Back program will close, and those “opt-outs” who declined Medi-Cal managed care will officially forfeit their CBAS benefits, according to Norman Williams, director of public affairs for the Department of Health Care Services.
The opt-outs — or the providers who are advising them to opt out — may be operating on false assumptions, Williams said in a written statement.
Forum Explores Dealing with Chronic Care Under ACA
Chronic health conditions remain one of the contributing factors to financial and utilization strain on the health care system, and there are a number of steps that can be taken to address them, according to a panel of experts that met recently in San Jose.
The forum, called “Chronic Disease: A Common Sense Approach to Solving Complex Health Issues,” was held Nov. 27 and hosted by the Partnership to Fight Chronic Disease. The moderator, Ken Thorpe, chairman of the partnership, said dealing with chronic conditions may be the most important health care concern of our time.
“We all know the prevalence of obesity has doubled since the early 1980s, and that doubling of obesity accounts for about 10% of health costs in this country,” Thorpe said. “Because the rise in prevalence of obesity has contributed to the rise in diabetes, as well as hyperlipidemia, hypertension and other related chronic health conditions.”