Latest California Healthline Stories
Call for MLR Regulation Gets Mixed Reaction
The Commonwealth Fund on Wednesday released a study on the federal medical-loss ratio rule, which concluded that regulation may need to be introduced to maximize the effect of the MLR.
“In future years, the MLR rule may need to be coupled with regulatory pressure in order for any further reductions in administrative costs to be reflected in reduced premium rates,” the study said.
That squares with the opinion from the state insurance commissioner, but the medical insurance industry does not agree.
Duals Project Edges Closer to Completion
More than 300 people attended a Department of Health Care Services seminar yesterday offering details of the duals demonstration project, also known as the Coordinated Care Initiative.
The department recently released several reports, including a draft of the care coordination and long-term services and supports readiness standards. Those guidelines are a big step toward the state’s readiness plan it eventually will need to submit to CMS, said Jane Ogle, deputy director of DHCS, at yesterday’s seminar.
The state released a summary of some of the significant details in the reports:
At-Home Nursing Services Rules Challenged
A lawsuit filed yesterday urges state health officials to alter California’s limit on adult at-home nursing services.
The limit doesn’t make sense, the Disability Rights California lawsuit said, because a higher limit would allow some beneficiaries to remain home, which would cost the state less than the price of institutionalization.
DHCS officials said the department has a policy of not commenting on pending litigation.
How Will Consumers Choose Exchange Coverage?
The Pacific Business Group on Health yesterday released the third and final installment of its comprehensive report on how to ensure that the people joining a health benefit exchange end up with the plan that works best for them.
“The whole notion of the Affordable Care Act and the establishment of the exchange is to improve the overall health care marketplace,” said Ted von Glahn, a senior director at PBGH, a not-for-profit business coalition focused on health care issues.
“If you don’t get it right when people are making those choices,” von Glahn said, “that would defeat the whole purpose of it.”
Senate Leader Asks to Slow Healthy Families Transition
California Senate President Pro Tem Darrell Steinberg (D-Sacramento) sent a four-page letter late last week to state health officials urging the state to move more slowly in its transition of approximately 860,000 children from the Healthy Families program into Medi-Cal managed care.
The letter to Health and Human Services Secretary Diana Dooley comes on the heels of several similar letters including one sent by 22 members of the U.S. House of Representatives, and another from a coalition of children’s health organizations.
The transition is scheduled to begin Jan. 1 with the first phase moving 415,000 children to Medi-Cal plans. The Healthy Families transition must be approved by CMS.
Higher Primary Care Rate Welcome News for California
Earlier this month, CMS made it official: The federal government will pay Medi-Cal primary care physicians in California at the same rate as Medicare in 2013 and 2014.
The higher rate, confirmed by CMS officials on Nov. 2, means more than just paying more to family practice, pediatrics and internal medicine physicians, said Kevin Prindiville, deputy director of the National Senior Citizens Law Center, a national legal advocacy group with an office in Oakland.
“We hope this will improve access,” Prindiville said, “and there aren’t too many things in our market-driven system that can do that.”
Uninsured Eligible for Mental Health Services
When major portions of the Affordable Care Act are implemented in 2014, almost all of the 500,000 uninsured Californians who were previously identified as being in need of mental health services will be eligible for those services, either through Medi-Cal expansion or the exchange, according to a study released yesterday by the UCLA Center for Health Policy Research.
“Last year we did a mental health report, and what we found is there are 500,000 or so people in California who are uninsured and in need of mental health services, so this year we wanted to see who among them would be eligible for coverage under the Affordable Care Act,” said Imelda Padilla-Frausto, lead author of the report released yesterday.
“We found about half of them would be eligible through expansion, and another 42% through the exchange,” Padilla-Frausto said. “That’s practically everyone. It’s a huge improvement for those adults who don’t have insurance coverage.”
No Agenda Yet for Special Session
The one-month delay in the legislative special session on health care should not affect the content of the discussion, according to Assembly member Richard Pan (D-Sacramento), who chairs the Assembly Committee on Health.
“The purpose of the special session is that there’s legislation that is really important to get passed prior to the Jan. 1, 2014 [Affordable Care Act] deadline,” Pan said. “So this will allow us to pass these bills and have them take effect prior to that time. So in [terms of the special session move from December to January], it doesn’t change anything.”
In August, Gov. Jerry Brown (D) announced he would convene a special session in the Legislature after the national election in November, to address elements of the Affordable Care Act. That special session was expected to happen sometime in December.
Advocates’ Challenge to Adult Day Process Denied
A federal judge ruled last week to deny a motion that would have forced the Department of Health Care Services to alter the way it is handling enrollment in the new Community Based Adult Services program.
The ruling means CBAS enrollment will continue without changes unless Disability Rights California, the health advocacy group that filed the motion, appeals the ruling. Deadline for appeal is Friday.
“The federal Magistrate recommended full denial of the plaintiffs’ motion regarding their concern with the state’s implementation of the Adult Day Health Care settlement agreement,” Norman Williams, director of public affairs for DHCS, said in a written statement.
Letter from Congress Focuses on Healthy Families Transition
California’s effort to move approximately 860,000 children from the Healthy Families program has drawn national attention.
Twenty-two members of the House of Representatives, including House Speaker Nancy Pelosi (D-San Francisco), last week sent a letter to state health officials, urging caution in the Healthy Families transition to Medi-Cal managed care.
The transition is slated to begin Jan. 1 when almost half the Health Families kids — about 415,000 — make the switch. The state still needs CMS approval for the plan.