Latest California Healthline Stories
Study: Pediatric Vision, Dental ACA Coverage In Limbo
California has yet to resolve several key questions about how insurers will provide pediatric dental and vision benefits under the federal Affordable Care Act, according to a new study from the California Health Benefits Review Program.
Recent state legislation helps define essential health benefits for children’s dental and vision care, “but does not clarify which ages are ‘pediatric,’ and thus eligible to use these benefits,” according to the study from CHBRP, a University of California initiative that analyzes public health issues for the state Legislature.
It’s also unclear how benefits will be handled when families purchase separate health coverage and stand-alone dental coverage, the report concludes. “These questions will need to be addressed at some point in the future in order to assist both the regulators and the carriers providing for this EHB to comply with ACA requirements,” it said.
Could Reform Initiative Affect Health Care?
Proposition 31 on California’s November ballot has some health advocates alarmed. They say it could hinder development of health programs, especially senior care options, and make existing programs more vulnerable to large cuts.
One of the big concerns about the measure, according to Steve Maviglio, a political consultant in Sacramento and former press secretary for Democratic Gov. Gray Davis, is that most people don’t know much about it.
“We haven’t heard a lot about Prop. 31,” Maviglio said. He said there is a lot of uncertainty about the measure, even among many who have studied it.
Legislature Receives Final Plan for Duals Project
This was a big week for the state Department of Health Care Services, which on Monday submitted its final version of the strategic plan for the Coordinated Care Initiative — a project in which the state eventually plans to move on million seniors and disabled “dual eligible” Californians to Medi-Cal managed care plans.
Dual-eligibles are eligible for both the Medicare and Medi-Cal programs. By meshing the two funding sources and patient services, the state plans to improve the quality of care while also saving money.
Initially, the duals demonstration project will start with eight California counties (Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara counties) and the approximately 700,000 dual-eligibles in those counties.
Ambitious Transition Plan for Healthy Families
State officials this week submitted a four-phase strategic plan to eventually move 875,000 children from the Healthy Families program into Medi-Cal managed care plans.
Health care advocates have expressed some reservations and concerns about the transition. State officials have said they’re confident they’re ready to meet the deadlines that have been set for it. The new plan hopes to simultaneously improve quality of care for children and save the state money.
It will happen quickly. On Jan. 1, the state plans to launch the first phase of the transition, shifting 415,00 of the Healthy Families kids to a managed care plan.
Physicians, Nurse Practitioners at Odds Over New Roles
It’s a time of celebration and indignation for Beth Haney, president of the California Association of Nurse Practitioners.
Last week, Gov. Jerry Brown (D) signed into law a bill that will remove a six-month waiting period for new NP graduates to write prescriptions.
However, earlier last week, the American Academy of Family Physicians came out with a policy paper that raised questions about the wisdom of expanding the scope of practice for nurse practitioners.
Governor Nixes Long List of Health Bills
Gov. Jerry Brown (D) vetoed a number of health care bills over the weekend. They ranged from a program designed to improve flu vaccinations among health care workers, to a proposal to define and promote patient-centered medical homes, to a regulation on hospital-nurse staffing ratios.
The governor had a variety of reasons he gave for the different vetoes, but at least one of those explanations didn’t make much sense, according Assembly member Henry Perea (D-Fresno). Perea is the author of AB 1000, a measure designed to make oral chemotherapy more affordable and accessible for Californians.
“While I support the author’s efforts to make oral chemotherapy treatments more affordable for the insured, this bill doesn’t distinguish between health plans and insurers who make these drugs available at a reasonable cost and those who do not,” Brown wrote in his veto message.
Access, Capacity Concerns for CBAS
California’s Community Based Adult Services program officially launches today, the culmination of a long and contentious effort to first eliminate and then replace the Adult Day Health Care program.
There were roughly 36,000 recipients of ADHC services when the governor first proposed eliminating it as a Medi-Cal benefit in January, 2011. After a long budget fight, the Legislature voted to end ADHC in May, 2011, with the proviso that a stripped-down replacement program would take its place. That plan was vetoed by the governor in June 2011, prompting a legal challenge by Disability Rights California. The settlement of that lawsuit in December 2011 led to creation of the new CBAS program.
According to Department of Health Care Services officials, about 80% of former ADHC beneficiaries now can receive CBAS benefits, which mirror ADHC services. The remaining 20% are eligible for enhanced case management services.
New Attention on End-of-Life Care
Partnership HealthPlan of California, a health insurer covering roughly 200,000 Medi-Cal beneficiaries in six Northern California counties, has decided to offer the optional benefit of palliative care to its members.
“It’s part of health care, and part of life,” said Richard Fleming, the regional medical director for PHP. “That’s why we’re arranging for greater availability of palliative care. It’s an enhanced benefit, for people before they’re in hospice.”
People in palliative care are severely ill, but don’t fall specifically into the definition of being within six months of dying. “They need a lot more medication management, and there are social issues they need help with,” Fleming said.
Is Quality Key to Cutting Long-Term Cost?
National health care reform presents an opportunity to improve the way California delivers and measures the quality of long-term care and save money along the way, according to organizers of a long-term care conference last week in Sacramento.
The long-term care population — often elders with multiple chronic conditions, multiple providers and sometimes dozens of medications — is an expensive one to treat. According to Lisa Shugarman, director of policy at the SCAN Foundation, which sponsored the conference, national reform gives California a chance to change the way it handles long-term issues.
“We are hoping to improve, not just the quality of long-term supports and services,” Shugarman said, “but also the quality of the system as a whole.”
Oversight Hearing Examines CBAS Concerns
A member of the Assembly Committee for Aging and Long-Term Care asked that the state Legislative Counsel look into variation in eligibility approvals for the state’s new adult day care program.
That was one of many concerns raised during an Assembly oversight hearing yesterday examining the state’s pending Oct. 1 implementation of much of its Community Based Adult Services program.
Toby Douglas, director of the Department of Health Care Services, which is overseeing implementation of the CBAS program, answered a number of questions from legislators about the state’s new program designed as part of a settlement of a lawsuit challenging the state’s plans following elimination of the Adult Day Health Care program.