Latest California Healthline Stories
State Under Fire for Adult Service Denials, Appeals
Dana O’Callaghan, a social worker for Americare Adult Day Health Center in San Diego, accompanied a young mentally ill patient to an appeals hearing last week — one of the first of approximately 1,800 scheduled appeals of denial of Medi-Cal eligibility for California’s new Community Based Adult Services program for adult day health care.
O’Callaghan wasn’t prepared for what she saw and heard.
“I expected something informal, but when I got there, the attorneys [for the state] were so meticulous about every little thing, every word,” O’Callaghan said. “They questioned the validity of this document [I had written], they questioned my intent. It was not, let’s hear what you have to say, it was more like grilling you on what you do, the dates of your paperwork, that kind of thing.”
Health Care Task Force Starts Up
This is not your usual task force, according to Diana Dooley, secretary of the state Health and Human Services department. This one, she said, is less interested in the ideal and more focused on producing real-world results. The idea is to figure out which programs across the state improve health care and keep costs down and then encourage and support them.
Dooley was in Los Angeles yesterday to co-chair the first meeting of the health care task force created last month by Gov. Jerry Brown (D). Dooley said the first gathering could not have gone much better.
“I thought it was energized, and energizing,” she said. “It went a long way toward really substantively addressing a meaningful plan, to see what it would look like for California to be healthier in 10 years than it is today. And how do we make some real changes to improve health, lower cost and reform the delivery system. I thought it was a great start.”
Copay Proposal for Some Drugs, Emergency Visits
The Senate Committee on Budget and Fiscal Review last week approved a significantly scaled-down version of a copay proposal for Medi-Cal beneficiaries.
The Legislature last year passed a more extensive copay proposal that was projected to save $511 million in general fund dollars for the state. It called for $5 per physician visit and $50 for an emergency department visit . In February federal health care officials nixed that plan.
The current proposal would impose a copay of $3.10 for non-preferred drugs, with an exception for patients who receive those medications by mail, and a $15 copay for non-emergency use of the emergency room.
Long-Term Care Crisis Is Now, Report Says
By 2030, the number of Californians 85 and older will rise by 40% and the overall senior population will comprise about 18% of all Californians. That’s the sobering news from a fact sheet released this week by the SCAN Foundation, a not-for-profit organization that tracks long-term care issues.
“There are many changes evolving here in the state, so being able to articulate that we’re in a time of increasing need is important,” said Gretchen Alkema, vice president for policy and communications at SCAN. “We feel there will be increasing needs in the state, especially when we’re seeing a scaling-back for providing those services.”
The higher demand for senior services, particularly from the 85-plus population, coupled with budget cuts to health care programs adds up to a potentially huge problem, Alkema said. “We need to transform our systems of care, and not just for seniors because we know those long-term care needs aren’t created in a vacuum, they’re usually brought on by a number of chronic conditions.”
Smoking In Long-Term Care Facilities Debated
California already prohibits smoking inside hospital buildings, so Assembly member Wilmer Amina Carter (D-Rialto) thought it made good sense to extend that ban to long-term nursing facilities.
The often elderly, frail population at nursing facilities might need more protection from secondhand smoke than most people, Carter said at a Senate Committee on Health meeting yesterday.
“There is no safe level of exposure to tobacco smoke,” Carter said. “One lit cigarette inside a long-term health facility exposes non-smoking workers, non-smoking patients and those who visit these facilities to over 7,000 harmful chemicals, of which over 70 of these chemicals cause cancer.”
Bill Aims to Expand Number of Residency Slots
Most of the health care reform expansion effort has focused on the logistics of adding coverage for up to 3 million more Californians, but that’s just the start, according to Senate member Michael Rubio (D-Shafter). Those millions of health insurance cards won’t be worth their weight in plastic if you don’t make sure the state has the providers to take care of all of those people, he said.
“Even if we resolve the issue of health insurance,” Rubio said, “health access still is a significant issue.”
Rubio spoke on the Senate floor last week on behalf of his bill to expand the number of residency slots in California, a plan with the potential to significantly increase the number of providers in the state, he said. Setting up the infrastructure to accept private contributions for residency expansion creates an opportunity to add providers in California without using any more general fund dollars, Rubio said.
State Health Officials Intrigued by New Medi-Cal Data
Len Finocchio is a numbers guy, so he’s genuinely excited by a new set of survey data that paints a picture of recipients’ impressions of the Medi-Cal program.
“There is lots of data, lots of it,” said Finocchio, associate director of the Department of Health Care Services. “We will be continuing to mine it for a long time, to get insights about how to make the program better.”
Last week, the California HealthCare Foundation, which publishes California Healthline, released a survey of the attitudes and concerns of Medi-Cal beneficiaries. It has been a relatively long time since a similar survey was completed in 2000, so state health care officials were extremely pleased to get updated information, Finocchio said.
Duals Project Goes to CMS for Approval
It was a big moment for officials in the Department of Health Care Services.
“We are thrilled to be getting this in,” said Jane Ogle, deputy director of DHCS. “It’s a big project. So to get this in, we’re all really excited. This is the result of a year’s planning, a year of planning and work with advocates and stakeholders and within the department. And all of that comes together in this document.”
The project is the Coordinated Care Initiative, also known as the duals demonstration project, and the document is the project’s final plan, which was submitted late last week to CMS.
Flu Vaccine Bill Approved by Senate
There’s more than one kind of resistance to the flu virus.
Senate member Lois Wolk (D-Davis) found that out, and Wednesday introduced to the Senate floor a substantially reworked version of her bill, SB 1318, which would require health care facilities to meet a 90% flu vaccine health-worker compliance rate by 2015.
The bill passed on a 23-9 vote. However, that vote came at a price.
Pre-Existing Condition Reform Passes
When state Sen. Ed Hernandez introduced his bill SB 961 to the Senate floor yesterday, the West Covina Democrat’s speech was laden with the historic nature of the legislation.
“As we all know, on March 23rd of 2010, the president of the United States of America signed into law the comprehensive health care reform bill known as the Patient Protection and Affordable Care Act,” Hernandez said.
“I feel tremendous responsibility to ensure that California continues to lead the nation in implementing federal reform,” he said, “and that we serve as a model for the rest of this country.”