Latest California Healthline Stories
Aid for Pregnant Women Pushes Through Committee
Holly Mitchell, for the first time in recent memory, was speechless.
Assembly member Mitchell (D-Los Angeles), who is known for being voluble and quick-tongued, yesterday had a bill before the Assembly Committee on Human Services.
AB 1640 is designed to allow low-income pregnant women to use TANF money (federal Temporary Assistance for Needy Families) without proving that they’re in their third trimester of pregnancy.
Hearing Focuses on Children’s Dental Care
Assembly member Richard Pan (D-Sacramento) knew the subject was a little out of the ken of the workforce committee, but that it was too important to be ignored.
“One of principles in looking at whether we have an adequate workforce is to make sure we can take care of our patients,” Pan said. “We need to take care of the oral health needs of children, and that depends, in part, on availability of coverage, and payment for those services.”
Pan, chairman of the Assembly Select Committee on Health Care Workforce and Access to Care, presided over a recent hearing on children’s oral health in Sacramento County.
Pediatric Centers Argue Retroactive Payments Don’t Make Sense
California’s 14 pediatric day health centers are a form of home health agency serving a 21-and-under population. Those are two groups exempted from the state’s 10% Medi-Cal provider rate reductions in June.
PDHC operators assumed they were exempt from that rate reduction. That notion was reinforced by the absence of PDHCs on the list of providers in the state plan amendment (SPA) that the state sent to CMS for approval of the rate decrease.
Officials at the Department of Health Care Services, when alerted about the discrepancy, recently decided that, yes, PDHCs should be exempt from that rate decrease. This was great news for the PDHCs, which operate on a tight and limited budget — except for one thing.
Counties, EDs Could Benefit from Pilot Project
California’s emergency psychiatric demonstration project, approved this week by CMS, may help counties deal with financial stress from a payment system half a century old.
“This is a great opportunity for California to participate in a demonstration that will help ensure patients receive appropriate, high-quality care when they need it most,” Norman Williams of the DHCS said. The project will provide “reimbursement to private psychiatric hospitals for certain services for which Medicaid reimbursement has historically been unavailable,” Williams said.
That is good news for counties, crowded hospital emergency departments and patients with acute psychiatric problems, according to Patricia Ryan, executive director of the California Mental Health Directors Association.
Trying To Provide Solutions to Patient Access
California is in a bit of a fix, according to Senate member Ed Hernandez (D-West Covina), chair of the Senate Committee on Health.
The state doesn’t have enough physicians and other primary care providers now, according to some estimates. That shortage will become more acute in 2014 when the Affordable Care Act brings up to four million newly insured Californians into the system, looking for providers to care for them.
“2014 is essentially here,” Hernandez said yesterday at a Senate health committee hearing on primary care workforce issues. “We have had a historic piece of legislation pass at the federal level, the most historic health legislation since the Lyndon Johnson administration, when the Medicare Act was passed. But there are a lot of unknowns still, including how to implement it.”
Caregivers make up a sizable volunteer workforce in California — people who put in about 1.7 billion hours of care last year and didn’t get paid for it. If they did, all of that work is valued at more than $20 billion. In California, where more than 10,000 people turn 65 every day, the need for that workforce will only grow.
That’s according to a raft of testimony yesterday at the Capitol Building in Sacramento, before a joint hearing of two committees: Human Services and Aging and Long-Term Care.
The state doesn’t do much for this vast and contributing population, and is about to do even less, according to Michelle Pope, executive director for Alzheimer’s Services of the East Bay, who testified yesterday before the joint committee.
Health Insurers, Physician Group Oppose Ballot Initiative
It’s not even a ballot measure yet, but it’s certainly getting ballot-measure treatment.
Yesterday, a coalition of health insurance organizations, the California Medical Association, the California Hospital Association and other groups announced they were joining forces to fight a ballot measure designed to regulate health insurance rate increases.
“This initiative does nothing to address the cost drivers in the health care system,” according to Paul Phinney, president-elect of the CMA. “I just think this initiative is the wrong idea.”
Legislature Examines Duals Transition
Toby Douglas took a good amount of heat last Wednesday at an Assembly joint hearing of the committee on Aging and Long-Term Care and the Budget subcommittee on Health and Human Services.
Douglas — director of the state Department of Health Care Services — with a full array of budget cuts, program transitions and agency reorganization on his plate, has been making presentations and fielding questions at a number of legislative hearings recently. None of them has been a cakewalk, but this hearing was a little more barbed than most.
Complaints and concerns ranged from a perceived lack of choice to worry over rapid-fire changes.
California Mandates 48 Specific Areas of Coverage
An analysis released yesterday by the California Health Benefits Review Program shows that a large cross-section of Californians — about 32 million people — will be covered by health care mandates passed by the Legislature. There are now 48 of those mandates that either require coverage or require an offer of coverage, and another five mandates that deal with more general terms and conditions of coverage.
That is not the final word on the number of mandates. CHBRP was asked to evaluate three more legislative bills recently that deal with mandated coverage of tobacco cessation, prescription drugs and children’s immunizations. In addition, some of the 16 bills the agency analyzed last year are up for approval this year. They include mandates ranging from mental health coverage to oral chemotherapy treatment.
State-passed mandates could have a financial impact on the health plans that need to cover those conditions and also may affect the list of essential health benefits offered by the California health benefit exchange.
More People May Be Eligible for Adult Day Services
There was a glimmer of good news for the 35,000 adult day health care Medi-Cal patients in California. It looks like a much higher percentage of them than previously estimated will be eligible to receive the new benefit called Community Based Adult Services.
Department of Health Care Services Director Toby Douglas originally said he expected about 50% of current ADHC patients to qualify for the new program. ADHC will be eliminated as a Medi-Cal benefit on Mar. 31 and the CBAS program starts Apr. 1.
Now it looks like 70% to 80% of those receiving the ADHC benefit will qualify for CBAS, according to Catherine Blakemore, executive director of Disability Rights California, which is monitoring the state’s assessment and placement of ADHC patients.