Latest California Healthline Stories
Three Meetings To Address Duals Conversion
This week, the state begins a series of stakeholder meetings across California, all looking at different aspects of the ambitious task of converting more than one million people who receive both Medicare and Medi-Cal benefits — known as dual eligibles — to a more comprehensive model of care.
According to Peter Harbage, who has been leading the information-gathering component of the effort, this is an important month in the process. Now that the first wave of input has been solicited, the three meetings scheduled for December can dive deeper into the details.
“The main goal is to talk about the design of the duals demonstration project, so the state can get a better understanding what people believe the challenges and opportunities are, and what consumer protections need to be done,” Harbage said.
Three new maternity coverage laws were passed this year in California, but that doesn’t necessarily mean the people who need that coverage will get it, according to experts who gathered at a recent meeting in the Capitol Building.
“Just passing a new law we found isn’t enough,” according to Jenya Cassidy of the California Work and Family Coalition, which co-sponsored the event. “It’s also really important that you need to empower people to use the rights they have.”
According to Cassidy, many women of reproductive age who qualify for services and protections under California law aren’t aware of them.
California Hospitals Ask Courts To Halt Cuts
Some California hospitals would take a significant and long-lasting hit from Medi-Cal reimbursement cuts recently approved by CMS, according to the California Hospital Association, which this week filed a petition in federal court to put a temporary halt to those reductions.
CHA’s lawsuit and injunction request are separate from the court action taken earlier this week by the California Medical Association and other provider organizations.
“They’re two entirely different lawsuits,” Jan Emerson-Shea of CHA said. “We have filed a declaration with the court, asking the court to stop certain cuts that were approved by the CMS and were retroactive to June 1. It’s all related to the same set of cuts, but we’re suing based on the hospital cuts.”
Design Element the First Step Toward No-Wrong-Door
California took an important first step toward implementation of the Health Benefit Exchange last week when it unveiled the initial design for enrolling Californians and determining their eligibility in 2014.
The initial design of the project, called Enroll UX 2014 (UX stands for “user experience”), was presented to the Health Benefit Exchange board by project director Terri Shaw.
“We have teams from 11 states participating in the process,” Shaw said. “The objectives are two-fold — to develop a first-class user experience, and to ensure retention of consumers.”
PCIP Enrollment Could Be Capped in Two Months
State officials may need to curtail enrollment in the federally funded Pre-Existing Condition Insurance Plan in as little as two months from now, if more federal dollars aren’t allocated to it.
That was the word last week from the Managed Risk Medical Insurance Board, which oversees the federal PCIP program. It was surprising news, given its history since the program launched last year.
Every month, at every board meeting, the report was always the same — that the flow of enrollees into the program was increasing, but at a surprisingly slow rate.
Lawsuit Settlement Ends Fight Over ADHC
Really, it’s all about Esther Darling.
The 74-year-old is the poster child for adult day health care services. She had a stroke, deals with diabetes and congestive heart failure, takes multiple medications and receives care and treatment at a day center in Yolo County.
“If it wasn’t for the [ADHC] therapy, I wouldn’t be able to walk today,” Darling said. “They said I wouldn’t walk anymore, but I was determined to prove them wrong.”
Rural Critical Care Access Hospitals Could Get Hit
Health care services across the country are expecting to be slammed if the congressional debt-reduction super committee makes its deadline and submits a plan to reduce the federal deficit by Wednesday, but rural California could take a particularly big hit, according to a Washington, D.C., policy expert who spoke in Sacramento yesterday.
In addition to Medicare reimbursement rate cuts, other reduction proposals have included eliminating all rural hospital payment programs, according to David Lee, a governmental affairs expert for the National Rural Health Association.
“There are a number of possible cuts that directly affect rural health care, but this one — that all rural hospital payment programs could be abolished — has come up over and over again,” Lee said, addressing the annual conference of the California State Rural Health Association.
Closed ADHC Centers Make State’s Exempt List
The state Department of Health Care Services recently released a list of 64 adult day health care centers among roughly 300 in the state that will be exempt from the recently approved 10% reduction in Medi-Cal reimbursements. Those centers will be not be charged retroactively to June as other proividers will be, nor will they be subject to the 10% cut going forward because they serve a mostly rural population that the federal government wants to make sure gets access to care.
“These are the centers that the state feels are critical to maintaining access, in order to follow federal law,” according to Norman Williams of DHCS.
But 13 of the 64 centers on the exempt list have already closed, some of them last year.
Settlement Expected in ADHC Lawsuit
Disability Rights California is close to settling its adult day health care lawsuit against the California Department of Health Care Services, according to a joint release from the two parties.
Today’s scheduled federal court date has been moved to Thursday, by mutual agreement. But according to the joint statement, the court date may not be necessary.
“This brief court date postponement is necessary to enable the parties to finalize a settlement, the details of which will be available on Thursday,” the release said.
Judge About To Rule on ADHC Issues
Tomorrow, a federal judge is scheduled to hear the long-delayed court case challenging the state’s adult day health care transition plan.
Both sides are trying to hash out a compromise settlement. Representatives from Disability Rights California, which filed the suit, and the state Department of Health Care Services met four days last week and may talk again today in an attempt to avoid the all-or-nothing judicial decision.
The state is due to eliminate ADHC as a Medi-Cal benefit on Dec. 1. The lawsuit challenges the efficacy of the transition plan proposed by DHCS to provide necessary care for 35,000 ADHC beneficiaries.