Latest California Healthline Stories
Northern California Addresses Safety-Net Challenges
Anticipating an influx of newly insured residents in 2014 when the Affordable Care Act fully takes effect, Northern California clinics are recruiting new primary care physicians and considering how to best use mid-level providers.
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:
Report Urges Exchanges To Help Consumers Make Right Choices
When Covered California opens for business in 2014, one of the first and most important tasks will be to get people to sign up for the right coverage — a simple but crucial step in making the health benefit exchange a success, according to a new report released this week.
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.
Will Firms Cut Jobs — or Benefits — Under ACA? Weighing the Evidence
Questions continue to swirl about the Affordable Care Act’s effect on employment and health coverage, with critics suggesting that the law will lead to more part-time hiring and supporters arguing that the concerns are overblown.
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.
High Desert Hospitals Fighting for Financial Solvency
Three rural, stand-alone hospitals in the Inland Empire’s High Desert are facing serious financial challenges. Victor Valley Community Hospital in Victorville, Colorado River Medical Center in Needles and Hi-Desert Medical Center in Joshua Tree are pursuing different strategies to regain financial solvency.
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.”