Latest California Healthline Stories
Legislature OKs First Special Session Bills
The Assembly and Senate yesterday voted to approve two similar bills that would reform the individual health insurance market and ban pre-existing conditions as a reason for denying health insurance.
They are the first bills from the special session on health care reform to pass legislative floor votes.
The bills now must pass a procedural vote by both houses of origination before heading to the governor’s desk. The governor’s office has expressed support for the bills, so both are expected to be signed into law.
No Diversion of Mental Health Money
A Senate budget subcommittee last week rejected a plan to divert roughly $34 million a year for mental health services to a CalWORKs (California Work Opportunity and Responsibility to Kids) fund.
The California Department of Finance wanted to redistribute realignment money so half the funds currently going to mental health services would instead be shared equally between mental health and CalWORKs starting in 2015-16.
“The realignment funds going into the CalWORKs maintenance of effort subaccount are capped at $1.1 billion, at which point any additional funds, or growth over that amount, are routed to the mental health subaccount,” said Judy Bowman from the Department of Finance, at last week’s Senate Budget Subcommittee for Health and Human Services hearing. “This … would adjust that structure so that those growth funds … would instead be split evenly between the mental health subaccount and the CalWORKs maintenance of effort subaccount.”
Committee OKs ‘Culture Change’ Spending
A new bill aimed at changing the culture of long-term care in part by redirecting nursing home penalty fees passed a surprisingly controversial hearing yesterday before the Assembly Committee on Health.
AB 973 by Assembly member Sharon Quirk-Silva (D-Fullerton) would direct roughly $150,000 a year in state penalty funds collected from long-term care facility violations to be used to “change the culture” at nursing homes, Quirk Silva said.
” ‘Culture change’ usually makes you think, well, what is that?” Quirk-Silva said. In this case, she said, “Culture change means looking at a shift in how we operate in our nursing homes, toward a more person-centered change in our long-term care facilities.”
Autism Families Directed to Regional Centers
Department of Health Care Services director Toby Douglas testified yesterday that some Healthy Families participants will probably lose a type of autism service in the transition to Medi-Cal managed care plans.
The service — applied behavioral analysis — is still covered by Medi-Cal, Douglas said, but in a different way. Families with an autistic child will need to reapply for the service through the state’s regional centers, where eligibility criteria are stiffer. Some children who qualified in Healthy Families may not be eligible under new guidelines, officials said.
Douglas testified yesterday before the Assembly Budget Subcommittee on Health and Human Services. His disclosure rubbed a number of legislators the wrong way.
Complaints, Specialty Services at Issue in Healthy Families Transition
State health officials said some of the official numbers may be a little low in monitoring the transition of children from Healthy Families to Medi-Cal managed care plans.
At last week’s meeting of the Managed Risk Medical Insurance Board, MRMIB executive director Janette Casillas said that, having overseen the Healthy Families program for so long, she sees some anomalies when looking at recent transition-monitoring numbers from the Department of Health Care Services.
“My observation in reviewing the monitoring is that the data appears to be understated,” Casillas said, referring to the low number of complaints and grievances DHCS has reported it received during the transition. Casillas said the few complaints received by the department could mean the bulk of complaints are going elsewhere.
Attorney: Decision Overdue In Suit Challenging Medi-Cal Disabled Cuts
A federal judge is “about to decide” a case with large ramifications for the developmentally disabled community. William McLaughlin, an attorney representing The Arc of California, a national disabled-rights group, said a final ruling from U.S. District Court judge Morrison England is coming “any time now.”
In a Jan. 24 hearing, McLaughlin argued for a preliminary injunction to halt the rate reductions. He contends a decision is overdue.
“We have not obtained any injunctive relief so far,” McLaughlin said, though a federal judge had issued a stay for a period of time. That stay was lifted by Judge England in August, which means providers have been absorbing the cuts since then. And not very well, McLaughlin said.
Bill Aims To Reverse 10% Provider Rate Reduction
Assembly member Luis Alejo (D-Salinas) yesterday said he wants to undo the 10% Medi-Cal provider reimbursement rate cut passed by the Legislature in 2011. The across-the-board reductions were challenged in a lawsuit still pending in federal court and have not taken effect.
California lawmakers in 2011 faced a huge budget shortfall, and this particular cut was made to save the state an estimated $50 million a month, health officials say. Physicians and other providers of Medi-Cal services have been leery of this further reduction, when California already ranks near the bottom in the nation in Medicaid reimbursement rates.
Alejo said he will expand AB 900 — a bill originally designed to reverse rate reductions to one small group of providers — to include all providers affected by the 2011 cut. That includes physicians, pharmacists, hospitals and ambulance services, he said.
“We want to really take a step back and look at the 10% cut to all providers,” Alejo said. “Medi-Cal providers in California already have some of the lowest rates in the country. We are ranked 47th in the nation right now, even before that cut.”
New Bill Proposes Insurer Fee to Expand Residencies
An Assembly committee yesterday approved a plan to provide a major boost to California’s physician-training residency programs by generating roughly $100 million a year with a $5-per-covered-life fee to be imposed on health care insurers.
The new bill is one of several legislative efforts to address a provider shortage in California that’s likely to intensify when the Affordable Care Act is implemented and Medi-Cal is expanded starting in 2014.
AB 1176, co-authored by Assembly member Raul Bocanegra (D-Pacoima) and Assembly member Rob Bonta (D-Oakland), would expand the number of resident physicians in California by an estimated 1,000 with the expectation that new physicians would remain in California and practice in the underserved areas where they fulfilled their residency training.
Pre-Existing Conditions Bill Up for Final Vote
The Senate Committee on Appropriations yesterday unanimously approved ABX1-2 by Assembly member Richard Pan (D-Sacramento), the bill to ban pre-existing conditions as a means of denial for health coverage. It now heads to the Senate floor for a final confirmation vote.
The bill already passed the Assembly, so Senate confirmation would be its ticket to the governor’s desk. Brown Administration officials have said they support the bill.
It’s the first of the set of bills in the special health care legislative session to reach the final vote stage.
Advocates Push for Expansion Compromise
The Legislature last week moved two key components of the special session bills on health care reform. SBX1-2 by Sen. Ed Hernandez (D-West Covina) and ABX1-2 by Assembly member Richard Pan (D-Sacramento) passed through committees of the opposite house. Bothbills make changes to the individual health insurance market.
The Assembly Committee on Health approved SBX1-2, and it’s now going to Appropriations; and ABX1-2 moved through the Senate Committee on Health on its way to Senate Appropriations. Both bills were approved in floor votes in their own house so they are nearing final approval.
Also last week, a Senate floor vote unanimously approved SBX1-3 by Sen. Hernandez, the bridge plan to help people move from Medi-Cal to the exchange more easily. That bill now moves to the Assembly.