Latest California Healthline Stories
New Survey Offers First Data on Managed Care Shift
A survey released yesterday revealed strengths and weaknesses in the state’s 2011 transition of about 172,000 seniors and persons with disabilities into Medi-Cal managed care plans.
Two-thirds of the responding beneficiaries said their care was the same or better than it had been before the transition but the survey raised concerns on several fronts, most notably a lower level of notification and communication, according to Carrie Graham, assistant director of research at Health Research for Action at UC-Berkeley School of Public Health. Health Research for Action conducted the survey in partnership with the California HealthCare Foundation, which publishes California Healthline.
The survey reached 1,521 Medi-Cal-only respondents who transitioned into managed care between June 2011 and April 2012. Graham said there was a 59% response rate to the survey.
Duals Demonstration Gets Green Light
CMS and California health officials yesterday announced they agree on a framework for the launch of the duals demonstration project starting as soon as October.
About 456,000 Californians who are dually eligible for Medicare and Medi-Cal coverage in the eight demonstration counties will be qualified to participate in the duals project.
State officials announced yesterday the project will be launched under the name Cal MediConnect.
Access at Issue in Provider Cut
A new Assembly bill would exempt one type of skilled-nursing provider from state-imposed Medi-Cal reimbursement cuts. The 10% reduction is being challenged in federal court and has not taken effect.
The new bill, AB 900 by Assembly member Luis Alejo (D-Salinas), would exempt hospital-based, acute-care skilled nursing facilities from the cut. Other providers could be included in the legislation, but so far the bill deals only one kind of provider.
Hospital-based skilled-nursing facilities were singled out because the cuts will affect them more than other Medi-Cal providers, according to Jan Emerson-Shea, vice president of external affairs for the California Hospital Association.
Concern Over Retroactive Medi-Cal Cut
State lawmakers last week got a reply to their long-held question about a 10% Medi-Cal provider reimbursement rate reduction — and they didn’t much like the answer.
At an Assembly budget subcommittee hearing last week, the testimony turned to what would happen if a federal appeals court rules in favor of the state’s effort to cut Medi-Cal reimbursement rates to providers by 10%.
Assembly member Holly Mitchell (D-Los Angeles) asked the director of the Department of Health Care Services, Toby Douglas, a question that has haunted provider groups facing the large rate reduction.
Committee Votes to Remove Limits on Coverage for UC Students
The Assembly Committee on Health last week voted to halt caps on health care coverage for some UC students. Currently, coverage for the roughly 135,000 students covered by UC plans runs out at $400,000, which can be catastrophic to students who develop rare and severe conditions, such as brain cancer.
“We want to make sure that UC students receive the same reforms as are in the Affordable Care Act,” said Assembly member Richard Pan (D-Sacramento), author of AB 314, which passed the Assembly Committee on Health last week by a 13-4 vote. Under the Affordable Care Act, caps on care cost have been removed.
“We want to ensure, if [UC students] get a serious illness like cancer, they’re not left without care,” Pan said.
Fate of Special Session Bills in Limbo
The California Legislature went on spring recess yesterday with the work of the special legislative session on health care still undone.
Proponents of the special session bills hoped to get them through a floor vote by now. One of the reasons the governor called the special session was to get bills passed in time to help set the stage for full implementation of the Affordable Care Act.
There are six bills, total, as three mirror-image proposals make their way through both houses.
Concerns Aired Over Health Bridge Bill
The Senate Committee on Health yesterday passed SBX1-3 by Sen. Ed Hernandez (D-West Covina) on an 8-0 vote.
“This bill would establish a bridge plan for the health benefit exchange, which we now know as Covered California,” Hernandez said. “It will allow people to move from coverage to coverage within the exchange.”
When beneficiaries have a change in family size or income, their eligibility to qualify for certain subsidies within the exchange can change, Hernandez said. The bridge plan tries to make it easier for those people and their families to maintain the same health plan and provider network, even when circumstances change, and that would cut down on churning (administrative upheaval caused when people move from plan to plan), he said.
Settlement Called ‘Less Harmful’ for In-Home Support Recipients
California officials and disability rights advocates yesterday announced a settlement of a lawsuit challenging a 20% budget trigger cut in In-Home Supportive Services care.
The settlement allows an 8% reduction this year and a 7% reduction in 2014. It also changes the cuts from permanent to temporary.
The size and timing of the cuts are based, in part, on a current 3.6% IHSS cut established in 2009. That reduction will remain in effect, and an additional 4.4% cut will be added onto that this year followed by a 3.4% additional cut next year, bringing the totals to 8% this year and 7% next year.
Federal Approval of Duals Plan May Come Soon
At a budget subcommittee hearing yesterday, Department of Health Care Services Director Toby Douglas said he hopes to get federal approval for the Coordinated Care Initiative within weeks.
The CCI, also known as the duals demonstration project, is a plan to move half a million Californians with dual eligibility in both Medicare and Medicaid into Medi-Cal managed care programs. The plan calls for consolidating disparate health care services and funding streams to improve and integrate care for seniors and persons with disabilities, while saving the state money as well.
“We hope it’s imminent,” Douglas said at yesterday’s Budget Subcommittee on Health and Human Services, when he was asked for an approval timeline by Assembly member Mariko Yamada (D-Davis).
Concern over Mental Health Provider Shortage
Legislation introduced last week would expand the scope of practice for nurse practitioners, optometrists and pharmacists. Separate legislation looks to expand scope of practice for physician assistants, as well.
The bills hope to address the dearth of primary care providers in California by allowing some mid-level health care providers to do more. With the Affordable Care Act’s expansion of Medi-Cal and introduction of the state exchange starting in 2014, there is expected to be a much greater need for primary care services.
Some mental health providers are citing a similar access concern for mental health professionals. Since the state’s essential health benefits include mental health coverage, the demand for mental health services is going to take a big leap, according to psychologist John Caccavale, executive director of the National Alliance of Professional Psychology Providers.