Latest California Healthline Stories
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.
State Advocates Happy Over Federal WIC Action
Action by a U.S. Senate committee has family advocates in California breathing a sigh of relief.
The Women, Infants and Children program — which supplies food, breastfeeding services and other benefits to low-income mothers — was included in the federal sequestration cuts, but this week the Senate appropriations committee included funding for it in an amendment to the Consolidated and Further Continuing Appropriations Act of 2013, and that means good things for the WIC program in California, according to Laurie True, executive director at the California WIC Association.
True spoke yesterday at a state budget subcommittee hearing.
“We’re really happy,” True said. “It passed Senate appropriations, and it’s already been conferenced [with approval from both federal houses], so it looks good right now for us.”
Financial Concerns for Ambulance Services
Health care providers in California are waiting for judicial rulings to see if they will be hit by a 10% cut in Medi-Cal reimbursement rates as a result of a law passed in 2011 and currently tied up in federal appeals court.
Ambulance service providers are among those who would be hit by the cut but they say they shouldn’t be included for one large and simple reason: Unlike physicians, ambulance providers are required by law to transport Medi-Cal beneficiaries. They’re not allowed to refuse them.
“We cant say ‘no’ like everyone else. We’re required by law to provide those services,” said Klark Staffan, vice president and chief operating officer for Sierra Medical Services Alliance in Lassen County. “And so we’re stuck. We have to provide the service, but we lose money with every Medi-Cal transport. We’re the only type of medical provider who can’t say we wouldn’t accept [Medi-Cal] patients. We think we’re unfairly treated.”
Administrative Law Office OKs Autism Measures
The California Office of Administrative Law on Monday approved emergency regulations governing health insurers’ treatment of autism coverage.
The regulations were issued by the Department of Insurance to implement details of the California Mental Health Parity Act as well as to implement SB 946 by Sen. Darrell Steinberg (D-Sacramento), an autism treatment law passed in 2011.
“These emergency regulations will ensure that insurance companies cover medically necessary treatment,” Insurance Commissioner Dave Jones said in a written statement. “Autistic children and their families should now, without delay, receive the transformative treatment that will enable them to succeed in school, their families and communities.”
Of the roughly 2,600 appeal hearings filed over eligibility for the Community Based Adult Services program, only 47 are still to be heard, according to Michael Weston, deputy director of public affairs for the Department of Social Services.
Administrative law judges from the Department of Social Services heard the appeal hearings and then forwarded their opinions to Toby Douglas, director of the Department of Health Care Services, the agency that issued the denials of eligibility. Douglas reviewed each case and made the final ruling on CBAS eligibility.
According to Douglas, about 49% of the appellants were granted eligibility as a result of the appeal.
Geographic Rating Regions Amended
The Assembly and Senate last week introduced amendments to SBX1-2 by Sen. Ed Hernández (D-West Covina) and ABX1-2 by Assembly member Richard Pan (D-Sacramento), which change the geographic rating regions for the individual and small health insurance markets in California.
The amendments establish the 19-region plan, the same regions adopted by the Legislature last year for larger-market insurers.
The state’s health benefit exchange, Covered California, favored the 19-region plan in part because it mirrors last year’s large-market legislation and could avoid consumer and industry confusion.
Floor Votes in Favor of Expansion Bills
The state Assembly and Senate yesterday passed companion bills to expand Medi-Cal eligibility to more than one million Californians making up to 138% of federal poverty level. The bills also simplify the Medi-Cal enrollment process.
“This bill takes an important step to make sure California remains a leader in health care reform,” said Assembly Speaker John Pérez (D-Los Angeles), author of ABX1-1. “And this also helps bring billions of dollars in federal funds into California.”
The Senate passed its version of the legislation, SBX1-1, authored by Sen. Ed Hernandez (D-West Covina). The expansion will be fully funded with federal money for the first three years, declining to 90% in 2020.
Expansion Hearing Highlights County-State Struggle
California health officials and legislators yesterday had a lively discussion over the two proposed choices for the optional Medi-Cal expansion.
At the onset, yesterday’s discussion in the Budget Subcommittee on Health and Human Services centered on the Brown Administration’s choices for a state-based or county-based approach to implementing expansion of Medi-Cal to adults up to 138% of federal poverty level, which is expected to open eligibility to as many as 1.4 million Californians.
But the meat of the conversation evolved into something else. Since counties have pretty firmly asserted they’re in favor of the state-based plan, and state officials have not stated a preference for either option, choosing one approach over another was not really the main issue during yesterday’s hearing.
Appropriations Approves Medi-Cal Expansion
The state Senate Committee on Appropriations endorsed a bill expanding Medi-Cal eligibility to 1.4 million Californians and to simplify the enrollment process for all Medi-Cal beneficiaries.
The special session approval Monday means SBX1-1 by Sen. Ed Hernandez (D-West Covina) is headed to the Senate floor as soon as the end of this week. The Assembly version of the legislation — ABX1-1 by John Pérez (D-Los Angeles) — won committee approval last week is pending a floor vote now.
“This is very important because we want to make sure we get as many individuals with coverage so they don’t utilize the system the way they utilize it now — which is, those who don’t have insurance would go to the emergency rooms,” Hernandez said.