Latest California Healthline Stories
Standards Release a ‘Milestone’ for Exchange
Covered California, the state’s health benefit exchange, yesterday released its benefit standards outlining the basis for choosing qualified health plans that will participate in the exchange.
“This is another milestone for the exchange,” said Diana Dooley, secretary of the state Health and Human Services Agency. “We have a lot of hurdles to get over, we still have a lot to do, but this is another successful milestone toward the health care reform effort.”
Covered California also submitted an intention to file emergency regulations with the Office of Administrative Law last week, outlining its pediatric dental benefit policy. The exchange is expected to file those regulations Friday, according to Brandon Ross, staff counsel for Covered California.
New Health Care Bills Introduced
One source of funding for pediatric trauma care could get a boost from a new bill being introduced in the state Senate, according to the author of SB 191, Sen. Alex Padilla (D-Pacoima).
“Pediatric trauma care is still not widely available in California,” Padilla said, referring to the 14 pediatric trauma care centers in the state. “SB 191 would provide essential funding for emergency care and pediatric trauma care throughout California.”
The pediatric trauma care bill makes permanent a temporary penalty imposed by counties on vehicle code violations, at a rate of $2 for every $10 in fines. That penalty is due to expire at the end of 2013. Padilla wants to eliminate a sunset date and make it permanent.
Preventive Dentistry Plan Shows Results
The dental outreach plan for the 860,000 California children in the Healthy Families program has shown strong results, including across-the-board improvement in health plans’ prevention efforts, according to officials from the Managed Risk Medical Insurance Board, which oversees the program.
“Every one of our health plans showed improvement in terms of prevention,” said Janette Casillas, MRMIB’s executive director. “That means improvement in the number of oral exams, and in prevention efforts such as using sealant.”
Among the report’s highlights:
Medicare Drug Savings in California Estimated at $454 Million Over Two Years
California seniors and the disabled saved about $454 million on prescription drug costs in the past two years, according to an annual report on Medicare released by CMS Thursday.
According to federal officials, almost 300,000 Californians qualified in 2012 for the Part D Medicare coverage gap known as the “donut hole.” Last year, those beneficiaries saved roughly $183 million, the report said.
Those 300,000 Californians last year could buy covered brand name drugs at half price, and received a 14% discount on generic drugs. Savings for both types of prescription drugs will increase over time, the report said, until the coverage gap is closed.
Health Reform Benchmarks Linked to FQHCs
Federally qualified health centers (FQHCs) already have shown some of the results pursued by the Affordable Care Act, according to a study released this week by the California Primary Care Association.
The CPCA commissioned researchers to compare high-cost factors, such as hospital stays and emergency department use, as well as total cost of care, between FQHCs and non-FQHCs in California.
Some of the findings from John Snow, Inc. Health Services Division, a public health research firm based in Boston, were released Monday and showed enviable differences in FQHC care:
Higher Profile Coming to Exchange
California’s health benefit exchange is nearing its move into the mainstream public spotlight — but there is a lot of work still ahead, according to experts who gathered in Sacramento yesterday for a roundtable discussion of the exchange.
Yesterday’s symposium, called “Covered California: The Challenges and Opportunities of California’s Health Benefit Exchange,” was presented by the University of Southern California’s Price School of Public Policy and the USC Schaeffer Center for Health Policy and Economics and Quintiles.
Assembly member Richard Pan (D-Sacramento) acknowledged that creation of the exchange has helped place California at the head of the health care reform pack, but he said that leadership role doesn’t change the 2014 deadline that’s looming for health care reform and the exchange.
Insuring a Better Future for the State?
State officials and health care experts yesterday said the governor’s decision to sign on to optional expansion of Medi-Cal could be a huge step forward for California’s health system — and a huge challenge, as well, they said.
More than 700 stakeholders gathered in downtown Sacramento for the annual conference of the Insure the Uninsured Project heard dozens of experts evaluate how far California has come in implementing health care reform, and how far it still has to go.
Adding roughly 1.4 million Californians to Medi-Cal eligibility in the optional expansion (adding adults up to 138% of federal poverty level) may be fully funded by the federal government for the first three years, but it also brings a boatload of work to the state. It’s worth the extra effort for the sake of beneficiaries and for the savings the state stands to make in reduced hospital and emergency department costs, said Diana Dooley, state Secretary of Health and Human Services.
Medical Marijuana Case in State Supreme Court
The California Supreme Court today in San Francisco will hear oral arguments over a legal conundrum involving medical marijuana. The city of Riverside wants to ban sale of medicinal marijuana, a decision that may violate state law ensuring legal access to it. At the same time it adheres to federal law banning marijuana’s sale and use.
To Riverside officials opposed to marijuana sales, the answer is pretty simple: “A medical marijuana dispensary constitutes ‘a Prohibited Use’ ” in Riverside’s zoning code, which makes it a public nuisance, the city’s attorneys wrote in a legal brief. “Any use which is prohibited by state and/or federal law is also strictly prohibited,” the attorneys said.
But marijuana advocates, in their own brief, said Riverside officials are prohibiting the distribution of medicine, and that’s against state law.
Finance, Health Care Linked in Expansion Effort
State health care and finance officials met for the first time with stakeholders Friday to outline some of the differences between two possible approaches — state-based or county-based — to implementing the state’s optional Medi-Cal expansion.
Many details of the proposed expansion of Medi-Cal are unknown, state officials said Friday because they’re waiting for more federal guidance in many areas. One important detail is known: the federal government will fully pay for the expansion benefits for new enrollees for the first three years.
Diana Dooley, the state’s Secretary of Health and Human Services, said implementing the expansion will be influenced in equal parts by financial and health care considerations.
First Step in Reform: Primary Care
The heart of a successful reform effort under the Affordable Care Act will be the creation and implementation of the patient-centered medical home model of care, according to testimony at an Assembly Committee on Health hearing in the Capitol Tuesday.
“We need to look at better management of chronic conditions,” said Assembly member Richard Pan (D-Sacramento), chair of the Committee on Health. “It’s one of the greatest cost factors in our health care system.”
How much cost?