Latest California Healthline Stories
Assembly Hearing Addresses Issues of Risk
It was not your usual subject for an Assembly hearing in the Capitol Building.
Yesterday’s hearing convened by the Assembly Committee on Health took on the arcane and important subject of adverse selection and risk pools. The nerdy-tech tone of the hearing was not lost on its participants.
“I have to applaud the committee — for taking on such a dry topic,” said David Panush, director of government relations for Covered California, the state’s health exchange. “But it is so important. I’m really glad to see it.”
Provider Rate Cut Case May Linger
The state budget proposed by Gov. Brown counts on $488.4 million in savings from rate reductions to Medi-Cal providers in keeping with a law passed in 2011 that hasn’t yet been implemented because it’s been held up in court.
Last month, a three-judge panel in federal Circuit Court overruled previous injunctions issued by federal appellate judges. However, the injunctions will remain in place and provider reimbursements won’t be cut at least until the end of this month. Litigants in each of the four lawsuits have until Jan. 28 to file a re-hearing request.
At least one of those litigants — the California Hospital Association — is going to file a re-hearing request, according to Jan Emerson-Shea, CHA’s vice president of external affairs.
Hospital Tax May Go to Reserve
The state budget proposed by Gov. Jerry Brown extends the Hospital Quality Assurance fee, which is due to expire at the end of 2013. The complicated fee structure was originally planned to gather about $2.8 billion from private hospitals over the 30-month life of the fee. Some of the money is used to tap federal matching money, which benefits both hospitals and the state.
The state estimates extending the fee would add $310 million to the state’s general fund in fiscal year 2013-14.
Private hospitals have no problem paying the Hospital Quality Assurance fee, according to Jan Emerson-Shea, vice president of external affairs for the California Hospital Association.
Budget Called a ‘Godsend’ for Health Care Community
California Health and Human Services Secretary Diana Dooley summed up the health care impact of yesterday’s budget proposal this way:
“The good news is, there are no cuts,” Dooley said. “While we are not restoring anything, we are not cutting, either.”
That was a tremendous relief to Senate member Ed Hernandez (D-West Covina), chair of the Senate Committee on Health. After enduring year after year of multi-billion-dollar cuts to health programs, he said no budget news is good budget news.
Health Proponents Watching Budget for Medi-Cal Provider Rate Cut
Governor Jerry Brown today will release his plan to fix a projected $1.9 billion deficit in the state’s budget. Despite the recently rosier financial outlook for the state, many in the California health community still hold concerns that those new cuts may come out of the hide of health care.
“It sounds like education is going to be made whole, it sounds like prisons are going to be made whole, so yes, we’re fearing further cuts to health care,” said Francisco Silva, general counsel for the California Medical Association. “There is still a $1.9 billion deficit, after all.”
Silva was discussing the possible inclusion in the budget of a 10% Medi-Cal provider rate reimbursement cut that was approved by the state Legislature but has not gone into effect because it’s being challenged in court.
Anthem, Jones Spar Over Premium Rate Hikes, Reinsurance Fee
California Insurance Commissioner Dave Jones yesterday said a recent rate submission by Anthem Blue Cross was “unreasonable” and took particular issue with Anthem’s plans to charge a reinsurance fee which Jones said forces small businesses to pay for a 2014 fee a year early, in 2013.
Anthem Blue Cross officials said Jones’ numbers are off and that the reinsurance fee is a benign and standard business practice which has been used for many years without complaints from government or advocates.
“I’ve concluded that the rate increase imposed by Anthem Blue Cross on its small employers customers is unreasonable,” Jones said. He said the average rate increase of 10.6% is not justified given the data submitted to the Department of Insurance by Anthem.
More California Kids Need Sealant, Study Says
A national study released today by the Pew Center on the States, part of the Pew Charitable Trusts, grades every state’s level of adherence to a basic preventive dental procedure for children — the application of dental sealant. California earned a “C.”
Dental sealant is vital for children, particularly for youngsters who don’t get regular dental care, according to Bill Maas, policy advisor to the Pew Children’s Dental Campaign.
“The most cavity-prone area is the molars, and the top surface of the teeth, and that’s what sealant helps protect,” Maas said. He said providing sealant is a simple way to reach a large number of at-risk children. “In places where we know there’s a concentration of [at-risk] children,” he said, “we can bring that to them very efficiently.”
How Can Hospitals Thrive in Future?
The first step in dealing with complex financial and care issues faced by community hospitals is to get people engaged and talking about them, according to the organizers of tomorrow’s online “Future of the Hospital” game. People will compete to present the most cogent and worthwhile ideas for improving hospitals in California and the nation.
Starting tomorrow morning and running for 24 hours, the Institute for the Future is putting on an online forecasting competition to prompt possible solutions for community hospitals with a discussion involving as many people as possible. The event is co-sponsored by the California HealthCare Foundation, which publishes California Healthline.
“As federal funding for hospitals nationwide dwindles, so does our ability to access basic care in hospitals,” said Jean Hagan, an executive producer for the Institute for the Future. “Our emergency medical system is over-burdened, underfunded and fragmented. The statistics are frightening.”
State Delays Adult Day Center Not-for-Profit Requirement
The requirement that adult day health care centers become not-for-profit operations has been delayed at least a year, according to Department of Health Care Services officials.
A Dec. 31 letter to centers caring for the frail and elderly population in the Community Based Adult Services program said “DHCS has decided to postpone until further notice and no sooner than January 1, 2014, the implementation of the requirement restricting CBAS providers to Non-Profit legal status.”
About two thirds of California’s 250 adult day centers are for-profit entities, according to state officials. Putting as many as 186 centers through the complexity of a not-for-profit conversion was a little too much for the state and the centers, according to Jane Ogle, deputy director for DHCS.
CMS Meets Deadline for Approving Healthy Families Transition
Tight up against the end-of-year deadline, CMS officials on Dec. 31 granted approval of California’s plan to move 860,000 Healthy Families children into Medi-Cal managed care programs.
Federal officials asked for changes to the transition plan, including more frequent monitoring and evaluation of the transition to better ensure children are able to access primary care physicians under the new plan.
The first phase of the transition started Tuesday, Jan. 1.