Latest California Healthline Stories
Sonoma Center Facing State Sanctions
The California Department of Public Health took a major step this week toward decertifying and revoking the license of the intermediate care facility at Sonoma Developmental Center.
The Sonoma facility, which serves 290 people with intellectual disabilities, is expected to appeal the state action.
The original survey in July by the Department of Public Health found 57 deficiencies, and four instances of immediate jeopardy to residents. The facility had two three-month periods to correct those problems. According to CDPH officials, time is up.
State Plans Retroactive Payment Rate Hikes
The good news for primary care physicians is the federal program to raise Medicaid reimbursement rates starts Jan. 1.
The bad news is Medi-Cal providers in California may have to wait several months to retroactively receive the higher payment.
California health officials have to wait for federal approval of a state plan amendment, which will take time, said Norman Williams, deputy director of public affairs for the Department of Health Care Services.
Healthy Families Set for January Transition
State health officials have made it clear that the first phase of the Healthy Families transition to Medi-Cal managed care will go on as scheduled, beginning Jan. 1. Children’s health advocates say they will do everything to support that effort while still keeping a careful eye on its progress.
The first phase of the transition will move about 415,000 children into Medi-Cal — almost half the 860,000 children enrolled in Healthy Families. The transition is dependent on federal approval by CMS within three weeks.
“We have said consistently that the state isn’t quite ready yet,” said Wendy Lazarus, the founder and co-president of The Children’s Partnership, a national not-for-profit children’s advocacy group based in Santa Monica. “So, yes, it would be good if CMS reached the same conclusion.”
Time Running Out To Opt Back In to Adult Day Program
About 4,400 frail and elderly Californians who qualified for Community Based Adult Services opted out of the managed care program to remain in traditional fee-for-service care. Less than three weeks remain for them to change their minds.
On Dec. 31, the state Easy-Way-Back program will close, and those “opt-outs” who declined Medi-Cal managed care will officially forfeit their CBAS benefits, according to Norman Williams, director of public affairs for the Department of Health Care Services.
The opt-outs — or the providers who are advising them to opt out — may be operating on false assumptions, Williams said in a written statement.
Forum Explores Dealing with Chronic Care Under ACA
Chronic health conditions remain one of the contributing factors to financial and utilization strain on the health care system, and there are a number of steps that can be taken to address them, according to a panel of experts that met recently in San Jose.
The forum, called “Chronic Disease: A Common Sense Approach to Solving Complex Health Issues,” was held Nov. 27 and hosted by the Partnership to Fight Chronic Disease. The moderator, Ken Thorpe, chairman of the partnership, said dealing with chronic conditions may be the most important health care concern of our time.
“We all know the prevalence of obesity has doubled since the early 1980s, and that doubling of obesity accounts for about 10% of health costs in this country,” Thorpe said. “Because the rise in prevalence of obesity has contributed to the rise in diabetes, as well as hyperlipidemia, hypertension and other related chronic health conditions.”
Call for MLR Regulation Gets Mixed Reaction
The Commonwealth Fund on Wednesday released a study on the federal medical-loss ratio rule, which concluded that regulation may need to be introduced to maximize the effect of the MLR.
“In future years, the MLR rule may need to be coupled with regulatory pressure in order for any further reductions in administrative costs to be reflected in reduced premium rates,” the study said.
That squares with the opinion from the state insurance commissioner, but the medical insurance industry does not agree.
Duals Project Edges Closer to Completion
More than 300 people attended a Department of Health Care Services seminar yesterday offering details of the duals demonstration project, also known as the Coordinated Care Initiative.
The department recently released several reports, including a draft of the care coordination and long-term services and supports readiness standards. Those guidelines are a big step toward the state’s readiness plan it eventually will need to submit to CMS, said Jane Ogle, deputy director of DHCS, at yesterday’s seminar.
The state released a summary of some of the significant details in the reports:
At-Home Nursing Services Rules Challenged
A lawsuit filed yesterday urges state health officials to alter California’s limit on adult at-home nursing services.
The limit doesn’t make sense, the Disability Rights California lawsuit said, because a higher limit would allow some beneficiaries to remain home, which would cost the state less than the price of institutionalization.
DHCS officials said the department has a policy of not commenting on pending litigation.
How Will Consumers Choose Exchange Coverage?
The Pacific Business Group on Health yesterday released the third and final installment of its comprehensive report on how to ensure that the people joining a health benefit exchange end up with the plan that works best for them.
“The whole notion of the Affordable Care Act and the establishment of the exchange is to improve the overall health care marketplace,” said Ted von Glahn, a senior director at PBGH, a not-for-profit business coalition focused on health care issues.
“If you don’t get it right when people are making those choices,” von Glahn said, “that would defeat the whole purpose of it.”
Senate Leader Asks to Slow Healthy Families Transition
California Senate President Pro Tem Darrell Steinberg (D-Sacramento) sent a four-page letter late last week to state health officials urging the state to move more slowly in its transition of approximately 860,000 children from the Healthy Families program into Medi-Cal managed care.
The letter to Health and Human Services Secretary Diana Dooley comes on the heels of several similar letters including one sent by 22 members of the U.S. House of Representatives, and another from a coalition of children’s health organizations.
The transition is scheduled to begin Jan. 1 with the first phase moving 415,000 children to Medi-Cal plans. The Healthy Families transition must be approved by CMS.