Latest California Healthline Stories
Ironing Out Details of Duals Conversion
State officials met with stakeholders in Sacramento yesterday to answer questions and work out the final details of the duals demonstration project — an ambitious plan to enroll an estimated 700,000 dual-eligible Californians in 10 counties into Medi-Cal managed care.
Enrollment will be mandatory for beneficiaries eligible for both Medi-Cal and Medicare. Jane Ogle, deputy director of health care delivery systems at the Department of Health Care Services, was quick to point out that beneficiaries would keep their own physician, even if that physician is not in the Medi-Cal network, and that beneficiaries have the power to opt out of the demonstration project, if they want.
“There is no need to assign a new doctor to people,” Ogle said. “There just is no need to do that.”
Changes Intended to Smooth MRMIP Operation
Assembly member Bill Monning (D-Carmel) is chair of the Assembly Committee on Health, but at yesterday’s meeting he went to the other side of the dais to present a piece of new legislation.
Monning’s AB 1526 would eliminate the annual and lifetime limits on coverage in the Major Risk Medical Insurance Program, popularly known as MRMIP.
“This bill is related to two goals I’ve had since I started in the Assembly. And number one is to make MRMIP more affordable for people who are in dire need of it,” Monning said. “And the other goal was, to actually meet Mister Mip.”
Pediatric Centers Must Pay Retroactively
If you were running a business on a shoestring budget, how hard would it be to pay off a lump sum payment equal to 10% of costs for the past 10 months?
That’s the question Terry Racciato would like to ask officials at the Department of Health Care Services.
Racciato, president of two Together We Grow pediatric day health centers in San Diego, is facing the prospect of paying the state $200,000 or more for what she considers to be a state administrative mistake.
Advocates File Contempt Motion Against State
The settlement now is officially unsettled.
Disability Rights California, which filed and then settled a lawsuit challenging the transition of adult day health care by the Department of Health Care Services, now has filed a contempt motion saying that DHCS officials have not been following the terms of the agreement.
That settlement prompted the state’s creation of the Community Based Adult Services program, due to launch Sunday, the day after ADHC is eliminated as a Medi-Cal benefit.
Legislative Hearing Looks at Transition Plans
During a Senate subcommittee review of a number of state health care proposals yesterday, one theme seemed to stand out: People are unhappy with them.
The budget subcommittee on Health and Human Services heard proposals by the Department of Health Care Services to cut health plan rate reimbursement for Healthy Families’ children by 25%. In addition, DHCS intends to move 900,000 children from that program into Medi-Cal managed care. The committee also heard from a long parade of people who opposed those proposals.
After all the testimony and acrimony, subcommittee chair Mark DeSaulnier (D-Concord) didn’t quite know what to say.
Solution to Physician Shortage May Lie in Mid-Level Practitioners
Ed Hernandez, an optometrist, can see it coming.
The Democrat Senate member from West Covina yesterday helped convene the second hearing in a week to explore the looming shortage of primary care providers in California. The addition of millions of newly insured along with a likely decline in the number of physicians in California is an equation that worries Hernandez. He said the gap is unlikely to be filled in traditional ways.
“Last week we looked at the shortage of providers in California, a shortage that will not lessen,” Hernandez said yesterday at a joint meeting of the Senate Committee on Health and the Senate Committee on Business, Professions and Economic Development.
Aid for Pregnant Women Pushes Through Committee
Holly Mitchell, for the first time in recent memory, was speechless.
Assembly member Mitchell (D-Los Angeles), who is known for being voluble and quick-tongued, yesterday had a bill before the Assembly Committee on Human Services.
AB 1640 is designed to allow low-income pregnant women to use TANF money (federal Temporary Assistance for Needy Families) without proving that they’re in their third trimester of pregnancy.
Hearing Focuses on Children’s Dental Care
Assembly member Richard Pan (D-Sacramento) knew the subject was a little out of the ken of the workforce committee, but that it was too important to be ignored.
“One of principles in looking at whether we have an adequate workforce is to make sure we can take care of our patients,” Pan said. “We need to take care of the oral health needs of children, and that depends, in part, on availability of coverage, and payment for those services.”
Pan, chairman of the Assembly Select Committee on Health Care Workforce and Access to Care, presided over a recent hearing on children’s oral health in Sacramento County.
Pediatric Centers Argue Retroactive Payments Don’t Make Sense
California’s 14 pediatric day health centers are a form of home health agency serving a 21-and-under population. Those are two groups exempted from the state’s 10% Medi-Cal provider rate reductions in June.
PDHC operators assumed they were exempt from that rate reduction. That notion was reinforced by the absence of PDHCs on the list of providers in the state plan amendment (SPA) that the state sent to CMS for approval of the rate decrease.
Officials at the Department of Health Care Services, when alerted about the discrepancy, recently decided that, yes, PDHCs should be exempt from that rate decrease. This was great news for the PDHCs, which operate on a tight and limited budget — except for one thing.
Counties, EDs Could Benefit from Pilot Project
California’s emergency psychiatric demonstration project, approved this week by CMS, may help counties deal with financial stress from a payment system half a century old.
“This is a great opportunity for California to participate in a demonstration that will help ensure patients receive appropriate, high-quality care when they need it most,” Norman Williams of the DHCS said. The project will provide “reimbursement to private psychiatric hospitals for certain services for which Medicaid reimbursement has historically been unavailable,” Williams said.
That is good news for counties, crowded hospital emergency departments and patients with acute psychiatric problems, according to Patricia Ryan, executive director of the California Mental Health Directors Association.