Latest California Healthline Stories
Access Issues Behind ADHC Exemptions
The Department of Health Care Services recently exempted 69 adult day health care centers from the 10% reimbursement cut. Because the cutback is retroactive to June 2011, it spared payback of a large amount of retroactive money for those mostly rural ADHCs.
“That is really good news for Contra Costa County,” Debbie Toth — executive director of the Mt. Diablo Center for Adult Day Health Care in Pleasant Hill — said. “We would have had to pay back a lot of money through June. And we’ve already gone through our reserves, so we wouldn’t have been able to do that.”
The 10% cut would’ve put centers in Contra Costa County over the edge, Toth said. “Our direct care staff is required by regulation, so there’s no way … I couldn’t reduce my cost by 10%.”
Assembly Hearing Laments a Torn Safety Net
It’s not just the 10% payment cut to a range of Medi-Cal services in California that have legislators and providers lining up in protest, according to Assembly member Holly Mitchell (D-Los Angeles), it’s the combined effect of all the cuts that came before as well.
“We are here to hear and understand the actual impact of the cuts we made this year,” Mitchell said yesterday at a hearing convened by Assembly Budget Subcommittee No. 1 on Health and Human Services. “And we also need to hear the cumulative impacts of cuts from previous years,” she said. “This economic crisis has hit our children very hard, and we need to hear what these cuts will do to those children.”
Down the street from the Capitol Building hearing, protesters representing the developmentally disabled gathered outside the offices of the Department of Health Care Services, the agency implementing the state’s cuts and that worked with CMS to get federal approval of the cutbacks.
Which Providers Get 10% Reimbursement Cuts?
Toby Douglas did not bring good tidings. Yesterday, the director of the Department of Health Care Services outlined the recently approved 10% cuts for California providers of Medi-Cal services.
“This is really hard,” Douglas said. “These are extremely painful reductions.”
The California Hospital Association on Tuesday filed a lawsuit in federal court in Los Angeles seeking to halt the implementation of Medi-Cal rate cuts approved last week by CMS.
Exchange Board Has Little Interest in Health Care Co-Ops
The federal government is ready to hand out $3.8 billion in loans to start up not-for-profit, member-governed health plans called consumer-operated and -oriented plans, or co-ops.
A deadline recently passed for the first round of applications, with a number of states taking up the idea, but not California.
So far, California has been pretty cool on the idea. At the August meeting of the Health Benefit Exchange board, concern was raised over what a co-op’s market share would be, and that a co-op might undermine what the exchange wants to do by dividing up its pool of participants.
Effort for Settlement of ADHC Lawsuit
State officials and advocates for seniors and the disabled are meeting today trying to work out a settlement of a lawsuit over adult day health care.
Today’s settlement conference comes exactly one week before a federal hearing of the suit brought by Disability Rights California, scheduled Nov. 8. The court is asked to determine whether the state’s transition plan is adequate to handle the needs of roughly 35,000 frail, elderly and disabled patients. The state’s ADHC program ceases to be a Medi-Cal benefit on Dec. 1.
Yesterday, advocates took to the sidewalk outside of the Ronald Reagan State Office Building in Los Angeles, marching up and down in front of the government center with “Stop Elimination” signs.
Access at Issue in Medi-Cal Cuts
You would think providers would be up in arms over having their Medi-Cal reimbursement rates cut — once again.
After all, California had one of the lowest Medicaid provider rates in the nation, even before this recent 10% reduction. But according to Carol Havens, president of the California Academy of Family Physicians, the rate reduction really affects patients, not doctors.
“Providers now, at the current level of reimbursement, have to make a decision about how many Medi-Cal patients they will see,” Havens said. “Since it actually costs them money to see Medi-Cal patients, they have to limit the numbers in their practice. So now, in a practical sense, these cuts will put an increased burden on that decision, and they’ll likely see fewer Medi-Cal patients.”
Telehealth May Be Led by Telederm
April Armstrong thinks the medical specialty that’s perfect for California’s nascent telehealth system is dermatology.
“Dermatology is visual,” according to Armstrong, director of the teledermatology program at UC-Davis Medical Center. “That’s the great thing about it, why it’s so suitable for telehealth, is that it’s a visual field. If the image quality is clear, you can tell a lot.”
Today, the Center for Connected Health Policy is scheduled to release an issue brief Armstrong authored on teledermatology. The brief was funded by the California HealthCare Foundation, which publishes California Healthline.
Medicare ACOs a Boon to Senior Care in State?
Don Crane is pretty happy. He’s president and CEO of the California Association of Physician Groups, and he’s been waiting for quite some time for federal officials to finalize the rules governing establishment of Medicare accountable care organizations.
The final regulations announced by CMS could be big news for California, Crane said.
“I think this is going to have a huge impact on the California health care landscape,” Crane said. “What this means is significantly more penetration of ACOs in the senior market.”
778 Assessments a Day To Meet Deadline
The clock is ticking, and it’s a big clock.
When the state eliminated adult day health care as a Medi-Cal benefit, the state Department of Health Care Services announced it would do a complete health risk assessment of all ADHC patients to better determine what their health needs are.
Filling those needs will be a huge chore, but conducting the assessments is big enough all by itself.
Getting Covered Kids To See the Dentist
Dental coverage for children is offered as part of the Healthy Families program, but not all kids who can see the dentist actually go.
Healthy Families, hoping to change that, just received a $100,000 grant to help start a utilization program. The grant was awarded by the DentaQuest Foundation as part of its Oral Health 2014 Initiative, a nationwide effort to reverse oral health disparities in the U.S.
“Our strategy is to create a multi-stakeholder, dental-medical collaboration designed to transform oral health care delivery to more than half a million low-income children in California — with the potential to reach upwards of 900,000 across the state,” according to Ellen Badley, the new deputy director of benefits, quality and monitoring at Healthy Families.