Latest California Healthline Stories
Out-of-State Physician Reviews Questioned
It’s relatively common practice for utilization reviews — that is, a request for medical services reviewed to comply with treatment guidelines — to be conducted by out-of-state physicians.
A new law, SB 933 by Senate member Paul Fong (D-Cupertino), would end that practice.
On Wednesday, the Senate Labor and Industrial Relations Committee approved Fong’s bill. It is headed to the Senate floor for a vote … maybe. A policy review is under way to determine whether the bill should first go through the Appropriations Committee.
Booming Need for Senior Centers
Like all social services in California, senior centers are short of funding. They are struggling to maintain their current level of programs and services and on top of that they need to prepare for the huge wave of aging Baby Boomers about to hit senior centers across the state.
According to a report by the Congress of California Seniors released Tuesday to coincide with a legislative hearing on the subject, the state’s senior centers are in disrepair and ill-prepared to deal with the burgeoning number of Californians expected to join the senior ranks in the next decade.
“The demographic shift is so undeniable,” Assembly member Mariko Yamada (D-Davis) said. Yamada, chair of the Aging and Long-Term Care Committee oversight hearing Tuesday as well as a Boomer herself, said she’s been seeing the approach of what she calls the “silver tsunami” for years. She vows she and other seniors-to-be will work to get senior centers the infrastructure funding they need to survive and thrive.
Tweaking Laws for In-Home Supportive Services
Last year around this time, the state legislature adopted a budget trailer bill called ABX4 19 by Assembly member Noreen Evans (D-Santa Rosa), which required background checks for In-Home Supportive Services providers.
But there were some unintended consequences of that well-intentioned law, according to Assembly member Ted Lieu (D-Torrance). Lieu hopes to fix a few details with his own bill, AB 1763, which is before the Senate Human Services Committee this week.
“Providers sometimes move from one county to another, or they have clients in multiple counties,” Lieu said. “The way the law’s written now, you may have to go through and pay for the same background check multiple times.”
High-Risk Success Riding on Twin Bills
Last week the Assembly passed AB 1887 by Mike Villines (R-Clovis) and the Senate passed SB 227 by Elaine Alquist (D-Santa Clara). The two-bill package would establish a temporary high-risk insurance pool to meet federal guidelines for national health care reform.
The legislation is now being considered in the appropriations committees in each house. The bills are procedurally joined, which means one can’t become law without the other. At stake is $761 million in federal funding, which is one reason the proposed laws have urgency status.
But urgency status has one big drawback — that means both bills need a two-thirds vote to become law.
Ombudsman Program on Life Support
“This program is going to run out of money this month.” That was the dire warning in a Senate Health Committee hearing Wednesday from Mike Feuer (D-Los Angeles), author of AB 2555, which would raise $1.6 million to finance California’s ombudsman program for at least one more year.
The program uses volunteers across the state to monitor long-term care facilities, handle patient complaints and advocate for long-term care patients.
“Residents are so dependent on the long-term care ombudsman,” said Jackie McGrath, director of public policy for the California Alzheimer’s Association. “Most are among the frailest of our citizens. Often the long-term ombudsman is their only advocate. We want to find a non-general fund solution for this year, so we can have time to design a long-term solution.”
Bill Aims to Limit Rate Hikes to One a Year
Beth Capell could barely contain her disbelief at the idea — that health plans and insurers suddenly might offer to lower their rates. And that they’d do that twice in one year.
“Not once in a blue moon,” she said.
Capell, policy advocate for Health Access California, was speaking at Wednesday’s Senate Health Committee hearing, presenting her side of what seemed like a relatively straightforward bill. AB 2042 (Mike Feuer, D-Los Angeles) seeks to prevent health plans and insurers from raising rates more than once a year.
Proposal Gives Stronger Status to Mental Health Claims
The Assembly Health Committee on Tuesday passed SB 1169 (Alan Lowenthal, D-Long Beach), which aims to raise the status of mental health claims.
“There are two problems in how mental health conditions are handled,” bill author Lowenthal said. “Plans and insurers require daily prior authorizations, but they don’t do that with physical conditions. And the second thing is that they often delay payments and authorization.”
Lowenthal said he hopes to even the mental health playing field, by requiring a tracking number to be assigned to every mental health claim, and by pushing health insurers to give mental health treatment the same urgency shown to physical treatment authorizations.
Assembly OKs High Risk-Pool to Protect ‘Uninsurable’
The state Assembly passed AB 1887 (Mike Villines, R-Clovis) that establishes a temporary high-risk health insurance pool program in California.
It’s designed to cover patients with a pre-existing condition who have been rejected for coverage by a private health plan. It would insure high-risk patients here for the next four years, until the federal government sets up a permanent health care exchange in 2014.
The legislation complies with new federal health care reform law, and allows the state to tap into $761 million a year in federal funds. High-risk coverage is expected to reach about 30,000 people in California.
The Slippery Territory of Autism
A treatment for autism called applied behavioral analysis is basically helping those with autism develop new behavior with a system of rewards and consequences.
It’s generally known as one of the most successful forms of therapy available for autistic children. So if it has some success, why isn’t it always covered by private insurance?
That was the central question at a hearing of the Senate Select Committee on Autism and Related Disorders.
Farewell To theWeekly, Hello Daily Capitol Desk
California Healthline’s Friday feature, theWeekly, has evolved to become Capitol Desk.
Where theWeekly provided a rundown of the week’s legislative news and an update on individual, health-related bills making their way through the political process, this page aims to provide a daily report from Sacramento. Since things change so quickly in the halls of power, I will be posting items here in a notebook format, everything from the news of the day to examinations of health policy issues that fall below the radar of most other media.
There is already plenty of health policy news to follow, but there will soon be even more as California begins to implement federal health reform. I hope to give a strong sense of what’s going on in the daily world of political wrangling over key issues while adding context and explanation to help make sense of it all.