Latest California Healthline Stories
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.
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.
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:
Higher Primary Care Rate Welcome News for California
Earlier this month, CMS made it official: The federal government will pay Medi-Cal primary care physicians in California at the same rate as Medicare in 2013 and 2014.
The higher rate, confirmed by CMS officials on Nov. 2, means more than just paying more to family practice, pediatrics and internal medicine physicians, said Kevin Prindiville, deputy director of the National Senior Citizens Law Center, a national legal advocacy group with an office in Oakland.
“We hope this will improve access,” Prindiville said, “and there aren’t too many things in our market-driven system that can do that.”
Republicans Changing Tune — but not Shifting Critical Tone — on Medicaid
A handful of prominent conservatives have dropped their fight against the Affordable Care Act and its Medicaid expansion, but GOP leaders say the program still needs immediate reform.
Healthy Families Notices Sent, Now Federal Approval Needed
The state late last week sent 415,000 notices to inform Healthy Families participants they will need to switch to Medi-Cal managed care plans on Jan. 1.
At the same time, almost two dozen organizations, including the California Medical Association, sent a letter to lawmakers and state health officials asking for a delay in the conversion for 880,000 children in California.
The 60-day notices went out on Thursday and Friday last week, according to officials at the Department of Health Care Services. That officially starts the clock ticking on the Healthy Families transition.
Assembly Committee Examines State’s Moves to Medi-Cal Managed Care
The Assembly Committee on Health last week asked for a progress report and assurances from Department of Health Care Services officials that the state was not only ready to move many Medi-Cal beneficiaries into managed care, but also ready to evaluate the process.
“The purpose of this hearing is to focus on what’s happening with the outcomes and evaluations of our various transitions,” said the new chair of the Assembly Committee on Health, Richard Pan (D-Sacramento).
“There are four major transitions in California — the SPDs [seniors and persons with disabilities], the dual eligibles project [also known as the Coordinated Care Initiative, or CCI], taking our Healthy Families program into managed care and taking our rural communities into managed care, as well,” Pan said. “So there is certainly a lot of movement going on.”
Legislature Receives Final Plan for Duals Project
This was a big week for the state Department of Health Care Services, which on Monday submitted its final version of the strategic plan for the Coordinated Care Initiative — a project in which the state eventually plans to move on million seniors and disabled “dual eligible” Californians to Medi-Cal managed care plans.
Dual-eligibles are eligible for both the Medicare and Medi-Cal programs. By meshing the two funding sources and patient services, the state plans to improve the quality of care while also saving money.
Initially, the duals demonstration project will start with eight California counties (Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara counties) and the approximately 700,000 dual-eligibles in those counties.
Ambitious Transition Plan for Healthy Families
State officials this week submitted a four-phase strategic plan to eventually move 875,000 children from the Healthy Families program into Medi-Cal managed care plans.
Health care advocates have expressed some reservations and concerns about the transition. State officials have said they’re confident they’re ready to meet the deadlines that have been set for it. The new plan hopes to simultaneously improve quality of care for children and save the state money.
It will happen quickly. On Jan. 1, the state plans to launch the first phase of the transition, shifting 415,00 of the Healthy Families kids to a managed care plan.
New Attention on End-of-Life Care
Partnership HealthPlan of California, a health insurer covering roughly 200,000 Medi-Cal beneficiaries in six Northern California counties, has decided to offer the optional benefit of palliative care to its members.
“It’s part of health care, and part of life,” said Richard Fleming, the regional medical director for PHP. “That’s why we’re arranging for greater availability of palliative care. It’s an enhanced benefit, for people before they’re in hospice.”
People in palliative care are severely ill, but don’t fall specifically into the definition of being within six months of dying. “They need a lot more medication management, and there are social issues they need help with,” Fleming said.