Latest Morning Briefing Stories
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.
DHCS Says State Is Ready for Adult Day Care Transition
Advocates for seniors and the disabled filed a motion on Saturday asking a U.S. District Court judge in San Francisco to intervene in some implementation details of the settlement agreement it signed eight months ago with the Department of Health Care Services.
State officials yesterday answered some of the questions about the Oct. 1 implementation of the Community Based Adult Services program.
Some advocates worried about confusion around the launch of the CBAS program since the state is holding training sessions for the CBAS changeover in October for both health plans and physicians.
Motion Could Delay Implementation
A court motion filed Saturday challenging the state’s implementation of a new program for adult day services raises a number of concerns about how the new legal hurdle may affect timing and appeals in the new Community Based Adult Services program.
One of the main issues revolves around the fate of approximately 2,400 former Medi-Cal beneficiaries of Adult Day Health Care services. Those frail, elderly and disabled people had been denied eligibility to the replacement CBAS program. Many of them had been denied eligibility after earlier being approved for it.
According to Elissa Gershon, attorney for Disability Rights California which filed the motion Saturday in U.S. District Court in San Francisco, there are approximately 2,200 appeals of eligibility still outstanding, and roughly another 200 who have had a hearing but are still awaiting a decision.
Mental Health, Substance Abuse Treatment Changing
New guidelines in the Affordable Care Act and new responsibilities for county governments mean significant changes ahead for mental health care and substance abuse treatment in California.
Promise, Peril of Duals Program
Advocates see potential for improvement but also are concerned about consumer protections in the transition of roughly 1.1 million Californians into Medi-Cal managed care. The state is launching a managed care pilot project for beneficiaries who are dually eligible for Medicare and Medi-Cal, California’s Medicaid program.
“This is really a critical moment in time for dual-eligibles and represents an amazing time to improve care for duals,” said Kevin Prindiville, deputy director of the National Senior Citizens Law Center office in Oakland. “But it’s also a time to be very careful and cautious about how we proceed to move forward.”
Prindiville, one of several speakers at an informational forum last month, said California is still negotiating with CMS officials, so some of the details of the plan are still uncertain.
Too Much Focus on Medicare — and not Enough on Medicaid?
The continued focus on how Barack Obama or Mitt Romney would shape the Medicare program has become a major focus of the presidential campaign. It also means that the candidates’ deep, actual differences on Medicaid policy are being overlooked.
With so many changes in Medi-Cal services and reimbursement rates, the state has been working on a system to constantly update and alert physicians, nurses and other providers about the latest wrinkles in Medi-Cal administration.
“We’ve never offered this before,” said Dan Nand, web content lead at Xerox State Healthcare, which is working with the state Department of Health Care Services on the updating project. “Providers have never had a chance to do this before. Now they’ll be able to read all of the announcements by desktop, or by mobile phones.”
The idea is to have a series of networks, like an advanced kind of listserv system, Nand said, in which providers can sign up for specific specialty areas, such as acupuncture or long-term care.
Safety-Net Hospitals Face Funding Cuts on Two Federal Fronts
Safety-net hospitals are facing a double-whammy of funding cuts: The Affordable Care Act lowers Medicaid payments to hospitals for uncompensated care and changes in Medicare reimbursements could mean further reductions in payments to safety-net hospitals.