Latest California Healthline Stories
Medicare Drug Savings in California Estimated at $454 Million Over Two Years
California seniors and the disabled saved about $454 million on prescription drug costs in the past two years, according to an annual report on Medicare released by CMS Thursday.
According to federal officials, almost 300,000 Californians qualified in 2012 for the Part D Medicare coverage gap known as the “donut hole.” Last year, those beneficiaries saved roughly $183 million, the report said.
Those 300,000 Californians last year could buy covered brand name drugs at half price, and received a 14% discount on generic drugs. Savings for both types of prescription drugs will increase over time, the report said, until the coverage gap is closed.
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.”
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.
Stakeholders: Medicare Should Cover Care Received in ‘Observation’
Medicare beneficiaries and care providers in California are part of a national chorus calling attention to Medicare’s lack of coverage for skilled nursing facility care after a patient has been “under observation” in an acute care hospital but not technically an “inpatient.”
California Could Lose $61B in Medicare Pay. Does it Matter?
A new analysis projects the impact of the Affordable Care Act’s Medicare cuts on California: at least $61 billion over a decade. It’s a striking figure — but the effect on patients and providers is still unclear.
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.
Inpatient v. Observation: A Medicare Change That Actually Matters
Presidential proposals sometimes lead to transformative Medicare changes — but more often lead to changes that die on the vine. Meanwhile, the government’s ongoing effort to tamp down Medicare fraud has indirectly led providers to pass more costs on to patients.
What Paul Ryan’s Reforms Would Mean for California
Mitt Romney’s running mate has authored several budget proposals that would transform Medicare and Medicaid. How would Ryan’s changes affect the Golden State, and how do they compare to the Affordable Care Act’s reforms?
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.