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July 12, 2019

Surprise Billing and Other Key Bills

Friday (July 12) marks the official start of the Legislature’s Summer Recess.    They will reconvene on Monday, August 12, and then will have a total of five weeks to finish their work for the 2019 Session, which ends on Friday, September 13.

One of the major accomplishments this week was AB 1611 (Chiu), surprise medical bills, being removed from the Senate Health Committee agenda, missing the legislative deadline for policy committees to meet and report bills.  AB 1611 is now a two-year bill.  Dr. Richard Pan, Chair of Senate Health Committee, understood our concerns with setting hospital emergency room rates in statute.  He attempted to work with the sponsors on alternatives to the bill that would continue to eliminate balance billing the patient when accessing out-of-network emergency department services, but not harm hospitals’ chances of seeking fair compensation for the care provided.  Those talks did not produce any compromise in time for the Committee hearing and the legislative deadline.  The bill can be

moved again next year, and we be attentive for any last-minute action (gut and amends) this session.  We anticipate this issue will continue to be a focus in the state Legislature.

Several key bills have been substantively amended in the last few days of the session, including SB 227 (Leyva), which sets fines for hospitals out of compliance with the nurse staff ratio.  The bill was amended to provide substantive exemptions that we will need to thoroughly review over the recess.  In addition, AB 204 (Wood) regarding reporting of charity care and community benefit data, has been amended.  The author’s office has been working closely with the hospital community to arrive at a definition of charity care that is reasonable and fair.  That revised definition is now in print, and we will assess whether the new language adequately addresses our concerns.  We will be reviewing all of the health bills still pending and will be prepared for action when the Legislature returns in August.

July 12, 2019

2018 State EOLOA Data Report

This week, the California Department of Public Health (CDPH) released the 2018 California End of Life Option Act (EOLOA) Data Report, presenting the data received from the EOLOA-mandated reporting forms received between January 1 and December 31, 2018 for those persons who participated in the assisted suicide law.   The following is a brief summary reported by the Coalition of Compassionate Care of California (CCCC):

New in the report this year are four data points which were not previously reported:

  1. 1. Patient informed family of decision: 87% reported informing family; 3% did not inform family; 2% had no family to inform, and for 8% it was unknown.
  2. 2. Class of drugs prescribed: 37% of patients were prescribed a sedative; 35% a Cardiotonic/Opioid/Sedative; 18% other; and 10% unknown.
  3. 3. Physician or trained healthcare provider present at the time of ingestion: 54% had a physician or trained healthcare provider present; 25% did not; and for 21% it was unknown.
  4. 4. Place of death (setting and/or location): 92 of patients died in a private home; 4% in an assisted living residence; 2% in a nursing home and 2% in an in-patient hospice residence.

The report also includes cumulative data: Between June 9, 2016, when the law came into effect, and December 31, 2018, prescriptions have been written for a total of 1,108 people under the Act and 807 individuals (72.8 percent) have died from ingesting the medications.

The 2018 data indicates that 452 individuals received prescriptions under the End of Life Option Act in that year. That figure appears to be down from a total of 577 individuals who received prescriptions under the Act in 2017
(some speculate the decrease in assisted suicide prescriptions was affected by the uncertainty created among providers due to the pending lawsuit challenging the constitutionality of the law). Other key 2018 data points include:

  • Of the 452 individual who received prescriptions, 337 died following their ingestion of the prescribed medications, including 23 individuals who received prescriptions prior to 2018.
  • Of those who died, 88.7 percent were 60 years of age or older, 94.4 percent had health insurance and 88.1 percent were receiving hospice and/or palliative care.

CDPH is required to provide annual reports, including information on the number of prescriptions written and the number of known individuals who died using aid-in-dying drugs as part of the End of Life Option Act legislation. The data is collected from the forms that participating patients and providers are required to complete and submit to the state. The information is aggregated by CDPH to protect the privacy of the participants.

The state does not report on all of the data elements it currently collects on EOLOA, which is an area of concern for CCCC and other stakeholders. We believe that the state has a duty to be as transparent as possible in sharing the EOLOA data, and we have requested that CDPH either report on all of the data collected on the forms or release the de-identified data to independent researchers to analyze. CCCC is pleased that the state included information on the four additional data points in the report this year. The data helps the state, researchers, and others to evaluate and monitor trends in the use of the law.

To view and download the 2018 and previous EOLOA data reports, visit CDPH’s EOLOA page here.

July 12, 2019

New Proposals on Surprise Medical Bills

While the issue of surprise medical bills has stalled at the California state level, this issue continues to get the attention of Congress.  This week, the House Energy and Commerce health subcommittee (by voice vote) advanced a measure that would limit surprise medical bills.  However, a bipartisan group of members are beginning to push back on how payment disputes between health providers and health insurers are settled – the key issue in this debate.  Committee chairman, Frank Pallone (D-NJ) and ranking member Greg Walden (R-OR) said they would continue to work on the bill, HR 3630 “No Surprises Act,” before a full committee markup, likely next week. This measure would set a federal benchmark rate, similar to a Senate HELP Committee-passed bill, “Lower Health Care Costs Act.”

However, Representative Paul Ruiz (D-CA) and Phil Roe (R-TN) are seeking major changes HR 3630, in particular the key provision that governs how providers and health plans settle payment disputes. Ruiz, one of several doctors in Congress backing an alternate approach, is advocating for an arbitration model favored by hospitals and physicians.  “Protecting People from Surprise Medical Bills Act” would use an independent resolution process to take patients out of the middle of disputes.  It has been reported that Representative Ruiz has said that nearly half of the Energy and Commerce Committee supports his arbitration approach.  According to Representative Dr. Ami Bera (D-CA), this latter bipartisan group now numbers more than 30 House members and aims to garner at least 100 cosponsors.

June 10, 2019

Insurance Industry Spotlight

The California Health Care Foundation has conducted a detailed review of new data released by the regulators of California’s large health insurers. Their report, “California Health Insurers: Large Insurers Remain on Top” provides a snapshot of the insurance market in California at the end of 2017.  They reviewed key data from the state’s two insurance regulators, the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI), and other sources were used to examine market share, enrollment, financial performance, and consumer satisfaction.  Key findings include:

  • ♦  California health insurance was a $183 billion business in 2017, up from $162 billion in 2015, a 13% increase. Only six insurers accounted for more than two-thirds of the revenue.
  • ♦  Total revenues for DMHC-regulated insurers increased by 15%, from $144 billion in 2015 to $166 billion in 2017.
  • ♦  Kaiser accounted for a third of total revenues – three times more than the next-largest insurer.  Most of the largest insurers, under both DMHC and CDI, were profitable in 2017.
  • ♦  Overall enrollment was relatively flat in 2016 and 2017. At year-end 2017, California’s insurers covered 14.1 million commercial enrollees and 13.2 million public managed care enrollees, of which 10.7 million had Medi-Cal. California insurers provided administrative services only to another 5.7 million enrollees in employers’ self-insured plans.
  • ♦  The ACA requires insurers to spend a minimum share of premium dollars on medical care or pay a rebate to consumers. In 2017, California insurers owed $97.4 million in premium rebates.
  • ♦  Rebates averaged $106 per person and benefited nearly 920,000 Californians.  Three insurers did not meet the ratio:  Anthem Blue Cross, Blue Shield, and Aetna.  Health Net Life and United Healthcare exceeded the ratio.
  • ♦  Most commercial enrollment growth in 2016 and 2017 occurred in HMO products.
  • ♦  In 2017, California insurers provided Administrative Services Only (ASO) for 5.7 million enrollees in employers’ self-insured plans.  Under ASO arrangements, insurers provide claims processing and provider networks.
  • ♦  ASO business was a large portion of the enrollment for Aetna, Anthem Blue Cross, Cigna and United Healthcare.
  • ♦  Kaiser covered nearly half (47%) of all Californians with commercial coverage.  Three insurers covered 75% (Kaiser, Anthem Blue Cross, and Blue Shield).

You can access the full report here:

And you can find the Quick Reference Guide here:

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