Friday, 28, February 2014Assembly Budget Subcommittee Revisits AB 97 Medi-Cal Provider Rate Reductions
On Monday evening, Assembly Budget Subcommittee #1 (Health and Human Services) held an overview hearing regarding the budget for the Department of Health Care Services (DHCS). As part of that hearing, the committee became the first legislative committee to wade into the Medi-Cal provider rate issue. Attached is the Subcommittee’s agenda and background document.
The Subcommittee heard from a panel of providers, including a physician, a dentist, and a hospital representative from Dignity Health who provided testimony about the negative effects of reimbursement reductions on distinct part nursing facilities. The Subcommittee then took public testimony from a long line of provider representatives from all sectors of the health care industry. The message was clear and unequivocal: while cancelling the clawback helps, it does not “fix” Medi-Cal rates. And putting 1.5 million new people into a system with very few providers is a recipe for disaster.
For the moment, the Subcommittee did not take any official action, but Chairwoman Shirley Weber (D-San Diego) expressed strong concern about the inadequacy of Medi-Cal rates, and promised that this hearing was just the “start of the conversation.
Friday, 28, February 2014
Final Bill Introductions Bring Additional Health Care Reform and Health Care Related Measures
Last Friday was the deadline for 2014 bill introductions. While introductions had trickled in preceding days, Friday saw a flood of more 700 bills introduced. While the Alliance continues to review new measures, listed below are some additional measures that may be of interest to Alliance members:
SB 1276 (Hernandez/D-West Covina) would change the definition of a person with high medical costs to include those persons who do receive a discounted rate from the hospital as a result of 3rd-party coverage.
SB 1004 (Hernandez/D-West Covina) would revise the definition of “hospice” so that the palliative medical treatment would no longer be limited to those treatments that do not provide for efforts to cure the disease.
SB 1357 (Wolk/D-Davis) is a spot bill dealing with resuscitative measures, which the Alliance is closely monitoring.
As a reminder, bills must sit for 30 days before they can be amended or heard by a committee, so anything introduced at the end of the deadline period will not be heard by a committee until late March at the earliest. Many amendments and proposals will likely be considered in the meantime.
Friday, 21, February 2014
2014 Bill Introductions
Today is the deadline for legislators to introduce new bills for the 2014 Legislative Session. While 213 bills were introduced on February 19th and 376 measures went across the desks yesterday, it is anticipated that many more bills will be introduced today and they will be in print on Monday, February 24th. The Alliance is continuing its review of the newly introduced measures and expects to have its preliminary review completed by the end of next week. Some of the higher profile bills identified to date include:
AB 1759 (Pan/D-Sacramento), sponsored by the California Medical Association (CMA), would extend the primary care provider rate increase authorized in the federal Affordable Care Act (ACA) beyond 2014, and create an annual independent assessment of Medi-Cal provider reimbursement rates and their impact on access to care and quality of care in the Medi-Cal program.
AB 1805 (Skinner/D-Berkeley and Pan/D-Sacramento), sponsored by the California Hospital Association, CMA, and SEIU, would repeal the cuts enacted by AB 97, the health trailer bill from 2011, which reduced payments to Medi-Cal providers by 10 percent. Hospitals were mainly affected by reductions to distinct part nursing facilities.
AB 1952 (Pan/D-Sacramento) would require a general acute care hospital to annually provide charity care or monetary contributions, or a combination, an amount equaling at least of 5 percent of the hospital’s net patient revenue. The bill would establish the Wellness Trust Fund, would require the revenues collected from hospitals to be deposited into the fund for the support of the Medi-Cal program. While it has been reported that SEIU is the bill’s sponsor, the author’s office as of this writing has yet to confirm that report. On a related note, as of this writing we have not seen a newly-introduced bill sponsored by the California Nurses Association that also targets nonprofit hospitals’ provision of charity care. It was expected that Assemblymember Wieckowski would introduce a new bill after not pursuing passage of AB 975 last session.
SB 972 (Torres/D-Pomona) would increase the number of California Health Benefit Exchange: Board members from five to seven, with the two additional members being appointed by the Governor. The bill would also add marketing of health insurance products, information technology system management, management information systems and consumer service delivery research and best practices to the list of areas of expertise. The bill’s author has been critical of the board and its staff for lagging efforts to enroll Latinos in Covered California.
SB 1005 (Lara/D-Bell Gardens) would enact the Health for All Act, which is sponsored by the author and a statewide coalition of advocates and labor groups. The ACA specifically excluded undocumented immigrants from insurance coverage provided through the health care exchanges. The author estimates that three to four million people in the state that will remain uninsured in spite of ACA and almost a million of those will be undocumented residents ineligible for coverage. The bill will: a) extend eligibility for Medi-Cal benefits to low-income undocumented California immigrants who would qualify for the assistance but for their immigration status; and b) create the California Health Benefit Exchange Program for All Californians, which would be run by officials at Covered California. The bill is silent on what non-federal or state-only funding source(s) would be used to pay for the program in the absence of federal dollars.
Other bills of interest to Alliance members that will need additional review and analysis include:
AB 2139 (Eggman) that would change the patient notification requirements when a patient is diagnosed with a terminal illness and of the patient’s right to comprehensive information and counseling regarding legal end-of-life options.
SB 1053 (Mitchell), a comprehensive bill, that appears to codify, in state law, the contraceptive services mandate under the federal Affordable Care Act, and other related provisions. This bill is jointly sponsored by the California Family Health Council and the National Health Law Program.
SB 1094 (Lara) sponsored by the state’s Attorney General would, among other things, deem that the applicability and compliance of the conditions set forth in an approved hospital transaction be explicitly and implicitly consented to, and would waive any right by the hospital to seek judicial relief with respect to those conditions
Friday, 07, February 2014
Senate Joint Hearing on Dual Eligibles
On Thursday, February 6th, the Senate Budget Committee and the Senate Health Committee convened a joint oversight hearing to discuss the “Coordinated Care Initiative” (CCI), California’s proposed project to enroll Medicare/Medi-Cal dual eligibles into Medi-Cal managed care plans. The CCI, which was originally supposed to begin in late 2012, has been plagued by continual delays. As currently planned, the project will begin in April 2014 in only four counties: Riverside, San Bernardino, San Diego, and San Mateo. Enrollment in Orange County has been delayed indefinitely due to a recent CMS audit of CalOptima that found significant concerns with that plan’s finances. In Los Angeles County, Medi-Cal has had to sign direct contracts with three additional health plans – Molina, Care 1st, and CareMore – due to concerns about quality of care provided by LA Care. Alameda and Santa Clara County have both been delayed due to concerns about plan readiness.
At yesterday’s hearing, senators from both parties expressed strong concern about the project and the state’s apparent lack of oversight. Senator Mark Leno, the chair of the Budget Committee, repeatedly raised a concern that the CalOptima audit may be indicative of larger problems that the state is not seeing. Senator Ed Hernandez and Senator Joel Anderson, the chair and vice chair respectively of Senate Health, both urged the Department of Health Care Services to delay implementation of the project to allow more time for planning and oversight. The senators were supported by advocates for medical providers and patients, who cited very severe problems that have already been seen with health plan enrollment processes. Click here for the agenda and background for yesterday’s hearing.
Friday, 31, January 2014
Legislature Meets House-of-Origin Deadline for 2013 Bills
The state Senate and Assembly finished work on bills introduced in 2013 in their respective houses. Three measures that the Alliance was following include:
SB 508 (Hernandez), which is a follow-up bill to last year’s special session Medi-Cal-related Affordable Care Act (ACA) implementation bills that would place into state law the modified adjusted gross income (MAGI) converted Medi-Cal income eligibility standards for parents and caretaker relatives, children, and pregnant women. SB 508 would also eliminate the deprivation requirement in the Medi-Cal Medically Needy program, and would clarify eligibility for the former foster youth Medi-Cal expansion. The bill passed out of the Senate and is on its way to the Assembly.
AB 369 (Pan), another ACA-related measure, allows a person with health coverage in the individual market whose health plan or policy was cancelled between December 1, 2013, and March 31, 2014, to request that his or her new health plan or insurance policy cover the completion of services for treatment of specified conditions, such as cancer or pregnancy, from the person's existing provider who is not a participating provider with the new health plan or policy. The measure was approved by the Assembly and sent to the Senate.
AB 175 (V. Manual Perez) would have established the Uncovered Worker Health Trust Fund, administered by the Department of Health Care Services (DHCS), to provide comprehensive primary health care to workers who do not have health care coverage beyond pregnancy or emergency care under the ACA or Medi-Cal. The measure envisioned contributions from employers of undocumented workers and other sources would fund the program. The bill was opposed by a coalition of agricultural interests who believed it unintentionally placed participating employers in legal jeopardy in order to create a state-run program that could be created without the state's involvement, potentially subjecting them to federal penalties and raising the risk of employment verification audits. Since the Assembly Appropriations Committee held the bill on its Suspense File, the measure is dead for 2014; however, a new bill could be introduced.
State of the State
Friday, 24, January 2014
On Wednesday, Governor Jerry Brown delivered his State of the State address. With a brighter financial picture, he thanked the voters for passing both Proposition 25 (2010), establishing a majority vote for passage of the state budget, and Proposition 30 (2012), the temporary tax increase, but warned that the state’s long-term liabilities are “enormous and growing” – more than $100 billion for public employee pensions, tens of billions needed to cover retiree health care, and $65 billion needed to for roads and other infrastructure repairs. He also noted that future risks – congressional decisions, natural disasters, uncertain Affordable Care Act costs – could negatively affect the state budget. And as he wants to do, he referenced the Book of Genesis saying, “Put away your surplus during the years of great plenty so you will be ready for the lean years which are sure to follow,” in anticipation of lawmakers who may too readily want to increase spending given the estimated surplus revenues. He did acknowledge the expansion of health care coverage and gave a nod to California’s leadership in biotechnology and its leading academic bioscience institutions.