Wednesday, October 1, 2014
Governor's Final Actions
Yesterday, September 30, marked the legislative deadline for Governor Brown to sign or veto bills presented to him.
In very good news for the Catholic health care ministry and the broader hospital community, Governor Brown vetoed SB 1094 (Lara), which would have given the state Attorney General (AG) the power to unilaterally change conditions of a nonprofit hospital sale, transfer, or affiliation after the transaction is completed. This unprecedented new power would have introduced an unacceptable level of uncertainty into hospital transactions, and have a chilling effect on the health care marketplace. Additionally, the bill provided virtually no procedural due process before the AG could unilaterally change the terms of a transaction to which the parties have agreed and which the AG previously approved.
At every step in the legislative debate, there was a unified and powerful hospital coalition opposing this bill. Special recognition goes to the collective and effective advocacy efforts of Shelly Schlenker (Dignity Health), Ron DiLuigi and Chris Manson (St. Joseph Health), and Michael Tou (Providence Health & Services), as well as the Alliance’s very skillful lobbying team of Nathan Manske and David Ford.
The Governor’s veto message on SB 1094 (attached) refers to the AG’s proposed amendments to the regulations (that were announced last spring) as a reason to “wait … before deciding what adjustments, if any, are needed to improve the approval process for nonprofit hospital sales.” It appears the debate now moves back to the AG and whether she moves forward with the regulatory process, and if so, whether she will revise her proposed regulations based on public comments received in June, as well as the concerns raised during the legislative debate. The proposed regulations are much more far-reaching that what was contemplated in SB 1094. The Attorney General has until next June 2015 to move the regulatory process forward. Expect more to come on this matter.
On other legislative matters, overall the results of this legislative session were very positive. The Governor signed SB 1004 (Hernandez), expanding palliative care in California for Medi-Cal Managed Care beneficiaries. And the two bills (AB 503-Wiecowski and AB 1952-Pan) that would have created very onerous changes to current laws on community benefit and charity care mandates stalled in the legislature.
Wednesday, October 1, 2014
New DMHC Abortion Coverage Mandate
The California Department of Managed Health Care (DMHC) recently announced a new requirement that California health plans, without exception, must cover all legal abortions. The DMHC took this action in response to earlier decisions by Loyal Marymount University (LMU) and Santa Clara University (SCU) to exclude coverage of “elective abortions” in their employee health insurance plans. The directive effectively precludes Catholic institutional ministries in California that are not self-insured and ERISA-exempt, from purchasing health plans that do not cover voluntary abortions. The DMHC’s action is a clear violation of the federal ”Weldon Amendment” statute, which prohibits government discrimination against health care providers and insurers on the basis that they choose not to provide, cover, pay or refer for abortions. However, neither the universities nor their insurance plans have standing under “Weldon” to challenge the DMHC’s action in federal court. In its current form, “Weldon” is enforced solely by the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) and the U.S. Department of Justice.
Of significant concern to the Catholic health ministry is that, for the first time, the DMHC has defined legal abortion as a “basic health care service,” and is prohibiting health plans from “discriminating against women who choose to terminate a pregnancy.” (Emphasis supplied.) The trajectory of policy decisions in California (and elsewhere) could very well move from mandates on insurers to mandates on providers, which would be a significant threat to the Catholic health care ministry.
Attached is a letter, and related materials, sent by the California Catholic Conference (CCC) to OCR requesting they conduct an immediate investigation of the California DMHC’s August 22, 2014 directive that requires health plans to cover all voluntary abortions. Also attached is a release from the Alliance supporting CCC’s request for an investigation by OCR.
Friday, September 19, 2014
Bills Awaiting Governor's Action
As reported previously, the Governor has until midnight, September 30, 2014 to approve or veto legislation passed during the 2014 Legislative Session, which adjourned on August 30, 2014. There are three key bills of interest to the Alliance, which are awaiting action by the Governor:
SB 1094 (Lara) – ACTION REQUESTED: VETO. This bill would allow the California Attorney General (AG) to impose new conditions of consent on a nonprofit hospital agreement or transaction, after the approval has already been granted and after the parties have closed the transaction in reliance on the AG’s prior consent. The main objection to SB 1094 is that it would allow the AG to unilaterally change conditions of a nonprofit hospital sale, transfer, or affiliation after the transaction is completed. This unprecedented new power would introduce an unacceptable level of uncertainty into hospital transactions, and have a chilling effect on the health care marketplace.
As noted earlier, it imperative that the Governor hears from each of our health systems, as well as hospital CEOs. The California Hospital Association is also suggesting that hospital and hospital system presidents and CEOs telephone the Governor’s Office in Sacramento to request that the Governor veto SB 1094.
SB 1053 (Mitchell) – ACTION REQUESTED: VETO. The bill would expand the contraceptive health care coverage requirements, commonly referred to as the federal contraceptive mandate, under the federal Public Health Service Act, as amended by the Affordable Care, in California state law. SB 1053 contraceptive coverage requirements are broader than the federal contraceptive mandate; does not conform the state definition of religious employer with federal regulations; and, does not provide an accommodation for non-profit religious organizations.
SB 1004 (Hernandez) – ACTION REQUESTED: SIGNATURE. This bill requires the Department of Health Care Services (DHCS) to develop standards and provide technical assistance to managed care plans to ensure that Medi-Cal managed care recipients receive palliative care services. SB 1004 directs DHCS to engage community stakeholders in the development of standards for the provision of these palliative care services. Among several important provisions, this bill would include hospice services that are provided at the same time that curative treatment is available, to the extent that the services are not duplicative, and are provided regardless of the estimated length of time a beneficiary may be expected to live.
Friday, September 5, 2014
Bills Awaiting Action by the Governor
Governor Brown has until September 30 to sign or veto bills. The Alliance has sent letters (attached) to the Governor on the bills listed below. We encourage our members to also send letters to the Governor - it will be especially important to urge his veto on SB 1094 (Lara) and his signature on SB 1004 (Hernandez).
SB 1094 (Lara) would allow the Attorney General to impose additional conditions on a nonprofit hospital transaction, after the approval has already been granted. Request the Governor to VETO SB 1094.
SB 1004 (Hernandez) proposes the development of a palliative care benefit under the Medi-Cal program. Request the Governor to SIGN SB 1004.
SB 1053 (Mitchell) would expand in California state law the contraceptive health care coverage requirements, commonly referred to as the federal contraceptive mandate. Request the Governor to VETO SB 1053.