Monday, August 30, 2004

HEALTH ACCESS ALERT
Monday, August 30th, 2004


URGE GOVERNOR SCHWARZENEGGER TO SIGN CONSUMER HEALTH BILLS!

As Governor Schwarzenegger gets set to deliver a speech to the Republican National Convention, he has many bills on his desk, including several that would benefit health care consumers. They include bills on prescription drug costs, hospital overcharging, coverage of prenatal care, out-of-pocket insurance costs, and hospital closures.

WRITE THE GOVERNOR ASAP!: While he has until September 30th to sign or veto bills, he is expected to make decisions on many of them sooner. Please send a separate letter for each bill you wish to support to Governor Arnold Schwarzenegger, State Capitol, Sacramento, CA 95814. The fax is 916-445-4633.

NEW ALERT/LIST OF PENDING BILLS: Apologies to those who got the Health Access weekend alert multiple times, and to those who got it garbled, and thus unable to read the list of the bills that had passed. We are working with our E-mail list manager to correct the problem. Also, please note that SB 1170 did not pass, as the alert indicated.

For a readable and updated one-pager alert with a list of key health care consumer legislation on the Governor's desk, go to the Health Access web site:
http://www.health-access.org/docs/HealthLegAlertGovSept04.doc

LEGISLATIVE HEARING ON PROPOSITION 72 COMING NEXT WEEK

FYI, the Assembly and Senate Health Committees will be holding a Joint Hearing on Proposition 72, the referendum on the law to protect and expand employer-based coverage, on WEDNESDAY, SEPTEMBER 8th, from 10am to 1pm, in Los Angeles, at the Marvin Braude San Fernando Valley Constituent Service Center, 6262 Van Nuys Blvd, Van Nuys.

Labels: Updates

posted by Anthony Wright | Permalink | 8:17 AM


 

Saturday, August 28, 2004

HEALTH ACCESS ALERT
Saturday, August 28th, 2004


HEALTH CONSUMER BILLS PASS AS LEGISLATIVE SESSION ENDS

• Major bills to enhance access to health care
• Several bills seek to address prescription drug costs
• First-in-the-nation bill to prevent hospital overcharging of uninsured
• Other bills on out-of-pocket costs, maternity coverage, hospital closures, etc.

In the last week of a two-year session, the California legislature passed numerous bills to help health care consumers get access to needed care. Here is a quick report on key bills that are have been passed and are heading to Governor Arnold Schwarzenegger’s desk.

The Governor will have until September 30th to either sign or veto these measures. Letters of support for these bills should be sent to Governor Schwarzenegger as soon as possible; his address is below.

* HOSPITAL OVERCHARGING OF THE UNINSURED:

SB379 (Ortiz) would provide first-in-the-nation consumer protections for self-pay hospital patients, including prohibiting overcharging by hospitals of the uninsured. The bill would provide self-pay patients with information about their consumer rights and financial options, prevent them from being sent to collections without a chance to negotiate with the hospital, and ensure that they don’t pay more than what is paid by Medi-Cal, Medicare, or worker’s compensation. (This bill was amended earlier to be similar to AB232, authored by Assemblymember Wilma Chan and sponsored by Health Access California.)

* PRESCRIPTION DRUGS:

A package of legislation, sponsored by a range of consumer, senior, labor, and health care organizations, is aimed to increase access to and lower the costs of prescription drugs. Their passage is a major victory; in past years, similar bills had died in the first house in the first committee.

CANADIAN RE-IMPORTATION

• AB1957 (Frommer) would establish websites to advise purchase of prescription drugs from Canada.
• SB1149 (Ortiz) would establish websites listing sources that are unsafe for purchasing drugs from Canada.
• SB1333 (Perata) would allow Medi-Cal and the AIDS Drugs Assistance Program (ADAP) to reimburse pharmacies that purchase drugs from Canadian pharmacies.
• SB1144 (Burton) would allow Department of General Services to use Canadian sources for drugs for Corrections, state hospitals, and other select state agencies.

OTHER PRESCRIPTION DRUG BILLS

• CALPERS PURCHASING POOL: AB1958 (Frommer) authorizes CalPERS to establish or enter into a pharmaceutical purchasing consortium with other private or public entities.
• GOVERNMENT REBATES: AB1959 (Chu) would ensure legislative oversight of Medi-Cal and other state government prescription drug rebate programs.
• PBMs: AB1960 (Pavley) would regulate pharmaceutical benefit managers, including requiring disclosures of their revenues and formularies.
• COST LIST: SB 1170 (Ortiz) would require DHS to establish a Maximum Allowable Ingredient Cost lists within a year.
• GIFTS: SB1765 (Sher) would codify the voluntary guidelines of Pharmaceutical Research and Manufacturers of America (PhRMA), requiring limits and disclosure on gifts, meals, and other inducements offered to doctors and other prescribing health providers.

* OUT-OF-POCKET COSTS: AB2289 (Chan), sponsored by Health Access California, requires the Department of Managed Health Care and the Department Insurance to gather detailed information on what people with insurance pay in deductibles, co-pays and other out-of-pocket costs.

* MEDI-CAL BALANCE BILLING: AB2285 (Chu) seeks to prevent and remedy the incorrect billing of Medi-Cal beneficiaries by health care providers, including providing for appropriate reimbursement.

* MATERNITY COVERAGE: SB1555 (Speier) ensures that maternity coverage is included in health insurance coverage. Prenatal care is cost-effective for the individual and for society, and the bill prevents the segmentation of the health insurance market.

* CHILD ASTHMA: AB2185 (Frommer) ensure that pediatric asthma devices such as inhaler spacers, nebulizers, and peak flow meters are included in health coverage.

* HOSPITAL CLOSURES: AB2874 (Diaz) would ensure notice in the event of the closure of an emergency room or hospital, to allow communities to consider purchasing the facility.

Many other proposed bills to aid health care consumers did not make it through the lengthy legislative process.


ALERT: SEND LETTERS OF SUPPORT TO THE GOVERNOR

Health advocates who wish to support these bills should send separate letters to Governor Schwarzenegger, urging him to sign them. Since the Governor only has until September 30th to sign or veto measures, and he will likely make decisions earlier, letters to the Governor are requested ASAP. Letters should be sent to:

The Hon. Arnold Schwarzenegger
Governor
State Capitol
Sacramento, CA 95814
Fax: 916-445-4633

Labels: Updates

posted by Anthony Wright | Permalink | 8:00 AM


 

Tuesday, August 24, 2004

HEALTH ACCESS UPDATE
Tuesday, August 24, 2004

CA ASSEMBLY VOTES TO PROHIBIT HOSPITAL OVERCHARGING OF UNINSURED

* First-in-Nation Consumer Protections for Self-Pay Patients May Go to Governor
* Other Consumer Protection Bills Also Pass Assembly

On Monday, August 23rd, the California Assembly passed SB379 (Ortiz) to prohibit hospitals from overcharging uninsured patients, and provide other consumer protections. Both SB379, and a similar bill, AB232 (Chan) are expected to be voted on in the Senate and, if successful, be sent to Governor Schwarzenegger's desk by the end of the week. Both bills would provide first-in-the-nation consumer protections for self-pay hospital patients.

OTHER BILLS: Other important bills of interest to health advocates also passed the Assembly. Key consumer protection bills of note include:

• Maternity coverage: SB1555 (Speier) to ensure that all health insurance plans include maternity coverage.
• Drug company marketing: SB1765 (Sher) to limit the gifts that pharmaceutical companies provide doctors and other medical providers.
• Hospital infections: SB1487 (Speier) to collect data on hospital-acquired infections.

SPECIFIC PROTECTIONS FOR HOSPITAL PATIENTS: The bills that address aggressive hospital billing and collections, SB 379 and AB232, are similar. They address an issue raised by dozens of “uninsured and overcharged” patients that have been sent to collections, court, or bankruptcy for the simple act of seeking needed care. Both bills ensure that self-pay hospital patients:

• Are informed of their consumer rights and financial options;
• Have at least 120 days before being sent to collections;
• If they are under 400% of the federal poverty level (under $60,000 for a family of three), don't pay more than the Medicare, Medi-Cal or worker's compensation rate for treatment.

A fact sheet on the bill is available at: http://www.health-access.org/ab232_fact_sheet.htm

The text for AB232 (Chan) is at: http://www.leginfo.ca.gov/pub/bill/asm/ab_0201-0250/ab_232_bill_20040817_amended_sen.html

The text for SB379 (Ortiz) is at:http://www.leginfo.ca.gov/pub/bill/sen/sb_0351-0400/sb_379_bill_20040817_amended_asm.html

ASSEMBLY DEBATE: Assemblywoman Wilma Chan, the author of AB232 (sponsored by Health Access California), served as the floor manager on the debate on SB379, by Senator Deborah Ortiz. She started the discussion by talking about a specific patient who, when her health insurance ran out, was forced to pay four times the amount that her insurance had paid for a similar treatment. Chan made the point that hospital debt is a leading cause of personal bankruptcy.

REPUBLICAN OPPOSITION: Several Republicans rose to argue against the bill, including Assemblymen Tim Leslie, Tom Harman, Dennis Mountjoy, Ray Haynes, and at the end of the discussion, Tony Strickland. Leslie questioned why “Democrats want to attack hospitals, and they are continuing to make hospital operations more difficult.”

Harman made several points in his objections. “Hospitals are businesses. They are run like any other business, whether it is a manufacturing business, a service business, a barber shop, a beauty salon.” He mistakenly stated that, “this bill simply says, well, you’ve got to provide free medical care to certain types of patients... that you can’t use wage garnishment or a collections agency.... Well, how else are they going to collect it if they don’t pay it?” He admitted that “we need to have a plan where everyone can get the necessary medical treatment that they need. I support that in some fashion, I don’t know exactly what it would be.” Finally, he referenced the individual story that Chan cited in her opening: “I’m sorry, but maybe that person should have had better health coverage, maybe that person should have thought about this problem. That’s what we have bankruptcy court for.... Is it any different that a contract debt? How is it different from any other kind of debt? I submit to you that it is not.”

Mountjoy also misrepresented the bill, stating that it said that “if you are a hospital that is serving a patient, and if they are low-income, you gotta give it to them. Well, why don’t we do that for plumbers?... And the electrician, he ought to give you a break, too. Where in the Constitution does it say that we owe folks health care?... We don’t own them health care.” He continued, “why should we put the burden on a business like hospitals?... They are a business not unlike any other. They are there to make a profit, they have a board of directors that looks for that every month.”

Haynes decried the “Orwellian state” he was in. “When you order somebody to give stuff away for free, or you order somebody to work for free, that is what is known in the parlance as slavery. We are basically ordering hospitals to be our slaves.” Later, Strickland stated that “part of the reason why costs have gone up in the hospital is that the hospitals are providing a lot of charity care. The uninsured are not paying their hospital bills.... The hospitals are shutting down their emergency rooms because they are providing too much charity care.”

DEMOCRATIC REBUTTALS: Democrats that rebutted these claims include Assemblymembers Lloyd Levine, Hannah-Beth Jackson, and Jackie Goldberg. Levine responded, “more and more people going without health care in California. And frankly, I actually... resent the implication that they should have had thought of this sooner, and gee, they should have had health insurance. The cost of health insurance is continuing to skyrocket..., many families cannot afford health insurance, and to say ‘oh, it is their fault,’ really misses the point.... We need to pass this bill and do everything we can to make sure people have access to health care when they need it.”

Jackson brought the discussion back to the question that the bill addresses: “Is it correct that many hospitals charge uninsured people higher rates than what they charge and are willing to receive from insurance companies and Medicare?” She continued: “This is a bill that tells hospitals that you can’t take advantage of poor people who don’t have insurance... Let’s be fair to the people that are least able to pay by not forcing them to pay more than you and I who have the benefit of having health insurance. It is a sad state of affairs when anybody takes a predatory practice to charge the least able to pay more money for any service because they can... The goal is to give everybody, whether they are rich or poor, a chance to have quality health care at a fair and reasonable price.”

Goldberg also clarified that the bill “asks that the hospitals require nothing more than the higher of Medi-Cal, Medicare, or worker’s comp. So it is not free. And why is this business different than any other business? Well, this business you can’t live without, in some cases.” She also cited statistics that showed that while the uninsured are a small percentage of the patients in many hospital chains, they account for a disproportionate share of the profits. “The only way that could be true is to be gouging those folks as compared to people who have insurance...”
Chan closed by rebutting the arguments: “This does not in any way call for free care. Back in the 80s, I believe, there were strict limits on what a hospital could charge. This does not even go that far... It just says, if you go to the hospital, there should be some ceiling on what you can be charged… Collections agencies can be called in, but this bill gives the person a chance.” She concluded: “We are not talking about something free here, we are talking about basic fairness.”
The bill passed with an unofficial vote of 41-31, along party lines.

BACKGROUND ON ISSUE: Earlier this year, California hospitals adopted "voluntary guidelines" to head off this legislation and public relations troubles, but consumer advocates still maintain that there is a need for statewide uniform and enforceable standards. This issue has attracted national attention:

• LAWSUITS: Several law firms have filed class action suits against nonprofit hospital chains around the country, including Sutter here in California, all attacking the billing and collections practices of the hospitals. The Sutter lawsuit mentions a report that Health Access co-authored, which you can get at our website, at http://www.health-access.org/.
• FEDERAL ACTION: Federal leaders have taken an interest in this issue. Earlier this year, U.S. HHS Secretary Tommy Thompson and the Centers for Medicare and Medicaid Services issues guidelines for hospitals, making clear that federal program do not condone or require these billing practices.
• CONGRESSIONAL HEARINGS: A Republican Congressman from Colorado has introduced H.R.4092, the “Hospital Billing Fairness Act.” The U.S. House Energy and Commerce Committee held an oversight and investigations hearing on "Hospital Billing and Collection Practices" toward the uninsured. Information is posted at: http://energycommerce.house.gov/108/Hearings/06242004hearing1299/hearing.htm
• MEDIA ATTENTION: In addition to the ongoing coverage that this issue had gotten from the Wall Street Journal and USA Today, ABC's Nightline did a full show on this issue a month ago, in devastating detail.
• OTHER STATES: Connecticut passed related legislation last year on hospital collections practices, but it is believed that these California bills are the first state legislation in the nation to pass to limit the actual amount that hospitals can collect from the uninsured. An issue brief summary on this issue, which talks about groundbreaking developments in California and other states, has just been published by the Commonwealth Fund, at:http://www.cmwf.org/programs/insurance/pryor_medicaldebt_749.asp

Labels: Updates

posted by Anthony Wright | Permalink | 9:32 AM


 

Monday, August 09, 2004

HEALTH ACCESS UPDATE
Monday, August 9th, 2004


CALIFORNIA PERFORMANCE REVIEW SEEKS COMMENTS; ADVOCATES GEAR UP

HEARINGS UPCOMING: The California Performance Review (CPR) Commission will start a series of hearings this Friday at UC-Riverside to hear comments about their proposals. According to their web site (http://www.cpr.ca.gov/): "At this hearing the topics to be discussed will include: Transportation; Hospital, Housing and School Construction; Water and Energy."

Of particular interest to health advocates, the AUGUST 20th HEARING at the UC-SAN DIEGO will be from 10:00 to 4:00p.m., and focus on Health and Human Services, Education, Training and Volunteerism.

NEW ANALYSES: For those who haven't had a chance to read the 2,500+ page report, here are two 10-page analyses. Health Access has a new version of our CPR "Summary and Initial Comment for Health Advocates" available at our web site, at: http://www.health-access.org/docs/CPRHealthSummaryComment.doc

The California Budget Project has also released their analysis, "Soup to Nuts: An Analysis of Selected Recommendations..." at http://www.cbp.org/2004/040806cpr.pdf

HEALTH ADVOCATE MEETING: With the Secretary of Health and Human Services asking for comment on the CPR proposals, and the public hearing coming up, health advocates will meet to discuss the report, share their analysis, and explore common efforts this WEDNESDAY, AUGUST 11th, in SACRAMENTO, at 10:00-11:45am.

Refreshments will be provided. Please RSVP to Louise Jones, Health Access, at ljones@health-access.org, or 916-497-0923. There will be a call-in line available. For those in Sacramento, the meeting will end well before the Senate Health and Human Services Committee, chaired by Senator Deborah Ortiz, that focus on Medi-Cal redesign, as well as a full agenda of legislation.

FINAL BUDGET SCORECARD

The Health Access web site also has the final Health Cuts Scorecard, indicating what was proposed and adopted in this last 2004-05 budget, as well as previous years of our current budget crisis. It is available at:http://www.health-access.org/docs/HealthCuts04ScorecardAug3FINAL.doc

Labels: Updates

posted by Anthony Wright | Permalink | 1:07 PM


 

Tuesday, August 03, 2004

HEALTH ACCESS UPDATE
Tuesday, August 3rd, 2004

CALIFORNIA PERFORMANCE REVIEW UNVEILED; PROPOSALS IN HEALTH CARE RANGE WIDELY
* One large Department of Health and Human Services: No more MRMIB, DMHC, OSHPD, CMAC, etc.
* Lots of specific policy recommendations in Medi-Cal, health plan oversight, etc.

* One proposal: consolidate Medi-Cal eligibility with CalWorks, Food Stamps, Healthy Families
* Another: relieve counties of responsibility for medically indigent adults

* Concerns over HMO patients protections, barriers to people enrolling in Medi-Cal

To great fanfare and apprehension, the California Performance Review (CPR) today unveiled its recommendations to restructure state government. The report comes out of the work of 275 state workers from various agencies, and others, to suggest changes to state government, under the direction of Governor Schwarzenegger to "blow up" boxes.

The Governor received the report today, and said, "I am looking forward to seeing what is in the report." He warned against "special interests" that would call the proposals "unfair and impractical." He added "Sometimes a surgeon has to cut in order to save the patient." The report is at the Review’s web site, at: http://cpr.ca.gov/

THE PROCESS: The proposal was formally presented to the Governor and the CPR Commission’s co-chairs, Joanne Kozberg and Bill Hauck, who will hear the report with the at five statewide hearings on upcoming Fridays: August 13th (Riverside), 20th (San Diego), 27th (San Jose), and September 10th and 17th. Of interest to health advocates, the August 20th hearing in San Diego will cover the proposed changes in Health and Human Services, Training and Volunteerism. (The San Jose hearing will focus on General Government; Information Technology, Performance–based Management, Procurement and Personnel.) The testimony of witnesses will focus on specific topics, but the Commission’s 21 members will take public comment at the end on any issue in the report.

Senator President John Burton has indicated that he didn't see the Legislature approving the full report as a package in its entirety. Governor Schwarzenegger is not expected to propose a final version of his plan to the Legislature until next year. However, some proposals could be enacted by executive order, and other proposals by individual bills this year and next year, in next year's budget, or through a ballot initiative.

THE PROPOSAL: The over 2,500-page proposal suggests that California move from the current set of many smaller departments within large agencies (11 agencies, 79 departments, over 300 boards and commissions) to a small number (11) of very large departments, with realigned and additional responsibilities, eliminating over 100 boards and commissions.

In addition to restructuring, the CPR makes over 1,000 recommendations for the Governor’s consideration in 280 issue areas. Some suggested changes are government-wide, toward overall goals such as instituting customer service goals, changing the personnel system, finding savings (through efficiencies, tax enforcement, and federal matching funds), instituting accountability measures, improving management systems, and better using information technology.

SPECIFIC HEALTH PROPOSALS: In health and human services, the stated goal is to "improve the delivery of health and human services efficiency and effectiveness at both the state and county government levels." A selected summary and analysis will soon be available at http://www.health-access.org. This includes:

• Reorganizing all "state health and human services functions into a single state Department of Health and Human Services," and thus eliminating entities from the Department of Managed Health Care to the Managed Risk Medical Insurance Board to the Medical Board.
• Realigning "current state-county relationship in providing health and human services," including the transforming and consolidating eligibility processing for multiple programs. (2 proposals)
• Refocus basic operations in delivery and oversight of health care, including in:
  Children’s services, such as child care, foster care and child support (7 proposals);
  Public health, mental health, and other services, including alcohol and drug programs, AIDS reporting, WIC, immunization tracking, etc. (8 proposals);
• Licensing and oversight services, of health facilities, health professionals and workers, community care facilities, and managed health care plans (5 proposals); and
• Medi-Cal services, addressing both operation and funding issues, including efforts to get more federal funding, change processing and procedures, and target fraud (10 proposals).

OVERALL COMMENT: It is a laudable goal to reform government, especially to make it work better for those that it serves. This report does not specific legislation toward that goal, but has a series of concept papers on a range of often-unrelated areas. So many of the ideas are just that, and at least to date have not been fully fleshed out. The proposals should be seen as several choices on a menu, rather than a coordinated plan. While some of the ideas are of interest (such as self-certification for the Medi-Cal asset test), others pose serious concern to advocates. Some of the biggest concerns by health advocates include:

• The undermining of HMO patient protections, by having the Department of Managed Health Care subsumed into the Department of Health and Human Services, and by scaling back the authority to audit health plans. The combination may make California's patient protections meaningless.
• The impact on access to care for low-income Californians, including proposals that may reduce access to care to uninsured adults; make it harder for families to find out about Medi-Cal, apply, and navigate the application process; and place other barriers to getting coverage and care.

PROPOSED: A NEW HEALTH AND HUMAN SERVICES DEPARTMENT

The California Performance Review recommendations would create a single new Department of Health and Human Services that would take the functions of dozens of existing agencies, boards, and other government entities. Under this plan, agencies familiar to advocates from the Managed Risk Medical Insurance Board (MRMIB) to the Department of Health Services (DHS) to the Department of Managed Health Care (DMHC) would no longer exist. Within this new department would be six divisions, or centers, each with an undersecretary, focused on health purchasing, public health, quality assurance, behavioral health, services to disabled, and social services.

CONCERN: Health care advocates should be concerned with how proposed restructuring would change the function and focus of government. It is unclear if all the functions of the Department of Managed Health Care (DMHC), or the Office of Statewide Health Planning and Development (OSHPD), are preserved in the new Department of Health and Human Services. There are real concerns that key functions will get lost in the shuffle. What is clear is that there will no longer be an "HMO czar" with the specific task of protecting managed care patients. Instead there would be a mammoth department that would responsible for everything from licensing doctors to administering child care.

PROPOSED: CONSOLIDATED ELIGIBILITY

The CPR proposes to centralize and consolidate eligibility processing for Medi-Cal, CalWORKs, and Food Stamps at the state level, taking the responsibility away from counties. It would contract out that work to create and implement a One-e-App system (like Health-e-App used for Healthy Families) as the main way that people can apply for these programs. In order to help this process, the report recommends moving to self-certification of the asset test, and providing a $50 fee for application assistance.

CONCERN: While the current process of enrolling people into Medi-Cal and other health and human services programs clearly needs to be reformed, health advocates should be very concerned about this proposal. Whether on paper or on the Internet, these applications require assistance, and this proposal seeks to eliminate 17,000 county workers, many of whose jobs are to help people go through the application process. We replace them with one private contractor to the state to administer an online application, and the private efforts of nonprofits and others funded only by the $50 assistance fee. The reliance on the Internet as the main way to enroll is troubling, and combined with other issues may result in many more children and families not getting services for which they are eligible. In addition, over half of Medi-Cal recipients—3.9 million—are not eligible for CalWORKs or Food Stamps, and should not have to be burdened with additional questions or application procedures that might also become a barrier to getting coverage. Self-certification of the asset test is a good step, but much more needs to be done to streamline the application and make it easier to enroll in these programs.

PROPOSED: REALIGN HEALTH AND HUMAN SERVICES

The CPR proposes to realign Medically Indigent Adults (MIA), In-Home Supportive Services (IHSS), Community Medi-Cal Mental Health, and Child Welfare Services (CWS), which are now a combination of state and county responsibility, both in funding and in administration. The proposal would transfer full responsibility for indigent health care, MIA and IHSS to the state, while full responsibility for all remaining state-administered and funded mental health services, and CWS, would be transferred to the counties.

CONCERN: The proposal also appears to eliminate the existing obligation for counties to serve as their providers of last resort, leaving the uninsured dependent on private emergency rooms that are only required to provide minimal emergency care. The report says that "a single eligibility standard would be created" under the state without recommending what that standard would be. There is a real possibility that the statewide standard would be lower than what some counties now provide. There would also be a concern to not encourage counties that make real efforts to treat the uninsured to dismantle their programs.

PROPOSED: AVOID AUDITS OF HEALTH PLANS

The CPR proposes to tequire the state to use the results from accrediting organizations where they are equivalent to or exceed the state’s standards regarding medical surveys/audits of health plans.

CONCERN: This proposal is at the behest of health insurance plans that seek to file less information with the state. Yet even the savings to the health plans is minor, ranging from $50,000 to $250,000. The report states, "the state could save or redirect valuable resources by accepting NCQA accreditation in lieu of regular surveys or audits…" But the power to audit is a key function of the power of a regulator. The state needs to have access to the books, and to act if enforcement is needed. The proposal could eliminate the enforcement of California-specific standards for medical quality and fiscal solvency, relying instead on a private, industry-dominated body. The California standards that would be at risk include: cultural and linguistic competency, timeliness of access, and reglation of specific benefits such as diabetes supplies, contraceptive coverage, and mental health parity. Although these provisions would continue in statute, the private accreditation agency would not inspect for compliance with them.

OTHER SELECTED PROPOSALS:

• Consolidate licensing and certification functions (& eliminate health professions boards)
• Enroll more Medi-Cal patients in Medicare
• Automate identification of Other Health Coverage (OHC) for Medi-Cal patients
• Use smart cards and fingerprint technology in Medi-Cal
• Discontinue Medi-Cal Disproportionate Share Hospital (DSH) Payments for some hospitals
• Centralize Medi-Cal Treatment Authorization Request (TARs) process
• Target Medi-Cal fraud efforts
• Eliminate dual capitation for Medicare/Medi-Cal managed care plans.

Please watch the Health Access web site, at http://www.health-access.org, for a more detailed summary and comment.

Labels: Updates

posted by Anthony Wright | Permalink | 4:22 PM


 

Monday, August 02, 2004

HEALTH ACCESS UPDATE
Monday, August 2nd, 2004


MEDI-CAL REDESIGN POSTPONED UNTIL JANUARY 2005
* Administration Still Moves Forward, But Different Timetable
* California Performance Review, Unveiled Tomorrow, to Include Some Proposals on Medi-Cal


Today, Secretary of Health and Human Services Kim Belshe announced that the Schwarzenegger Administration will NOT be releasing its controversial proposal to restructure the Medi-Cal program, which provides health coverage to more than 6.7 million low-income children and their parents, seniors, and people with disabilities.

"A few key issues still need to be resolved," read a statement. Yet it continued: "The Administration remains firmly committed to restructuring Medi-Cal, and the Governor plans to present a restructuring proposal as part of the January budget." The statement is available at the Medi-Cal redesign web site, at:
http://www.medi-calredesign.org/pdf/Medi-Cal%20Redesign_Web_Message_80204.pdf

While not explicitly stated, it is understood by several advocates that the Administration is NOT planning on seeking a Medi-Cal redesign waiver from the federal government this fall, as had been suggested in previous documents. The Administration will be seeking a renegotiation of a SPCP (Selective Provider Contracting Program) waiver, which expires at the end of the year, and is critical for the funding of California's public and other safety-net hospitals.

The statement indicated that the Administration will work until January to refine policy components of the proposal, to work "with federal officials and safety net hospitals to resolve outstanding issues on hospital financing," and to "review and analyze Medi-Cal program improvement ideas coming out of the California Performance Review for possible inclusion in the restructuring proposal."

In fact, the California Performance Review report, to be released tomorrow, Tuesday, August 3rd, is expected to include a number of proposed changes in Medi-Cal, including: consolidating eligbility processing and reporting requirements for Medi-Cal, CalWORKs, and food stamps. realigning state and county responsibility for health care of indigent care and children's services; contracting to boost enrollment of eligible Medi-Cal patients into Medicare; adopting a self-certification process for the asset test for children and families; identifying and disenrolling Medi-Cal patients who have other health coverage, and other proposals. Health Access will put forward a more complete analysis after the report is released.

The delay in the unveiling of Medi-Cal redesign is a victory, however temporary, for health advocates concerned about the various proposals that would have made millions of Californians pay more for care, or experienced greater barriers for getting the care they need. Advocates were successful in raising hard questions about the proposals. It was also hard to imagine the Legislature adopting such an ambitious proposal in such a short timeframe, of less than a month. While the Schwarzenegger Administration is clearly committed to the proposals as has been outlined to date, the delay until January could impact the politics around the proposal, especially if California is negotiating with a federal Administration under a new President.

Labels: Updates

posted by Anthony Wright | Permalink | 5:01 PM


 

Sunday, August 01, 2004

HEALTH ACCESS UPDATE
Sunday, August 1st, 2004


CALIFORNIA BUDGET SIGNED
* Worst of Health Cuts Again Prevented, Yet Threats Loom This Year and Next
* California Performance Review, Medi-Cal Redesign To Be Unveiled Early Next Week
* Announcements Will Have Significant Impacts for Health Care Consumers


2004-05 CALIFORNIA BUDGET SIGNED

One month after the start of the fiscal year, Governor Arnold Schwarzenegger yesterday signed a state budget (SB 1113) through June 2005. He hailed it as a "fair and responsible budget," and used his line-item veto power on about 40 items totalling an additional $116 million--including a $20 million cut to mental health services for children. No major line-item cuts were in Medi-Cal or other specific programs of interest to health advocates.

The final budget message and information about the line-item vetoes are available at the Department of Finance, at: http://www.dof.ca.gov/HTML/BUD_DOCS/Bud_link.htm or more directly, here: http://www.documents.dgs.ca.gov/osp/vetopackage/State_Budget_2004-05w.pdf (The Health and Human Services section starts at page 16. Line-item veto messages start at page 45.)

HEALTH BUDGET UPDATE: Unlike in previous years, when funding for health care programs and services were central in the final negotiations, the major proposed health care cuts were either rejected, withdrawn, or postponed months ago, including enrollment caps on various public insurance programs, and Medi-Cal provider rate reductions. The budget document cites some savings in health programs, from the result of anti-fraud efforts, delaying Medi-Cal checkwriting by a week, and other tactics. The adminisrations does budget for the administrative changes needed to, starting July 2005, increase premiums for children at 200-250% of the federal poverty level covered by the Healthy Families program. IMPLICATIONS

FOR NEXT YEAR: While once again the worst of the proposed health care cuts did not make it into the budget, health care advocates continue to be apprehensive. The budget still has a significant structural deficit, meaning that next year's budget will have a deficit of billions of dollars. This will once again put pressure of policymakers to seek major cuts, especially in health care, a significant part of the state budget. The only way to prevent significant health care cuts in a sustainable way into the future is to raise new tax revenues.

NEXT WEEK: But advocates don't need to wait long for the next announcement of proposed cuts and threats to health care programs and services. The Schwarzenegger Administration is set to announce major restructuring of both the Medi-Cal program and the whole state government as a whole in the next few days.

CALIFORNIA PERFORMANCE REVIEW AND MEDI-CAL REDESIGN PENDING

On Tuesday, the California Performance Review will release its 2,500+ pages of recommendations to restructure the California bureaucracy, as part of Governor Schwarzenegger's effort to "blow up the boxes" in state government. Some details have already been revealed in the press, such as the elimination of over 12,000 state jobs and 118 boards and commissions.

In health care, the reports indicate that the various government bodies, including the Managed Risk Medical Insurance Board, Department of Managed Health Care, Office of State Health Planning and Development, Health Policy and Data Advisory Commission, Medical Assistance Commission would get folded into one large Department of Health and Human Services, with various divisions. In monitoring efforts, health advocates will be seeking to ensure that the functions and focus of these government entities are preserved to continue to provide health coverage and protect consumers rights. Health Access will work to put out an analysis of this plan as soon as it is officially released.

The plan encourages the privatization of various functions, including the enrollment of children in public insurance programs. The plan also seems to include other changes in both the enrollment, financing, and eligibility of Medi-Cal and other public insurance programs, as has also been advanced in the Medi-Cal redesign process. The Administration is slated to announce its intentions on Monday, August 2nd, with regards to its proposed Medi-Cal redesign, which would seek to save money largely by making Medi-Cal recipients pay more and face more barriers in getting the care they need.

While details are not available, it is clear that both the Medi-Cal Redesign and the California Performance Review potentially will have far reaching impacts on health care consumers, and health advocates should be vigilant.

Labels: Updates

posted by Anthony Wright | Permalink | 9:29 AM


 

Digging a bigger whole for reform...

 

Scoring at home...

 

We are hiring, to make a difference...

 

Field Poll: strong opposition to the health cuts.....

 

An Unhealthy Trend

 

Dressing up the Individual (Market)

 

A great debate on the great divide...

 

Jones to be chair of Health Committee...

 

Bass on the budget...

 

Pretty soon, the insureable will be a pretty exclu...