Friday, September 22, 2006

MEDICARE PART D "DONUT HOLE" DAY; OVERSIGHT OF PART D PLANS URGED

• Statewide Protests Over Part D Deficiencies, Including Lack of Coverage
• New Health Access Policy Brief Shows Minimal Oversight Over Private Part D Plans
• Key Bills on Gov's Desk (AB2170, AB2667, AB2911) Would Fill Gaps in Federal Law
• Also: Universal Health Care Bill, SB640(Kuehl), Officially Vetoed

Today, many senior groups took grassroots actions around the state to mark Medicare Part D "Donut Hole Day," the statistical date that an average senior will hit a coverage gap and start have to pay full price for medications under the new Part D prescription drug plan. More information about the actions, new policy briefs, and pending bills on the Governor's desk, is below.

ALSO: SB840 VETOED: Many of these same seniors groups were also disappointed today at Governor Schwarzenegger's official announcement vetoing SB840, the California Health Insurance Reliability Act, to create a universal, publicly-financed health system for all Californians. (For more information, see the Health Access Update for September 8th, at the Health Access blog: http://www.health-access.org/blogger.html.)

In the Governor's veto message against "government-run" health care, he was making arguments that have been made against Medicare, which is deeply valued by California families. When Medicare was enacted 40 years ago, it set a standard of ensuring that seniors and people with disabilities get comprehensive medical care. Unfortunately, that reputation has been tarnished a bit in the last year by the confusing and controversial Part D plan, which is ironically the only part of Medicare that is totally privatized.

BACKGROUND ON MEDICARE: When Congress crafted the Medicare Part D plan, they deliberately decided to prohibit the federal government from negotiating with the drug companies for the best possible price. Instead, they delegated the administration of this benefit to newly-created private prescription drug plans, each with their different levels of cost-sharing, pharmacy networks, formularies, and other paperwork.

THE DONUT HOLE: Because these plans were not able to get the same levels of discounts as Medicare could, the coverage is less comprehensive--most notably with the "donut hole." This month, millions of seniors across the country are expected expected to fall into the so-called Medicare Donut Hole -- the gap in coverage where plans pay nothing, but beneficiaries must continue to pay the premiums on their prescription drug plans. The "Donut Hole'' begins once a senior's drug cost reaches $2,250 and continues until they reach $5,100, when catatrophic coverage kicks in.

PROTESTS TODAY: The California Alliance for Retired Americans held protests in front of PhRMA Offices in Sacramento and at UnitedHealth Group offices in Long Beach. Seniors chanted slogans such as "PhRMA got the donut, we got the hole," and were locked out of the office building Sacramento, even with dozens of seniors knocking on the door to do be let in. The Congress of California Seniors visited Congressional offices up and down the state, delivering donut holes to staff of Representatives, in Sacramento , Gold River , Palo Alto , San Jose , Campbell , Garden Grove , Newport Beach, and Los Angeles.

As California seniors find themselves paying more out-of-pocket for their needed medications, health, consumer and senior advocates were urging Gov. Arnold Schwarzenegger to sign bills to help remedy the issues raised by Part D.

One bill that the Governor has also pledged to sign is AB2911(Nunez/Perata), to create a prescription drug discount program. In addition to helping millions of uninsured people, it would also provide a discounts to Medicare recipients who are not covered in the “donut hole" in Part D.

POLICY BRIEF REVEALS MINIMAL OVERSIGHT

However, Medicare Part D doesn't just have a gap in coverage, but in oversight over these newly-created, private prescription drug plans.

A policy brief released today by Health Access Foundation provided some stark findings about the lack of public oversight over these plans:

1. The federal government has placed few resources in overseeing these new drug plans.
2. The federal government is not providing data to the public on complaints about these drug plans.
3. Five of these plans are operating but not licensed in California ; two are not licensed anywhere.
   

The PDPs are only loosely overseen by the federal agency responsible, The Centers for Medicare and Medicaid Services (CMS). The law that established the Medicare Part D program attempted to pre-empt state regulation of them. But, the federal government has had its hands full getting the program off the ground and has demonstrated so far little ability to or interest in overseeing their work. CMS has allocated only two employees to oversee all plans nationally – even with all of the problems – making it crucial for California draw on its knowledge and experience with plans and insurers to exercise regulatory authority where appropriate.

With such lax oversight at the federal level, the care is clear for a more aggressive effort by the state of California to ensure that seniors and people with disabilities have consumer protections. A copy of the brief is available at the Health Access website, at:
http://www.health-access.org/providing/docs/PartDPolicyBriefDraft2.doc

LEGISLATION ON THE GOVERNOR'S DESK FOR MORE STATE OVERSIGHT

Senior, health, and consumer groups urged Governor Schwarzenegger to sign key legislation that would offer consumer protections for seniors and people with disabilities in the new federal Medicare Part D.

Gov. Arnold Schwarzenegger has until midnight September 30th to act on bills that would have the state use its authority to place some state oversight over the newly-created prescription drug plans in the program.

The pending bills are:

• AB 2170 (Chan) calls for information on the performance of prescription drug plans to be included in a report card for California consumers.
• AB 2667 (Baca) allows the state to monitor Part D prescription drug plans, and to use the state’s ability as a purchaser and contractor to penalize those plans with bad records.
  

The two bills on Medicare Part D creatively use the state’s authority to provide some consumer protections for these newly-created prescription drug plans. Creating a report card similar to what is done for HMOs, the state can act as a collector and publisher of information. Having the state use it authority as a contractor (through Medi-Cal, CALPERS, etc.) can also discourage “bad actors” from coming into California .

This oversight is important given the problems that have been faced, some of which can be traced back to some of these private plans. In the first eight months of the Part D program, beneficiaries encountered widespread difficulties in obtaining their necessary prescription drugs at affordable prices under the new federal program. Especially hard-hit were vulnerable Medi-Cal beneficiaries who were automatically converted to the new program on its first day. Beneficiaries and pharmacists encountered many computer errors that showed incorrect eligibility for people and inaccurate cost-sharing requirements. Seniors and people with disabilities have had issues being able to get information from the plans about the formularies, participating pharmacies, and other issues. With this backdrop, advocates call any attempts at state oversight essential.

For more information on Medicare Part D, contact Elizabeth Abbott, Policy Director, 916.497.0923 or eabbott@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 2:12 PM


 

Thursday, September 21, 2006

GOVERNOR SIGNS CHILDREN’S HEALTH BILLS; OTHER BILLS STILL PENDING

• New laws would make it easier for children to get and stay enrolled
• Still many health bills remaining on governor’s desk

California Governor Arnold Schwarzenegger has been crisscrossing the state signing and vetoing legislation before the September 30th deadline. Hundreds of bills remain on the governor’s desk including nearly a dozen bills of interest to health advocates. As of Wednesday night, the Governor had signed 376 bills and vetoed 13 bills, with hundreds more to consider by the end of September.

KIDS HEALTH BILLS SIGNED: STREAMLINING, BUT NO COVERAGE EXPANSION

This week, in Fresno , he signed a package of bills, under the theme of improving access to health care for children. “These bills ensure that children, from the moment they are born, have access to the best medical care possible,’’ he said.

The bills include:

• SB437 (Escutia), which streamlines and simplifies enrollment of children to Medi-Cal and Healthy Families programs. It also helps identify children whose families are enrolled in the federal Women Infants and Children program and usher them into a state health coverage program.
• AB1948 (Montanez) which creates a feasibility study on simplifying application for Medi-Cal and Health Families using the CHDP Gateway and electronic applications.
• AB2560 (Ridley-Thomas) which would increase support for school health centers – one of the ideas proposed by Schwarzenegger as part of his increased interest in health care this year.

The Governor's description of the bills, and his press release, is available at his website: http://gov.ca.gov/index.php?/press-release/3964/

Child and other health advocates were pleased with the governor’s support of these bills, even thought the final versions of both Escutia and Montanez’s bills were significantly more modest than originally intended.

For example, Escutia’s SB437 originally would have provided health insurance to all of California’s children in families below 300% poverty ($49,800 for a family of three annually). While the final bills will help children obtain coverage, none of them expand coverage to a single child, and thus none of these bills fulfills the governor's election campaign promise to cover all children.

But the effort continues: many child and health advocates are focusing on Proposition 86, the tobacco tax initiative which would fund, among other health programs, an expansion of children's health coverage.

OTHER HEALTH BILLS OF NOTE

The governor has taken action on nearly 400 bills so far, including last week's veto of SB1414 (Migden) that would have imposed an 8 percent payroll tax for health care on businesses with more than 10,000 employees. He repeats his stance on health care reform, as he did with his op-ed opposing SB840(Kuehl).

The signing statement is here: http://gov.ca.gov/index.php?/press-release/3881/

This week, he also signed AB3070, a health committee bill which clarifies last year's Medicaid Hospital Waiver bill; and AB2059 (Berg) which continues the County Medical Services Program, which contracts with smaller counties to administer their Medically Indigent Adult Programs.

STATUS OF HEALTH ADVOCACY BILLS

Following is a list -- by category -- of bills health advocates have worked on this year that are awaiting action on the governor's desk. Blank boxes means the governor has not acted or announced his action on the bill.

This chart is being updated throughout September at the Health Access California website, at: http://www.health-access.org/advocating/pending2006_bills.htm

HEALTH CARE COVERAGE
Major coverage expansion

• SB840 (Kuehl)
  As the California Health Insurance Reliability Act, creates a universal, publicly-financed (single-payer) health care system, similar to Medicare
  Veto announced

Streamlining Access to Children's Coverage in Public Program

• SB437(Escutia)
  Streamlines and simplifies enrolllment of children in Medi-Cal and Healthy Families
  Signed
• AB1948 (Montanez)
  Creates a feasibility study on simplifying application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application
  Signed

Related Legislation on Access and Coverage

• AB1840 (Horton)
  Requires the state to disclose names of employers who, rather than providing health coverage, have their workers and their families on Medi-Cal and Healthy Families
• AB2889 (Frommer)
  Prohibits health plans from discriminating against people who have been insured, but who have chronic or serious illnesses in certain instances.
• SB1448 (Kuehl)
  Implements "Coverage Initiative'' using money from state's federal hospital Medicaid Waiver
  Signed
• SB1702 (Speier)
  Extends sunset for current Managed Risk Medical Insurance Program.
• SB1704 (Kuehl)
  Extends California Health Benefits Review Board to 2011

Hospital Overcharging of uninsured patients

• AB774 (Chan)
  Provides consumer protections against abusive hospital billing and collections practices, including those that charge uninsured patients multiple times what insurers pay for the same service. Patients under 350 percent of poverty, or with inadequate insurance qualify for discounts.

Affordable Prescription Drugs

• AB2911 (Nunez/Perata)
  Allows the state to negotiate for the best possible price for up to 6 million Californians. The first three years, the program is voluntary. However, after August 1, 2010, if drug companies are not participating or their discounts are still insufficient, the state may use the purchasing power of its Medi-Cal program to steer some business away from less cooperative drug companies.
  Signature announced
• AB2877 (Frommer)
  Establishes a website for consumers to compare prices on prescription drugs, but no longer links to Canadian websites.

CONSUMER AND PATIENT PROTECTIONS
Medicare Part D Patient Protections

• AB2170 (Chan)
  Creates a consumer report card on Medicare Part D prescription drug plans
• AB2667 (Baca)
  Allows the state to monitor Part D prescription drug plans in the same way it monitors health plans

For questions or information, please call Hanh Kim Quach, policy coordinator at 916-497-0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 10:23 AM


 

Wednesday, September 13, 2006

CONGRESS INVESTIGATES NONPROFIT HOSPITALS; BILLING SCRUTINIZED

• Sen. Chuck Grassley, R-Iowa, interrogates non-profit hospitals on services to poor
• Grassley takes suggestions to add more IRS accountability to check non-profit status
• ACTION NEEDED: California ’s AB774 (Chan) – on the Governor’s desk – would require hospitals to have financial assistance policies, prohibit overcharging of uninsured & underinsured patients.

The U.S. Senate Finance Committee turned its focus to familiar issues for health and consumer advocates in California – hospital billing and collections practices, and charity care. Meanwhile, California is poised to join New York in passing landmark legislation this year to, for the first time, provide consumer protections to uninsured and underinsured patients against hospital overcharging.

WHAT BENEFITS SHOULD NON-PROFIT HOSPITALS PROVIDE?

At a Wednesday hearing, Sen. Chuck Grassley, R-Iowa, examined whether non-profit hospitals needed to prove that they were doing enough to deserve their tax-exempt status, which amounts to billions in tax breaks from federal, state and local governments. The hearing and documents are available at the U.S Senate website, at:
http://finance.senate.gov/sitepages/hearings.htm

He started with a story about Diance Insco, a low-income woman who was charged $4,639 by a hospital--"far more than if she had insurance. No one told her about financial assistance or charity care at the hospital. The tax-exempt hospital went after her for the debt and ultimately put a lien on her house." Ultimately, "the hospital did the right thing and tore up the bill," said Grassley, but asked "whether we are comfortable with a system that works only if you have every lawyer in the yellow pages getting in on the act."

Thus, among the issues raised were both the practice of hospitals charging the uninsured more than insurers, and the issue of what obligations nonprofit hospitals had to provide "charity care"--care provided without expectation of payment--to low-income patients.

“There seems to be some agreement that nonprofit hospitals should be providing charity care. It is our responsibility to examine these billions of dollars in tax breaks to understand what benefits they’re providing to Americans,’’ Grassley said. “This is about real people and real people’s lives.’’

Charity care has been an issue for Grassley since 2005, when he asked 10 non-profit hospitals – including Sutter – to answer an extensive questionnaire about their charity care practices and collections against uninsured and underinsured.

Grassley released the hospital responses this week and came to this conclusion: “Non-profit doesn’t necessarily mean pro-poor patient. Non-profit hospitals may provide less care to the poor than their for-profit counterparts. They may charge poor, uninsured patients more for the same services than they charge insured patients.’’

Additionally, the survey found that hospitals varied dramatically in their definitions of charity care, how its valued, eligibility and how they measure their benefit to the community.

“The different yardsticks used makes weighing and considering the charity care and community benefit of different non-profit hospitals less like comparing apples to oranges as comparing apples to farm tractors,’’ Grassley said.

Most egregiously, Grassley noted, hospitals compensate their executives with “gold-plated’’ compensation packages including country club memberships. “All of this calls into question whether non-profit hospitals deserve the billions of dollars in tax breaks they receive.’’


RECOMMENDATIONS OFFERED TO HOLD HOSPITALS ACCOUNTABLE

Among the panelists at Wednesday’s hearing was Dr. Nancy Kane, Professor of Health Management at the Harvard School of Public Health, who decried the billions that non-profit hospitals receive in both tax breaks and disproportionate share payments without any clear requirements – or way to track – whether they are providing care to the poor.

“We have created a ‘funded non-mandate’ for charity care and many hospitals enjoy the funds without obeying the ‘non-mandate,’ taking the money and not providing much charity care or responding to the needs of the local community -- the most vulnerable communities’’ Kane said.

In spite of recent federal and state attention on hospital billing practices, “both state and federal authorities are finding that the existing standard does not prohibit behavior that society is finding pretty unacceptable.’’

Kane advocated for legislation to address the following issues:

• Tying patient’s eligibility for a discount or charity program to income – and including underinsured patients.
• Requiring the IRS to certify the “reasonableness’’ of a hospital’s level of charity care.
• Requiring hospitals to partner with community groups to plan what benefits it would provide to a community.
• Requiring a standardized community benefit report to be attached to a nonprofit hospitals Form 990 report to the IRS so its actions would be easily available to the public.

WHAT SHOULD BE EXPECTED?

Kane and Grassley pointed to recent guidelines reported to be implemented at 95 percent of Catholic Health Association hospitals in the nation, which define “community benefit’’ and what counts as charity care.

Of contention, however, is whether care provided through Medicaid – which hospitals say do not adequately reimburse for medical services -- should be considered charity care. Catholic Health Association does not consider Medicaid services as part of charity care, but the American Hospital Association does.

Kevin Lofton, chair-elect of the American Hospital Association, said, “Everyone needs to know the amount of underfunding because that cost is borne somewhere in the system.’’

But Sister Carol Keehan, Catholic Health Association’s CEO, said that underfunded Medicaid payments, and debt defaults should not be considered a “community benefit.’’

NEXT STEPS

Within weeks, Grassley’s office, along with Sen. Max Baucus, D-Mont., would have a draft proposal that considered both Kane’s suggestions, and the various hospital "voluntary" guidelines.

“It’s important that we make real progress in ensuring that these billions of dollars in tax breaks actually are effective in helping those in need,’’ he said.

CALIFORNIA LAW TO ALLEVIATE HOSPITAL CHARGES ON GOVERNOR’S DESK

On a related issue, advocates are still awaiting the outcome of AB774 (Chan), which was sent to Gov. Arnold Schwarzenegger’s desk in the waning hours of the 2006 Legislative session.

AB774(Chan), sponsored by Health Access California, would require all hospitals (not just nonprofits) to adopt a financial assistance policy, and that uninsured or underinsured patients below 350% of poverty (or $58,100 for a family of three) would have to pay more than the Medicare, Medi-Cal or worker's compensation rate. Income eligible Californians would need to be informed of the hospital’s financial assistance and charity care policies upon admission.

While the bill does not require any provision of free care or charity care, it prevents the widespread practice of hospital overcharging. It also ensures that patients have the necessary information about their consumer rights and financial options, and prevent them from being sent prematurely to collections and court.

This is the fifth year that advocates have fought for remedies to aggressive collection practices by hospitals. The California Hospital Association is now officially neutral.

ACTION ITEM: The Governor has not yet still needs to hear from you. Urge Gov. Arnold Schwarzenegger to sign AB774.

Gov. Arnold Schwarzenegger

State Capitol
Sacramento , CA 95814
FAX: 916-445-4633

For a sample letter or information, please contact policy coordinator Hanh Kim Quach at 916.497.0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 8:17 AM


 

Tuesday, September 12, 2006

NEW ASSEMBLY COMMITTEE CHAIRS ANNOUNCED FOR NEXT YEAR

• Dymally To Chair Health Committee; Berg To Chair Health Budget Subcommittee

Even though many bills passed still have yet to be signed or vetoed by Governor Arnold Schwarzenegger, and the election is not until November, Sacramento watchers are already thinking ahead to next year's legislative session. Due to term limits, there will be considerable turnover in the California Legislature, with at least 38 Assemblymembers not returning.

With possibly half of the next year's Assembly being new members--depending on the outcomes in the handful of competitive races, health advocates will no longer see some familiar faces. Those that have been very active on health issues, but who won't be in the Assembly again next year, include Majority Leader Dario Frommer, Assembly Appropriations Committee Chair Judy Chu, Assembly Health Committee Chair Wilma Chan, Former Assembly Health Committee Chair Rebecca Cohn, and many others.

As many lawmakers are expected to leave office November 30, Assembly Speaker Fabian Nunez on Monday announced a new slate of lawmakers, who are continuing in the Legislature, to head committees. Of interest to health advocates are the following new chairs of the relevant committees:

• Appropriations Committee Chair: Mark Leno, of San Francisco , will replace Judy Chu.
• Budget Committee Chair: John Laird, of Santa Cruz , will keep his position.
• Budget Subcommittee #1, on Health and Human Services, Chair: Patty Berg, of Arcata, replaces Hector De La Torre, who will now be chair of the Rules Committee.
• Health Committee Chair: Mervyn Dymally. of Compton , replaces Wilma Chan.

No official announcements have been made yet about next year's Senate leadership, which will place new chairs as head of the Senate Health, Insurance, and Appropriations Committees, given that term limits is capping the Senate careers of Senators Deborah Ortiz, Jackie Speier, and Kevin Murray, respectively.

For questions or information, please call Hanh Kim Quach, policy coordinator at 916-497-0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 2:20 PM


 

Thursday, September 07, 2006

ADMINISTRATIVE UPDATE: MEDI-CAL, LANGUAGE & DISABILITY ACCESS

• New Documentation Requirements in Medi-Cal Reviewed at DHS
• Comments Sought on Language Access Regulations at DMHC & DOI
• Disability Access Issues and Reporting Debated Within OPA

Even with all the end-of-session action at the California state legislature, health and consumer advocates are also active at the important deliberations happening within the various state agencies, including the Department of Health Services, the Department of Insurance, and the Department of Managed Health Care.

Here's an update by Elizabeth Abbott, Project Director, who managed administrative advocacy for Health Access:

STATE IMPLEMENTATION OF NEW MEDI-CAL DOCUMENTATION BURDENS

On February 8, 2005, President Bush signed into law the Deficit Reduction Act (DRA) which made certain changes to Medicaid (Medi-Cal in California) law. One of those changes was the requirement for individuals declaring to be U.S. citizens or U.S. nationals to show documentary evidence of this fact as well as proof of identity.

On August 18th, 2006 the California Department of Health Services (DHS) hosted a meeting with stakeholders on the implementation of these onerous citizenship and identity requirements newly-imposed by the DRA. The principal purpose of the meeting was to provide some feedback to individuals and groups who had provided comments to the Department in the preparation of their letter to the counties to implement these provisions.

Between 50 and 60 organizations commented on the draft letter to the counties and offered many hundreds of comments, questions, and recommendations. DHS is taking the comments they have already received, together with the discussion at the meeting, and plan to issue a revision of the letter to the counties. Their intention is to hold another stakeholders' meeting to discuss that document before final release. However, advocates are concerned that as federal implementation deadlines are fast-approaching, the consultation process may be shortened or eliminated.

DHS also sent the official California response to the Centers for Medicare and Medicaid Services (CMS) interim final federal regulation on August 11, 2006. They said that many of their comments to federal officials mirrored comments raised by the advocacy community. They would not speculate on how long it would take for the final implementing regulation to be released by CMS, but they did not anticipate that it would be soon.

FEEDBACK: DHS identified 23 major issues raised by a significant number of advocates regarding their letter to the counties. The issues fell into four major categories:

1. Major legal/conceptual concerns. Perhaps the most fundamental concern is that many advocates believe that proving citizenship and identity is not a prerequisite for an individual's eligibility to Medi-Cal, but merely a requirement for the state to be able to receive federal matching funds. If this is a correct interpretation of the DRA, it does permit the possibility that the state could establish a limited state-only funded program for certain Medi-Cal sub-categories as a last resort. There also were many recommendations regarding providing temporary eligibility, less than full-scope Medi-Cal benefits, retroactive eligibility, and presumptive eligibility while people are making efforts to secure the proper documents.
2. Maximizing Data Match Opportunities. Many advocates urged the greatest possible use of data matches, within the state of CA (with Vital Statistics, DMV), among states (to check availability of birth records for people born outside CA), with other federal agencies (SSA). All these efforts would be aimed at eliminating the need for the applicants and beneficiaries to secure expensive and hard-to-obtain proofs.
3. Outreach. There were many suggestions about how to make outreach efforts more effective including translating into threshold languages, being conscious of literacy limitations, correcting the misunderstanding that this applies to non-citizens, and enlisting the help of advocates and health plans to assist applicants in securing proofs.
4. Technical Clarifications . There were several ideas about how to make this law actually work better. These suggestions included expanding the role of the counties in assistance to applicants, tapping state resources to pay for the cost of obtaining proofs, giving guidance on how counties should collect, maintain, and return proofs. There also was a discussion of whether or not to establish a separate aid category on their system to identify Medi-Cal recipients affected by this law in case there is a federal statutory or policy change.

DOCUMENTS AVAILABLE: DHS said they planned to put the following documents on their website:

• Their formal response to CMS on the interim regulation.
• The full text of the 23 broad comments discussed at the stakeholders' meeting.
• The entire text of letters from advocates on this issue.

The website is at: http://www.dhs.ca.gov/mcs/DRA/default.htm.


LANGUAGE ACCESS REGULATIONS UP FOR COMMENT AT DMHC, DOI

The Department of Managed Health Care (DMHC) is in the process of finalizing its regulations on SB 853, Language Assistance Programs # 2004-0015. DMHC held public hearings on the proposed regulation in Los Angeles and Oakland earlier this year and incorporated almost all of what was requested by consumer and health advocates, despite some contrary testimony by some plans and providers.

This regulation establishes requirements that health plans provide free interpretation and translation services in threshold languages to Limited English Proficiency (LEP) enrollees in their plan. This requirement extends to the plan’s contracted providers, and includes clinical encounters, administrative services, appeals and grievances, and billing and financial notices.

Interested groups can still submit comments in support of this regulation by 5:00 PM on September 25, 2006 by email to Regulations@dmhc.ca.gov or by mail to Emilie Alvarez, Regulations Coordinator, Department of Managed Health Care, Office of Legal Services, 980 9th Street, Suite 500 , Sacramento , CA 95814.

The full text of the modified regulation can be viewed at the DMHC website at
www.dmhc.ca.gov

In addition, the Department of Insurance (DOI) has been working with the advocacy community to “match” their Health Care Language Assistance regulation governing insurers to the DMHC model that regulates health plans (described above.)

Interested groups can give testimony in support of the draft regulation at the public hearing scheduled for 9:00 AM on September 26 at the Employment Development Department, Conference Room A, 750 N Street, Sacramento, CA 95814. Written comments may also be submitted via email no later than 5:00 PM on September 26, 2006 to the attention of Elena Fishman at The Department of Insurance at fishmane@insurance.ca.gov. The full text of the draft regulation can be viewed at the DOI website at www.insurance.ca.gov/industry.


DISABILITY ACCESS DEBATED

The Office of the Patient Advocate (OPA) convened a meeting on August 23, 2006 for health plans, advocates, and researchers to report on the findings and recommendations from the Survey of Disability Access Services Provided by California Health Plans. The survey was conducted in January and February 2006. The full text of the survey report and the Executive Summary may be found on OPA's website (www.opa.ca.gov).

There were 13 formal recommendations that came out of the survey and the discussion at the meeting also touched on methodology, standards, and the purpose of the survey. Although the survey was solicited from 28 health plans in California , only 10 plans returned the voluntary survey. Many plans admitted to the surveyors that they had not completed the survey because:

• They had other priorities with their limited staff.
• The timing of the survey coincided with several other mandated governmental submissions
• The survey was cumbersome to complete.
• Most significantly, by completing the survey the plans were opening themselves up to increased liability and requests for public records access.
• And, in some cases, the plans acknowledged they were not doing much in this area and they were reluctant to furnish the information.

OPA conceded the response was disappointing and, as a result, they were cautious about drawing broad conclusions and looking for ways to increase plan participation.

There was acknowledgement of the plans' concerns about the confidentiality of data provided in the survey. However, advocates stated emphatically that if real differences exist between plans, the ultimate purpose of a survey of disability access is to publish the information to help people with disabilities make informed health care choices. California Association of Health Plans (CAHP) responded that if the disability access services offered by plans were made public, it would result in adverse selection of the most generous plans by the most disabled (and expensive) members of that community. Several advocates acknowledged there could be higher initial costs, but the greater access to care and better coordination of care, would pay long-term health (and cost) dividends.

OPA agreed that it would be worthwhile to establish a Disability Advisory Committee to provide input on policy issues and a Technical Advisory Group to assist OPA to operationalize those broad objectives. These two groups would be composed of members representing plans, providers, advocates, consumers, governmental agencies, and legal experts. They envisioned that these groups would replace the large, loosely-constituted, and somewhat unwieldy ad hoc advisory structure that currently exists.

There was a spirited discussion about the plans' responsibility to undertake changes to actually improve disability access. The CAHP expressed frustration that as an association they did not want to be in the position of "certifying" that each of their contracted providers met all of the requirements for disability access (e.g. ramps to all providers' offices for wheelchair access, or all plan materials produced in Braille). Advocates responded that the plans had to provide program access within the network of providers (in essence, that equivalent services must be available within the geographic area), but not necessarily ensure compliance by every facility. The enforcement responsibility remained a governmental function.

OPA plans to conduct this survey again and have as their ultimate objective to incorporate the results into the Health Plan Report Card. They will explore combining this disability access survey with their survey on cultural and linguistic access (where they get almost a 100% return rate from the plans,) and rethink the timing of the survey to ensure greater plan participation.
OPA intends to offer training on the legal standards for disability access with examples of innovative services provided by plans to persons with disabilities. The training would be conducted by staff from DMHC, DHS, the health plans, providers, advocates, contractors, and academics.

For more information on any of these agency updates, or to get involved with the coalitions working on any of these issues, contact Elizabeth Abbott, Project Director, at (916) 497-0923, ext. 201 or at eabbott@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 8:09 AM


 

Wednesday, September 06, 2006

GOVERNOR TO VETO UNIVERSAL HEALTH CARE BILL (SB840)

• Governor Schwarzenegger Sends Signal Opposing Legislation; Record Builds
• UPDATE: How Lawmakers Voted on Health and Consumer Bills

Even before SB840(Kuehl) lands on his desk, Gov. Arnold Schwarzenegger has declared that the bill that would provide every single Californian comprehensive benefits and better health care a "serious and expensive mistake.''

The Governor announced his intention in an op-ed that ran today in the San Diego Union-Tribune: (http://mail1.icpbounce.com/icp/relay.php?r=1012041699&msgid=3431169&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fwww.gov.ca.gov%2Findex.php%3F%2Fpress-release%2F3751&l=1)

In that article, Schwarzenegger laid out his rationale for his planned rejection of SB840. Among his reasons, stating that it is "socialized medicine" that would create a "vast new bureaucracy to take over health insurance and medical care for Californians," and that it would lead to "significant new taxes on individuals and businesses." To Schwarzenegger, SB840 did not solve "the critical issue of affordability.''

Supporters of SB840 disagree, and argue that the proposed framework is one of the most comprehensive efforts put forward to acheive health care affordability, since it would attempt to control costs through prevention, planning, and administrative simplification. The financing of the health care system under the SB840 framework would have taken the existing money already paid into the system through employers, employees and the government, and redirected in in a more efficient manner. They pointed to independent studies that suggest that the approach would have actually saved money.

The bill's author for the past four years, Sen. Sheila Kuehl, shot back with this statement. http://mail1.icpbounce.com/icp/relay.php?r=1012041699&msgid=3431169&act=XIOO&c=5484&admin=0&destination=http%3A%2F%2Fdemocrats.sen.ca.gov%2Ftemplates%2FSDCTemplate.asp%3Fa%3D6092%26z%3D144%26cp%3DPressRelease%26pg%3Darticle%26fpg%3Dsenpressreleases%26sln%3DKuehl%26sdn%3D23&l=2

"Such a statement shows that he has not read the bill, doesn't understand the bill, or is being completely misdirected by his handlers,'' Kuehl said. She took issue that the Governor made the decision before ever meeting with her, or having the bill reach his desk.

Schwarzenegger did not put forward a specific alternative, and he reiterated his intention to announce his plans for health reform in January 2007, if re-elected.

This is the third year that Governr Schwarzenegger has opposed efforts to expand coverage and make health coverage more affordable for Californians, without putting forward a proposal of his own. For instance:
* In 2004, he actively campaigned against Proposition 72--passed in the legislature as SB2(Burton)--which would have required large employers to provide health coverage to their workers.
* In 2005, he vetoed AB772(Chan), which would have expanded public health insurance programs like Medi-Cal and Healthy Families to cover all children in California.
* In 2006, he plans to veto SB840(Kuehl), to create a universal, publicly-funded health care system to provide health coverage and financial security to all Californians.


CALL TO ACTION: While the Governor has now announced his intention to veto SB840, there are many other bills on his desk that health advocates are actively urging him to sign. While none expand coverage or are of the same scope as SB840, many of the bills would have significant impact to uninsured and insured Californians if signed.

Organizational and individual letters are needed to urge the Governor to sign the bills listedbelow. The governor's address is:

Gov. Arnold Schwarzenegger
Capitol Building
Sacramento, CA 95814
FAX: 916-445-4633

COMPREHENSIVE CHART: HOW LAWMAKERS VOTED ON HEALTH CONSUMER BILLS

Following is a list -- by category -- of bills health advocates have worked on this year, and that were supported by several health consumer groups including Health Access California.

This lists includes the breakdown of the final floor votes with these bills.

LEGEND:
PL=Party Line vote with Democrats supporting, Republicans opposing
No/Yes=Legislators that explcitly voted "no" or "yes" on the bill, usually against party line
Abs.=Abstentions, with the legislator either simply not present on the floor during the vote, or intentially not voting)

HEALTH CARE COVERAGE
Major coverage expansion

SB840 (Kuehl) -To Governor - As the California Health Insurance Reliability Act, creates a universal, publicly-financed (single-payer) health care system, similar to Medicare
Assm. 45-33 PL; Assm. 'No': Matthews, Nation; Assm. Abst.: Parra; Sen. 24-13 PL; Senate abst.: Cedillo, Denham, Harman

Measures on Access and Coverage
AB1840 (Horton) - To Governor - Requires the state to disclose names of employers who, rather than providing health coverage, have their workers and their families on Medi-Cal and Healthy Families
Assm. 48-30 PL; Assm. abst. Garcia; Sen. 22-15 PL; Sen. abst.: Florez, Perata, Runner;

AB1948 (Montanez) - To Governor - Creates a feasibility study on simplifying application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application
Assm. 51-24 PL; Assm. abst. Cohn, Garcia, Hancock, Koretz; Sen. 25-13 PL; Sen. abst. Chesbro, Florez;

AB1971 (Chan) - Failed - Extends the sunset for the Managed Risk Medical Insurance Program (MRMIP) and the Guaranteed Issue Pilot, which covers patients with "pre-existing conditions'' unable to get coverage elsewhere.
Stalled before final vote: action taken on more modest bill: see SB1702.

AB2889 (Frommer) - To Governor - Prohibits health plans from discriminating against people who have been insured, but who have chronic or serious illnesses in certain instances.
Assm. 76-2; Assm. 'No' Matthews, Haynes; Assm. abst.: Dymally; Sen. 37-1; Sen. 'No': McClintock; Sen. abst.: Chesbro, Morrow

SB437 (Escutia) - To Governor - Streamline and simplifies enrollment into children’s insurance programs. This is an extremely tame version of the bill, which was originally intended to expand coverage to all children in California
Assm. 56-20 PL; Sen. 25-15 PL

SB1702 (Speier) - To Governor - Extends sunset for current Managed Risk Medical Insurance Program.
Assm: 78-0; Sen. 40-0

CONSUMER PROTECTIONS AGAINST MEDICAL DEBT
Hospital Overcharging of uninsured patients
AB774 (Chan) - To Governor - Provides consumer protections against abusive hospital billing and collections practices, including those that charge uninsured patients multiple times what insurers pay for the same service. Patients under 350 percent of poverty, or with inadequate insurance qualify for discounts.
Assm: 50-28 PL; Assm abst.: Dymally; Sen. 22-14 PL; Senate abst. Ducheny, Florez, Soto, Battin

Affordable Prescription Drugs
AB2911 (Nunez/Perata) - To Governor - Authorizes the state to negotiate for the best possible price for up to 6 million Californians. The first three years, the program is voluntary. However, after August 1, 2010, if drug companies are not participating or their discounts are still insufficient, the state may use the purchasing power of its Medi-Cal program to steer some business away from less cooperative drug companies.
Assm. 47-31 PL; Assm. abst: Negrete McLeod; Sen. 25-12 PL; Senate abst: Denham, Harman, Runner

AB2877 (Frommer) - To Governor - Establishes a website for consumers to compare prices on prescription drugs, but no longer links to Canadian websites.
Assm: 49-26 PL; Assm "Yes": Daucher, S. Horton, Blakeslee, Maze; Assm. abst. Klehs, Koretz, Leslie, Mullin; Sen.: 22-14. Sen. abst.; Alarcon, Ashburn, Kuehl, Soto

SB452 (Alarcon) - Failed - Requires Medi-Cal to report to Governor on whether Medi-Cal prices are higher than prices for federal programs
Assm: 34-39 PL. Assm. 'No': Calderon, Canciamilla, Chavez, Lieu, Matthews, Negrete-McLeod, Parra. Assm. Abst. Arambula, Cohn, Mullin, Torrico, Vargas, Wolk.

PATIENT PROTECTIONS
Medicare Part D Patient Protections
AB2170 (Chan) - To Governor - Creates a consumer report card on Medicare Part D prescription drug plans
Assm: 49-31 PL; Assm "Yes": S. Horton; Sen. 23-15 PL; Sen. Abst: Escutia, Machado.


AB2667 (Baca) - To Governor - Allows the state to monitor Part D prescription drug plans in the same way it monitors health plans
Assm: 75-1; Assm. 'No': Haynes; Assm. abst. Koretz, Leslie. Nation; Sen:23-14 PL; Sen. abst: Alarcon, Chesbro, Escutia

Insurance Oversight
SB1405 (Soto) - Pulled from vote. Author & advocates working with Administration -
Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care
Assm: 51-28 PL; Assm "Yes": Garcia, S. Horton, Daucher

SB1704 (Kuehl) - To Governor - Extends sunset for the existing California Health Benefits Review Program to 2011.
Assm: 49-27 PL; Assm abst. Nakanishi, Negrete McLeod, Umberg; Sen. 23-14 PL; Sen. abst. Battin, Dunn, Perata

Prescription Drug Safety
AB71 (Chan/Frommer) - Failed - Establishes a clearinghouse for information about the safety and effectiveness of prescription drugs that are advertised on television
Sen. 16-18 PL; Sen. 'No': Florez; Sen. abst: Alarcon, Cedillo, Chesbro, Figueroa, Kehoe, Machado

For questions or information, please call Hanh Kim Quach, policy coordinator at 916-497-0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 10:16 AM


 

Tuesday, September 05, 2006

2006 SESSION RECAP: HEALTH HIGHLIGHTS OF BILLS SENT TO GOVERNOR

• Passage of Universal Healthcare Framework (SB840); Statement on Need for Reform
• Fair Prices on Rx Drugs (AB2911) & Hospital Charges (AB774) for Uninsured
• Addition Oversight Over New Medicare Part D Plans (AB2170 & AB2667)
• Other Measures: Streamline Kids Coverage; Help Those with "Preexisting Conditions."
• UPDATE: The Final Results on Pending Bills: What Made It to the Governor?
  

With the 2005-06 California legislative session having ended last night, Thursday, August 31st, several landmark health care bills now make their way to the Governor's desk. In this current political environment, many (though not all) are expected to be signed.

HEALTH HIGHLIGHTS: These groundbreaking bills would bring down the cost of prescription drugs, prevent hosptials from overcharging self-pay hospital patients, provide greater state oversight over private Medicare Part D plans, and provide health security for all Californians. Among the highlights:

* UNIVERSAL HEALTH CARE: SB840(Kuehl), the California Health Insurance Reliability Act, would create a universal health care system for all Californians, to provide comprehensive benefits, choice of doctor, better health outcomes, increased system savings, and financial security for California residents. The bill creates a framework and a timetable to establish the system and determine a financing structure.

* DRUG DISCOUNTS: AB2911(Nunez/Perata) would create a prescription drug discount program that would use the purchasing power of the state to bargain for signficant discounts for up to over 6 million Californians with no or inadequate prescription drug coverage. This compromise from last year's ballot battles of Prop 78 & 79 is seen by many advocates as a workable, enforceable, and verifiable plan to bring down those costs for Californians.

* HOSPITAL BILLS: AB774(Chan) would prevent self-pay hospital patients from being overcharged, and provide other landmark consumer protections. Uninsured patients who go to the emergency room get charged several times what an insurance company pays, and this allows these self-pay patients to pay a fair rate, at the level of Medicare, Medi-Cal or worker's compensation. It would also prevent bills from going to collections or court prematurely. The result of a five-year effort by health advocates, this bill could prevent many from needless going into medical debt and bankrtupcy.

* MEDICARE PART D: AB2667(Baca) would increase state oversight over Medicare Part D drug plans. AB2170(Chan) would create a report card on them. When Congress decided not to have the federal government negotiate directly with the drug companies for the best price, they instead turned over the Administration of the Medicare prescription drug program run to these newly created private plans, with little oversight over them. These bills attempt to place some state oversight over these private plans that now have little accountability.

NATIONAL & HISTORIC CONTEXT: The passage of these measures in the legislature of the largest state will not just benefit millions of Californians, but are expected to have national implications for impacting policy in other states and with the federal government. The passage of many of these key bills show renewed political will in providing significant help to those Californians without insurance.


Even without signature, health advocates scored a historic victory as lawmakers passed SB840(Kuehl) to create a universal, publicly funded, comprehensive health care program. Gov. Schwarzenegger has indicated that he is likely to veto this bill, but the mere fact that it cleared both houses of the Legislature sends a strong message that major health reform is needed.

FAIR PRICING FOR THE UNINSURED: Many health advocacy organizations were finally successful, after multi-year, parallel efforts, to protect patients against overcharging by pharmaceutical companies and hospitals. These bills prevent uninsured, underinsured and low-income patients--oftentimes those with the least--from paying the most for the hospital care and medications needed to keep them alive.


STREAMLINING KIDS COVERAGE: Efforts to make it easier to enroll and retain children on public insurance programs made their way to the Governor, with SB437(Escutia) and AB1948(Montanez).

HELP FOR THOSE WITH "PRE-EXISTING CONDITIONS": AB2889 (Frommer) would allow patients with "pre-existing conditions" to transfer between similar plans from one insurer to another. Yet for those "uninsurable" Californians without coverage, they suffered a setback with the failure of AB1971(Chan). That bill would have extended the Manged Risk Medical Insurance Program (MRMIP) for four years, as well worked through the waiting list, extended the coverage, and made the financing more stable and equitable among insurers. Due to a late opposition push, the measure stalled. In its place, SB1702(Speier/Cox) will go to the Governor, to simply extended the sunset on MRMIP for four months through the end of 2007, to allow policymakers to address the ongoing issues next year, and not leave those on the MRMIP program in a bind.

EMPLOYER COVERAGE: AB1840(Horton) would produce information about the employers of the families on the Medi-Cal and Healthy Families programs. SB1414(Migden), dubbed the "Wal-Mart bill,'' would require employers of 10,000 or more to pay into a fund if they do not spend a minimum level on health benefits. Both go to the Governor.

DRUGS: The high-profile agreement on prescription drug discounts AB2911(Nunez/Perata) did not mean that the drug companies came away without stopping consumer-backed legislation. Two bills on prescription drugs died in the last days, including AB452(Alarcon), to require a report to the Governor about the prices paid by Medi-Cal for medications; and AB71(Chan), to establish a clearinghouse for unbiased information about the safety and effectiveness of widely-used drugs. However, AB2877(Frommer) did pass, to create a website to assist consumers in comparison shopping about the retail cost of drugs between pharmacies. (While it was amended to take out references to the re-importation of drugs from other countries, it envisions a useful resource for consumers.)

OTHER MEASURES: Other items that passed included SB1534(Ortiz), a new measure to clarify counties' ability to provide care to undocumented Californians. SB1312(Alquist) as part of licensing reform, would allow hospitals to be fined for patient care violations, in a manner similar to nursing homes--a major step in hospital accountability.

CALL TO ACTION: Organizational and individual letters are needed to urge the Governor to sign these bills, and those below. The governor's address is:

Gov. Arnold Schwarzenegger
Capitol Building
Sacramento, CA 95814
FAX: 916-445-4633

COMPREHENSIVE LIST: HOW HEALTH CONSUMER BILLS FARED

Following is a list -- by category -- of bills health advocates have worked on this year, and that were supported by Health Access California:

HEALTH CARE COVERAGE
Major coverage expansion

SB840 (Kuehl) As the California Health Insurance Reliability Act, creates a universal, publicly-financed (single-payer) health care system, similar to Medicare Sent to Governor

Measures on Access and Coverage

AB1840 (Horton) Requires the state to disclose names of employers who, rather than providing health coverage, have their workers and their families on Medi-Cal and Healthy Families Sent to Governor.
AB1948 (Montanez) Creates a feasibility study on simplifying application for Medi-Cal and Healthy Families using CHDP Gateway and electronic application.Sent to Governor.
AB1971 (Chan) Extends the sunset for the Managed Risk Medical Insurance Program (MRMIP) and the Guaranteed Issue Pilot, which covers patients with "pre-existing conditions'' unable to get coverage elsewhere Failed, but a narrower version was passed at the last minute in SB1702 (Speier)
AB2889 (Frommer) Prohibits health plans from discriminating against people who have been insured, but who have chronic or serious illnesses in certain instances. Sent to Governor.
SB437 (Escutia) Streamline and simplifies enrollment into children’s insurance programs. This is an extremely tame version of the bill, which was originally intended to expand coverage to all children in California Sent to governor.
SB1702 (Speier) Extends sunset for current Managed Risk Medical Insurance Program.
Sent to Governor.

CONSUMER PROTECTIONS AGAINST MEDICAL DEBT
Hospital Overcharging of uninsured patients

AB774 (Chan) Provides consumer protections against abusive hospital billing and collections practices, including those that charge uninsured patients multiple times what insurers pay for the same service. Patients under 350 percent of poverty, or with inadequate insurance qualify for discounts. Sent to Governor.

Affordable Prescription Drugs

AB2911 (Nunez/Perata) Authorizes the state to negotiate for the best possible price for up to 6 million Californians. The first three years, the program is voluntary. However, after August 1, 2010, if drug companies are not participating or their discounts are still insufficient, the state may use the purchasing power of its Medi-Cal program to steer some business away from less cooperative drug companies. Sent to Governor.
AB2877 (Frommer) Establishes a website for consumers to compare prices on prescription drugs, but no longer links to Canadian websites. Sent to Governor.
SB452 (Alarcon)Requires Medi-Cal to report to Governor on whether Medi-Cal prices are higher than prices for federal programs. Failed.

PATIENT PROTECTIONS
Medicare Part D Patient Protections

AB2170 (Chan) Creates a consumer report card on Medicare Part D prescription drug plans
Sent to Governor.

AB2667 (Baca)
Allows the state to monitor Part D prescription drug plans in the same way it monitors health plans. Sent to Governor.

Insurance Oversight

SB1405 (Soto) Creates a Task Force on Reimbursement for Language Services to recommend actions for achieving linguistic access to care. Pulled from vote. Author & advocates working with Administration.
SB1704 (Kuehl) Extends sunset for the existing California Health Benefits Review Program to 2011. Sent to Governor.

Prescription Drug Safety

AB71 (Chan/Frommer) Establishes a clearinghouse for information about the safety and effectiveness of prescription drugs that are advertised on television. Failed.

For questions or information, please call Hanh Kim Quach, policy coordinator at 916-497-0923 x 206 or hquach@health-access.org.

Labels: Updates

posted by Anthony Wright | Permalink | 2:02 PM


 

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