Remembering Beth Abbott, Deluxe Patient Advocate

We at Health Access, along with the wider California Capitol community and nationwide health care policy and consumer advocacy community, were saddened to hear yesterday that our dear colleague and friend Beth Abbott passed away this weekend.

Beth served as the Director of Administrative Advocacy at Health Access California for nearly nine years, after a long and distinguished career in federal service, including as Regional Administrator for the Centers for Medicaid and Medicare Services. She left us when she was appointed by Governor Brown to direct the Office of the Patient Advocate. She retired (again) a few years ago, but was still active in the community. She was scheduled to be re-appointed to the Yolo County Health Council today; instead, the Yolo Board of Supervisors adjourned in her honor.

To use a Beth Abbott term, she was “deluxe,” both in her dedication to public service, and her personality. Tributes to her from colleagues and friends in just the last day have called her “a feisty firecracker and tenacious troublemaker,” “a bright light in the advocacy world,” a “great advocate, funny, warm and caring,” “not only brilliant but kind and thoughtful,” “generous with her time and sharing her wisdom and expertise,” ” a remarkable force of nature,” “a class act” and “a lot of fun.” “She had this incredible balance of being elegant and gracious yet relentless and tireless in her advocacy.” She was serious when needed, silly and sarcastic when appropriate, and we appreciated her and her anecdotes, told with flourish. Her husband Don Abbott, a retired professor of Rhetoric and English at UC Davis, informed us that she passed unexpectedly but peacefully in her sleep this Saturday. We will update this blog with any information about gatherings in her honor.

Beth has B.A. in psychology from the University of Redlands and has done graduate work in public administration at the University of Southern California. She already had one full life well lived when she retired after serving as the Regional Administrator of the Centers for Medicare and Medicaid Services (CMS), which serves the states of California, Arizona, Nevada, Hawaii, and the Far Pacific. In that role, she was responsible for the oversight of the Medicare and Medicaid programs, managed care plans, and the quality of care delivered in hospitals and nursing homes. The region serves over 10 million beneficiaries, and has a programmatic budget exceeding $30 billion per year. Before CMS, she worked for the Social Security Administration (SSA) in 17 field and regional offices in Massachusetts, Connecticut, Illinois, Indiana, and throughout California.

After a few years off, Beth was looking to continue to serve, and came to Health Access on a part-time basis to manage a project with our partners in senior advocacy, including the California Alliance for Retired Americans and the Congress of California Seniors, on the implementation of the Medicare Part D prescription drug benefit. I wondered how she would handle the transition from a federal administrator to a consumer advocate, and asked her during the interview if she would be OK working for a grassroots groups that held protests and even media stunts to make our points. In fact, I should not have worried:

Her new role suited her well, and she stayed with with Health Access for nearly nine years, serving as our Director of Administrative Advocacy since 2006, working on behalf of California consumers before state and federal agencies. She became a constant consumer advocate presence at many agencies, including the Department of Managed Health Care (DMHC), the Department of Health Care Services (DHCS), the Department of Insurance (CDI), the Managed Risk Medical Insurance Board (MRMIB), Covered California, and many more. As part of that work, she was one of 15 designated national health Consumer Representatives advising the National Association of Insurance Commissioners (NAIC) on the implementation of health care and insurance market reforms. I remember her work of dozens of conference calls at the NAIC to implement the medical loss ratio, helping influence the decisions there. She also served on the DMHC’s Financial Solvency Standards Board and other workgroups and task forces.

Among her many contributions, Beth co-authored a 2012 Health Access “secret shopper” report on how state health consumer assistance agencies fared when dealing with consumer calls. It was then appropriate when Governor Brown and HHS Secretary Diana Dooley tapped her, as one of California’s leading patient advocates, into his administration to run the agency that tracked consumer complaints.

Beth Abbott was appointed to lead a revamped Office of the Patient Advocate, in charge of publishing quality ratings and a report card on health insurers, and she took on new responsibilities collecting, tracking and reporting on data from state health consumer assistance agencies. Under those changes in state law, OPA’s major functions include health care quality report cards, with clinical performance and patient experience data for the state’s largest health plans and over 200 affiliated medical groups; compiling and reporting on how state health consumer assistance call centers are (or are not) helping patients, from the Department of Managed Health Care, Department of Insurance, Department of Health Care Services, and Covered California; and the development of model protocols for these call center agencies. She was interviewed on this blog about her good work, which she was proud of and got international attention.

This picture was published in the Sacramento Business Journal during her appointment when she left Health Access, and the inside joke was that we provided that picture, which was actually taken in Paris, as our vacations overlapped. She often jokingly (?) lobbied me for a Health Access Paris office, one of the few times her advocacy was unsuccessful.

We send our condolences to her husband Don Abbott, and a whole community of people who respected and appreciated her, from her neighbors in Davis, her fellow public servants in state and federal service, and her health advocacy colleagues in the Health Access family, in California, and nationally. We will miss her.

Office of Patient Advocate Releases 2017-18 Health Care Quality Report Card

The California Office of the Patient Advocate (OPA) has released its 2017-18 Health Care Quality Report Card, a tool that helps consumers compare the quality of health plans and find information to help them get the care they need. With California’s Open Enrollment starting November 1st and continuing until January 31, 2018, consumers can evaluate the health plan and medical group options in their county and see how they fare on a variety of quality measures. The tool helps consumers shopping for coverage through Covered California or with employer-based coverage make decisions not just based on how much the health plan costs, but also whether they provide the best care based on your medical needs.

With this report card consumers can compare health plan quality as open enrollment begins this week.

Consumers can use the Report Card tools to filter health plan comparisons by health topics like, “Cancer Care,” or “Diabetes Care,” and see the plan’s rating, ranging from Excellent to Poor.  The report card rates health plans on both the quality of medical care a patient receives as well as consumers’ rating of their overall experience with their plan. To measure the quality of medical care a patient receives, plans are rated on how successful each is at helping patients get the care they needed using specific quality markers. For example, when measuring quality of care on an issue like diabetes care, the report card measures how well a provider controls  blood sugar and blood pressure for diabetes patients, among other care markers. The report card also provides a rating on patients overall experience with the plan, by rating how easily a consumer can access care, and rating satisfaction on plan features like customer service and how quickly health plans pay claims.  

Updates to the 2017-18 California Health Care Quality Report Card include a HMO/PPO comparison tool, where you can filter HMO and PPO plans next to one another to make direct comparisons. The star rating methodology has been updated to remove obsolete quality measures, better aligning it with data sets used by the National Committee for Quality Assurance to measure quality in the healthcare system. Information was collected from health plans and scored based on standards for quality of care set by the Healthcare Effectiveness Data and Information Set (HEDIS) performance measurement system to make sure that health plans offer quality care to their members. The HMO Report Card uses data  from the CAHPS® (Consumer Assessment of Healthcare Providers and Systems) survey, which surveys a random sample of members from each HMO and PPO on their consumer experience.

Beth Abbott, Director of the Office of the Patient Advocate, says this tool is also beneficial for employers looking to select health plans for their employees. By 2018, the report card will also include information on the total cost of care, which is the average amount that health plans and patients of the medical group pay for all of the care provided for one year, for purchasers, helping businesses determine the best “bang for their buck” when purchasing coverage for employees.

The OPA also provides consumers with tips on how to compare health plans, questions to ask your doctor, and refers you to resources if  you have a problem or complaint with your health plan. The OPA’s overall goal is to improve healthcare quality through publicly reporting data for consumers’ informed decision making.

The 2017 Health Care Quality Report Cards was published on October 31, 2017 and can be found here.

Q & A with the California Office of the Patient Advocate OPA: 2015-16 Report Cards Release

Background

Last week the California Office of the Patient Advocate released the newest edition of its 2015/16 Quality Report Cards. The Report Cards provide a tool to assist Californians in comparing quality scores for health plans and medical groups in order to make fully informed health care decisions based on the latest quality data and not just costs.  The information includes more than 2,000 clinical data points and patient experience information to help inform their choices. It is available on their website (www.opa.ca.gov) in English, Spanish, and Chinese, and as a downloadable app for smartphone, IPAD, and tablets:  (http://www.opa.ca.gov/Pages/MobileApplications.aspx)

OPA_ReportCard_screenshot

The Report Card ratings are based on care that more than 16 million commercially insured consumers received from the state’s ten largest HMOs, six largest PPOs, and more than 200 medical groups. Users can drill-down to see specific plan performance on topics of greatest interest to them, such as diabetes care, checking for cancer, and behavioral and mental health care, and much more.

Q & A on Report Card Release 2015-16

Health Access (HA): What’s new in this release of the Report Cards?

OPA Director Elizabeth “Beth” Abbott (OPA): Starting with this 2015-16 Edition, these online Report Cards now have sorting and filtering features to enable users to compare only the smaller group of plans the consumer has under active consideration, or only the top-rated plans, or the ones available in their county. This information is available through our website at www.opa.ca.gov.  This enables the consumer to have information displayed on the screen only the plans or groups that you are choosing between, and not extraneous information.

HA:  What is the best feature of the Report Cards that people may not know about? 

OPA:  In addition to the overall star ratings for health plans and medical groups, you can find some specific ratings regarding some common clinical conditions.  For example, if you or a member of your family has diabetes or a respiratory condition or are planning on having a baby, you may want to select a plan or medical group that does an especially good job of delivering that kind of care for those kinds of conditions.  Look in the dark blue box on the right side of the first page of the Report Card for what conditions have special data, questions, measures and specific ratings for that condition to evaluate their performance and explanations as to what these measures mean and why they are important.

HA: Last year when you were named OPA Director, you set about to promote the widespread use of the Report Cards and similar tools, knowing what you were up against: Historically, such tools have not been well used by consumers. Recent research by Consumers Union and the Center for Advancing Health suggests consumers would use comparative information (like the Report Cards) if they trusted the source, the information was easy to find, and tailored to meet the audience’s need at a salient point in their health care decision making process—Covered CA open enrollment might be applicable here.  What progress have you made over the last year in getting California consumers to actually use the Report Cards when they shop for plans or select a provider?

OPA: We have reached out to consumer organizations, state agencies, industry associations, legislative staff, and in media interviews throughout this last year.  We have been particularly focused on other state agencies who use our data.  We have asked all these contacts to provide a link to our website on their website, in their newsletters, on their blog.  We have conducted webinars for organizations that have clinics, provide consumer assistance, or have chapters or memberships to get the word out about using the OPA website.  At the most recent Covered California (the state-based marketplace/exchange) last week, I offered to provide a link to our Report Card to anyone who gave me their business cards—and a bunch of the people present did so, including organizations representing brokers and agents, small businesses, unions and others.  We are also reaching out to navigators and certified enrollment entities to make sure their staff and volunteers are aware of the OPA website as a resource.

HA: What lessons have you learned for next year or future iterations of the Report Cards?

OPA:  We are now featuring our mobile application because we have found that people can generally be persuaded to check out the star ratings on our Report Cards, but don’t want to install the entire program on their home or desktop computer.  The mobile app is free, is downloadable off our website, and can be used easily from wherever people are (find it here: (http://www.opa.ca.gov/Pages/MobileApplications.aspx).

 HA: It’s hard enough getting any consumer to use tools like the OPA Report Cards: what is the OPA doing to promote their use among LEP, low literacy audiences, and other diverse groups? Are there plans to report the quality data by race/ethnicity, or any equity data?

 OPA: We are making strides to improve our Report Card every single year.  The Report Cards are available in three languages (English, Spanish, and Chinese) and for the first time we have done consumer testing as to how understandable our materials are in Spanish.  We also did an independent assessment of the literacy level and we are revising some parts of it to be clearer to the average consumer, and moved some policy and research data interesting to mostly academics to separate pages.  We are striving to expand the data we are able to display on our Report Cards, but are, of course, limited to what is currently being tracked and that passes our data validation thresholds.

HA:  Given that so many California health care consumers do not have a real choice to make—their employer picks the plan for them—to what extent have these Report Cards or the data on which they are based been used by employers and/or unions in California?

OPA: We are trying to make inroads in this area, but we have a ways to go yet. Our tabulation of visits to our site is continuing to grow.  We had 119,366 visits to www.opa.ca.gov in 2014, an average of 9947 visits per month.  We are pleased to see that our visits to the site for the first two weeks of October 2015 are running 9,358 which is almost twice as many as our monthly average for last year.  October is our busiest month because people look at our website in connection with making their health plan choices which begins for many people this month.  Although we are not neck-and-neck with fantasy football sites, we are making steady progress in increasing its utilization and our overall visibility.  This is true even in unexpected ways.  I recently met a professor who teaches health economics at a university in Columbia (Latin America) who uses our OPA website as a textbook for the college course he teaches in health policy in that country.

HA:  What can we look forward to in the coming year from the OPA?

There are several things that we are working on now that will be launched soon or in early 2016.  We are finishing up our Consumer Health Complaint Baseline Review for 2014 which catalogs complaints across four health agencies in the state (Department of Managed Health Care, Department of Insurance, Covered California Exchange, and Medi-Cal.)  We are also taking over the Medicare Report Card for California (a review of performance of health plans that serve people over 65 on Medicare and people receiving Medicare based on disability entitlement).  We are also adding information on our Report Card that reflects the cost of health care.  It will not list specific costs for services, but give a designation of a composite of total costs with the legend “higher than average costs,” “average costs,” or “lower than average costs.”  We want to aid in the understanding among consumers that high costs do not necessarily represent better care.  These new initiatives are undergoing consumer testing right now.

HA:  Would you like to revisit your long range goal for the report cards? 

OPA: Consumers often have some general understanding about some of the up-front costs of their health insurance coverage.  This is likely to be true particularly about their premiums, but less so about their out of pocket expenses (deductibles, co-payments, co-insurance when they actually use their insurance.)   We find that although consumers understand that the quality of that health care is important, they don’t really know where to find it or how to evaluate it.  This is where the OPA Report Cards come into the picture.  We use nationally developed standards of what represents quality health care and display it in easy-to-understand language.  Our quality data includes clinical data (e.g. regular blood pressure testing or appropriate pre-natal care when you are pregnant) and patient experience (e.g. how easy was it to get an appointment?)  We want to have consumers use the Report Cards to evaluate health plans whenever they have to make a selection—and not assume their plan or medical group has the same scores as last year.

OPA is now starting to be asked why some health plans and medical groups are not demonstrating improvement in these quality measurements.   Our long-range goal is that we would like to see employers and unions and other purchasers who contract with health plans factor those quality measures into their contracting decisions.  In other words, when they are deciding which plans to offer to their employees, they offer them a selection based not only on costs, but what kind of results they get for their patients based on accepted clinical standards and patient experience.

HA: What can community groups do to help promote the use of the report cards?

OPA: I would like this newest information to get the widest distribution possible so it can be used by everyone who wants quality measurement to be part of their criteria when selecting a health care provider or plan in 2015 and 2016.  We encourage publication via email, newsletters, blog posts, conference calls and any other communication mechanism you can put to use.

HA: Which groups should help promote the new Report Cards?

OPA:  Everyone should make the use of the OPA Report Cards an important, necessary step in selecting your health insurance coverage.  This includes your staff, colleagues, affiliates, coalition partners, contractors, customer service center personnel, advisors, navigators, counselors, county staff you work with, press and media experts, and other members of your organization.  We regularly get invited to present a quick summary of the Report Cards as part of monthly conference calls or webinars to introduce this tool to groups who are not familiar with it.

HA: What tools are available to community groups to help promote the use of the OPA Report Cards?

The OPA has provided the following tools for community partners to use in promoting the Report Cards.

  • A web badge designed for other organizations to place on their websites that will link people directly to the Health Care Quality Report Cards. The html code needed for the web badge placement can be found here: www.opa.ca.gov/Pages/PartnersBadges.aspx.  There also are general OPA web badges available in additional languages and sizes that link to OPA’s home page instead of the Report Cards.
  •  OPA’s social media accounts and links:
    Facebook –  Office of the Patient Advocate
    Twitter – @CAPatientAdv
    YouTube – CAPatientAdvocate
  • Last but not least, OPA has a “California Health Care Report Card” Mobile App available for free download through iTunes and Google Play. An overview about the Mobile App and the links to the two online stores can be found here:   www.opa.ca.gov/Pages/MobileApplications.aspx.

Senate Budget Subcommittee #3 Hearing on CHHS Programs

The Senate Budget Subcommittee on Health and Human Services held its first hearing of the year on March 5, 2015. Programs within the California Health and Human Services Agency (CHHS) were on the committee’s agenda. The Senate Budget Subcommittee #3’s hearing agendas can be found here.

Office of Systems Integration – CalHEERS Oversight
First on the agenda for CHHS programs was the Office of Systems Integration, which manages the CalHEERS (California Healthcare Eligibility, Enrollment, and Retention System), an IT system that supports the application process for insurance affordability programs (Medi-Cal and Covered California). It is jointly sponsored by DHCS and Covered CA.

CalHEERS has had a number of problems, resulting in key populations not being able to access the coverage they need. For example, under the ACA, former foster youth qualify for Medi-Cal coverage until age 26 regardless of their income. This law has been in effect since January 1, 2014 but has not been programmed accurately into CalHEERS, resulting in enrollment delays, enrollment in the wrong affordability program, or denial of Medi-Cal for former foster youth. Similar issues arise with the Medi-Cal Access Program (formerly known as Access for Infants and Mothers – AIM).

Our colleagues at Western Center on Law and Poverty testified about the lack of transparency and stakeholder engagement in setting the policies and priorities for CalHEERS, contrary to the requirements of AB 1296 (Bonilla, 2011). Specifically, stakeholders have received limited updates regarding CalHEERS changes but have not had an opportunity to give input on those priorities. Health Access echoed the concerns raised by WCLP and other consumer advocates and urged the subcommittee to maintain oversight over this issue.

Senator Holly Mitchell, Chair of the Budget Subcommittee, expects further conversations on CalHEERS at the March 19 hearing, when the DHCS programs and budget will be on the agenda. The subcommittee held this item open for further discussion and information gathering.

Office of the Patient Advocate
Beth Abbott, former Director of Administrative Advocacy at Health Access and new Director of the Office of the Patient Advocate (OPA), was “pleased as punch” to present her office’s budget change proposal to the committee.

Last year, the OPA was revamped and its responsibilities include producing health care quality report cards with clinical performance and patient experience data for the state’s largest health plans and over 200 affiliated medical groups; compiling and reporting on how state health consumer assistance call centers are (or are not) helping patients, from the Department of Managed Health Care, Department of Insurance, Department of Health Care Services, and Covered California; and the development of model protocols for these call center agencies.

OPA has requested $206,000 in 2015-16 and $182,000 ongoing to support the implementation of the Complaint Data Reporting Project. Health Access testified in strong support of OPA’s funding request. Health Access has a long history of working to strengthen consumer assistance hotlines to help Californians navigate the system, exercise their rights, and make informed health care choices. We have sponsored and supported legislation to revamp the OPA and give it the new responsibility of collecting, tracking and reporting on data from state health consumer assistance agencies. Having this information will help the state know whether its call centers are (or are not) helping patients. We also expressed our hope that OPA will, in the future, include reporting on call center metrics such as call wait times and dropped calls because call center performance is an important element of consumer complaint handling. Our colleagues at Western Center on Law and Poverty, CPEHN, and Congress of California Seniors also spoke in support. The Subcommittee held this item open for additional discussion.

High Cost Drug Proposal
The Governor’s budget includes $300M set aside to pay for new breakthrough drugs, such as those used to treat Hepatitis C. The budget does not allocate this funding to specific departments at this time. Individuals enrolled in Medi-Cal, the AIDS Drug Assistance Program (ADAP), patients in state hospitals, and inmates in state prisons are among those who may potentially be treated with the new Hepatitis C drugs. The Administration is convening a workgroup to address the state’s approach regarding high-cost drug utilization policies and payment structures. Right now, the workgroup only includes state departments and county representatives.

Health Access and other consumer advocates urged the inclusion of consumer and patient advocates in the workgroup. Advocates also requested that this process look at all high-cost drugs and not just those for Hepatitis C. Concerns about access and affordability will apply to all high-cost drugs coming to market.

Health Access will continue providing updates about the budget subcommittee process throughout the spring.

Office of the Patient Advocate Releases 2014-2015 Health Care Quality Report Cards

Office of the Patient Advocate Releases 2014-2015 Health Care Quality Report Cards

The much anticipated 2014-2015 edition of the OPA’s Health Care Quality Report Cards comes months ahead of the usual release date so that the information can be of use to consumers in the coming open enrollment season. The OPA release actually includes three different report cards: one for the health plans (HMOs); one for Preferred Provider Organizations (PPOs); and one for the Medical Groups. All told, the findings will of interest to more than 16 million Californians, most enrolled in job-based coverage but also those enrolled in the individual marketplace through Covered California.

There’s good news and bad on these tools. Historically, the tools have not been all that well utilized by consumers or employers. While many Californians not in position to make their own plan selection—their employer typically picks it for them—the report card is useful for those who have choices in “open enrollment” period coming this fall, including potentially for those in Covered California. Purchasers and employers have been clamoring for better tools, and indeed the tools seem to be getting better (learn more here).

Health Access is honored to feature OPA Director Beth Abbott (former Director of Administrative Advocacy at Health Access) in a Q & A about the new report cards…\

Health Access: What’s new or different about the 2014-15 Report Card Release?

Beth Abbott of the OPA: This year’s release provides one point of entry to the most recent quality information on all commercial plans in the state: www.opa.ca.gov . The release features a few new measures, including the percentage of readmissions to hospitals that are preventable.  This is important because if the readmission to the hospital shouldn’t have been necessary, it both increases the cost of the care and can have an adverse impact on health outcomes. 

HA: Why release the report card now?

BA: We are releasing the Report Cards to coincide with open enrollment periods for both employer-sponsored health coverage [for people who get their insurance through their job) and for people who are making selections of plans through our state-based marketplace at www.CoveredCA.com.  This means that this easy to use tool is available at the precise time when many Californians will be making selections and they will be able to evaluate health plans, PPOs (Preferred Provider Organizations), and medical groups, not only based on costs, but also with the most up-to-date quality information at their disposal. 

HA: What is your long range vision for the report card and related transparency tools?

BA: We want to have consumers select health plans based on value, which is the intersection between cost and quality.  Getting the cheapest plan based on the monthly premium is not always the best choice, since there are also out-of-pocket expenses that should be considered when you use the plan (deductibles, co-payments and the like.)  Also, if a plan is low cost, but does not deliver good quality, it is not a good choice.  Using the OPA Report Cards to evaluate the plans enables the consumer to consider quality metrics in easy-to-understand terms.  In addition to having consumers use the Report Cards to evaluate health plans as a matter of routine, we would like to see employers and unions who contract with health plans factor those quality measures into their contracting decisions.  In other words, when they are deciding which plans to offer to their employees, they offer them a selection based not only on costs, but what kind of results they get for their patients based on accepted clinical standards and patient experience. 

HA: What can the report card do to help advance the goals of health reform?

BA: One of the chief goals of the Affordable Care Act is to promote the integration of health care for the patient and to help lower the costs of providing health care.  These cost and quality measures go hand in hand.  If health care achieves a high degree of integration, patients don’t have to undergo duplicate tests and procedures, and their clinical data can be easily shared among the team that is treating them so that all information is available.  A well-integrated approach to care means, for example, that simple things can be handled by email between the patient and the doctor or pharmacist. This gets answers to the patient more quickly without having to wait for a formal appointment to be scheduled.  All of these kinds of things mean that the cost of health care is going down and the quality of health care is much more coordinated and responsive to patients’ needs. 

HA: What can groups like Health Access go do to help promote use of the report card?

BA: Health Access and its allies, friends, and relations can help by publicizing the Reports Cards.  It continues to amaze me how few people actually are familiar with these important quality tools.  I have come to refer to the Office of the Patient Advocate that I now work for as the “best undiscovered gem in CA state government.”  People should share our website with their employer, their union, their PTA group, their church or synagogue organization, their neighborhood association, and all of their friends.  I want this to be second nature for everyone who is making a health plan choice to get the right plan for them. 

The OPA has provided the following tools for community partners to use in getting the word out about the Report Cards.

  • A web badge designed for other organizations to place on their websites that will link people directly to the Health Care Quality Report Cards. The html code needed for the web badge placement can be found on this webpage: www.opa.ca.gov/Pages/PartnersBadges.aspx.  There also are general OPA web badges available in additional languages and sizes that link to OPA’s home page instead of the Report Cards.
  •  OPA’s social media accounts and links:
    Facebook –  Office of the Patient Advocate
    Twitter – @CAPatientAdv
    YouTube – CAPatientAdvocate
  • Last but not least, OPA has a “California Health Care Report Card” Mobile App available for free download through iTunes and Google Play. An overview about the Mobile App and the links to the two online stores can be found here: www.opa.ca.gov/Pages/MobileApplications.aspx.

HA: Anything else we should know about the report card and the OPA?

BA: If you think you want to stay with the plan you have now, you might want to look at our Report Cards, and click on your plan name.  It will give you your “plan profile” with all the details.  You can also click on any other plan you have under active consideration for a comparison.  And if you have particular health concerns in your family, e.g. diabetes or a heart condition, you can compare plans clinical measures of that treatment to make sure you’ve selected a plan that excels in that kind of care. 

Comings and Goings, and Best Wishes

Big news today, as Toby Douglas, the director of the Department of Health Care Services, announced he would be leaving that post by the end of the year. For the last four years in that position, he ran Medi-Cal, which provides health care and coverage for a staggering 11 million Californians–more than a quarter of the state.

It was a surprise for many of us–we were with Toby all yesterday at an all-day Medi-Cal Stakeholders Advisory Committee, and he hid this news like a good poker player. The meeting provided updates on what will be his legacy at the Department: the shift of seniors and people with disabilities into coordinated and managed care, the budget cuts during the recession and the partial restoration of key benefits, the absorption of programs like Healthy Families, and most notably, the expansion of coverage and the other eligibility and enrollment changes under the Affordable Care Act. He talked about the need for the Department and Medi-Cal to grow and evolve, to meet a new mission and mandate.

The meeting, which we will post the notes from shortly, also delved deeply into two areas that he will start the work but leave unfinished for his successor: the work to ensure access to patients in Medi-Cal, with more rigorous reviews of network adequacy and timely access, and the discussion around a new 1115 waiver and negotiations with the federal government–the plan for Medi-Cal for the next five years, and the implementation of additional delivery system reform.

It’s hard to overstate the importance of Medi-Cal in general, of Toby’s job, and as part of the Affordable Care Act. Covered California may have been the bright shiny object, but Medi-Cal covered more people and could be seen as having greater successes (nearly 2 million enrollees, the Low-Income Health Programs and express lane enrollment) and failures (the still-pending 350,000 backlog of applications).

We are glad Toby is staying through the end of the year, to provide a good transition, and appreciate his work, and wish him well in whatever his new career offers.

BethAbbottSwearingIn

Also this week, our former colleague Beth Abbott started as the new head of the Office of the Patient Advocate. We are excited about her tenure, and were happy to see these pictures of her getting sworn in by Health and Human Services Secretary Diana Dooley. We look forward to seeing who Secretary Dooley gets to swear in for the DHCS job in the beginning of 2015.

Key Health Bills On the Governor’s Desk After Legislature Adjourns

HEALTH ACCESS ALERT: Tuesday, September 2, 2014 

KEY PATIENT PROTECTIONS ON GOVERNOR’S DESK AS LEGISLATURE ADJOURNS

*        Legislature ends 2013-14 session with a flurry of activity; Governor has month of September to sign or veto bills passed, including SB 964 (Hernandez) on network adequacy and timely access to care.

*       Also pending on Governor’s desk are key Medi-Cal bills: limiting Medi-Cal estate recovery (SB1124), and allowing State to accept foundation money for Medi-Cal renewal assistance (SB18).

       Closely-fought bill to require paid sick leave passes, as does SB1094(Lara), to expand the Attorney General’s authority to enforce conditions of non-profit hospital mergers and acquisitions. Other measures on out-of-pocket costs stall, with advocates commiting to action next year.

*        POST-LEGISLATIVE SESSION RECEPTION TODAY to wish Health Access’ Beth Abbott well as she transitions to her new post as director of the revamped Office of the Patient Advocate. Please RSVP here for the reception Today, Tuesday, September 2nd, 4-7pm, Ambrosia Cafe in Sacramento.

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The Legislature ended its 2013-14 session early Saturday morning, passing a flurry of bills to the Governor’s desk for his consideration.  Some key health care consumer protections and proposals made it through the legislative process, and are now headed to the Governor for his final review. Several other measures stalled, some earlier in the year and some in the last days or even hours of the session.  Governor Brown now has the month of September to either sign or veto bills before him.

BILLS HEADED TO THE GOVERNOR:

In this year where California was successful in enrolling people into coverage under the Affordable Care Act, new scrutiny focused on whether patients had timely access to care once enrolled in Medi-Cal managed care, which has long been criticized for lack of adequate access,  or Covered California with some plans offering “narrow networks.” Passing this week was the Health Access California-sponsored bill, SB 964 (Ed Hernandez), which would require DMHC to do annual reviews for timely access and network adequacy, separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal and Covered California have the guarantee that they can get needed care, when and where they need it.

Two important Medi-Cal bills are also headed to the Governor. SB 18 (Leno/Hernandez) would have the State accept $6 million from the California Endowment to fund Medi-Cal renewal assistance by community based organizations, and drawing down federal matching funds as well.

Getting near unanimous votes in the legislature was SB 1124 (Hernandez) which would limit Medi-Cal estate recovery to long-term care, so those getting Medi-Cal managed care services would not find that their family home had a claim on it after death. Over 40 states already do this, allowing Medi-Cal to be a true safety-net for medical care without putting the family’s assets at risk. “Estate recovery,” which amounts to about $500 per month in liens for those over age 55, arbitrarily seeks assets from a small slice of lower-income families who are trying to do the right thing and get covered. While this would have a small state budget impact, enactment would be a big deal for families’ economic security: health and low-income advocates are making it a major priority to get the Governor’s signature.

Another Health Access California-sponsored bill that is headed to the Governor is AB 2088 (Roger Hernandez), which makes, in the large group market, limited benefit plans supplemental to comprehensive coverage. This consumer protection already exists in the individual and small employer market; the bill closes a loophole for employers to possibly avoid compliance with the full intent of the ACA. Employees who accept employer coverage are barred from subsidies in Covered California even if that coverage is unaffordable or does not meet 70% minimum value: AB2088 would protect those employees by assuring that they get comprehensive coverage.

Also passing, but not without major effort, was SB 1094 (Lara), which would expand the Attorney General’s authority to enforce conditions of non-profit hospital mergers and acquisitions, to assure that a nonprofit hospital will continue to serve its community after a transaction in which ownership changes. SB 1094 initially failed passage on the Assembly Floor and was granted reconsideration, passed out of the Assembly Floor Thursday evening with a vote of 43-27 thanks to the tireless work of advocates ranging from Planned Parenthood to the California Labor Federation, from SEIU to Consumers Union to Health Access California. This bill is now headed to the Governor.

A last minute bill of interest to health advocates in Fresno County was AB 2731 (Perea) which would give Fresno County the budget flexibility it says it needs to preserve safety-net services to the undocumented and indigent—the bills allows the County to defer the county’s maintenance of effort requirement for its transportation fund, with the freed-up resources required to go to indigent care. The County felt that the language in the budget passed in June was too restrictive, and had voted to nearly eliminate its medically indigent program a few weeks ago—but put a 90-day stay in anticipation of a legislative fix such as AB2731, which now heads to the Governor.

While not about health insurance or treatment, the health-related bill that got the most attention was AB 1522 (Gonzalez), the requirement on employers to offer at least 3 days of paid sick leave to their workers. While major cities across the country have adopted similar policies, California would be only the second state to require paid sick leave—but with a major and problematic exemption of home care workers, a carve-out requested by Governor Brown, but actively opposed by the unions representing in-home supportive services caregivers.

There were also a few bills that were held in the Legislature, some with commitments from the Administration to address the issue at hand in the next legislative session and others with commitments from the State to address the issue at hand via changes in regulations.

BILLS HELD:

Three bills on trying to make out-of-pocket costs manageable were held—but health advocates hope to revisit these issues in the year ahead.

AB 1917 (Gordon) which would have capped prescription drug co-pays at 1/12 of the annual out-of-pocket limit so that patients with HIV/AIDS, cancer, MS, and other diseases will not be forced to pay high upfront costs for their medication was held due to insurer and Administration opposition. Assemblyman Gordon, sponsoring organization Health Access California, and others are committed to continuing the effort and conversation with the Administration to address this issue in the next legislative session.

Another bill that has been held is SB 1176 (Steinberg), which would have made a health plan or insurer responsible for tracking out-of-pocket costs for in-network providers, and reimbursing the consumer when they exceed their out-of-pocket limit. The Department of Managed Health Care has committed to developing regulations that will require health plans and insurers responsible for tracking out-of-pocket costs for in-network providers and responsible for reimbursing consumers when they exceed their out-of-pocket limit.

Also not proceeding was AB 2533 (Ammiano) which would have ensured that if a patient can’t get timely access to care, the health insurer must arrange for needed care out-of-network, but with in-network cost sharing. This is now the practice with plans regulated at the Department of Managed Health Care, but not the Department of Insurance.

Finally, a late push to extend the July 2015 sunset for the California Health Benefits Review Program, which provides University of California analysis of benefit mandate proposals, AB 1578 (Pan), stalled in literally the last moments of the legislative session.

Below is a full bill list of all the key health legislation on the Governor’s desk.

 

RECEPTION TODAY: This afternoon/evening, Health Access California is hosting a reception to recognize our director of administrative advocacy, Beth Abbott, as she is about to start working as the Governor’s appointment to direct a revamped Office of the Patient Advocate. The reception will take place Tuesday, September 2nd, from 4-7pm, at Ambrosia Cafe in Sacramento. Please RSVP at this link to join our advocates and colleagues to wish her well.

 

*** 2014 HEALTH CONSUMER BILLS ON THE GOVERNOR’S DESK  

Ø  Insurance Consumer Protections

NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews for timely access and network adequacy to be done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal managed care and Covered California get timely access to necessary care. Sponsored by Health Access California.

JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez) while not banning limited benefit plans, makes them supplemental to comprehensive coverage. California’s Insurance Code allows the sale of “insurance” that provides very limited benefits with a minimum actuarial value of less than 60%. This bill extends this consumer protection to large employer coverage, closing a loophole for employers to possibly avoid compliance with the full intent of the ACA. Sponsored by Health Access California.

SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the ACA enacted in 2012 and 2013. SUPPORT.

Ø  Medi-Cal

FOUNDATION & FEDERAL FUNDS FOR MEDI-CAL RENEWAL: SB18 (Leno/Herrnandez) provides $6 million to the State from the California Endowment to fund Medi-Cal renewal assistance Sponsored by Health Access California.

LIMIT ON MEDI-CAL ESTATE RECOVERY: SB1124 (Hernandez) limits Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of all medical care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. Co-sponsored by Western Center on Law and Poverty (WCLP) and California Advocates for Nursing Home Reform. SUPPORT.

AB2325 (Speaker Perez) would create a Medi-Cal medical interpreter program. The bill was vetoed last year: this is a re-introduction of that measure. SUPPORT.

Ø  Cost/Quality Transparency

SB1182 (Leno) would provide claims data or other detailed information to large purchasers.  SUPPORT.

AB1962 (Skinner) would make transparent what dental-only plans spend, as a percentage of premium, on patient care. It requires specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage. The bill is sponsored by the California Dental Association. SUPPORT.

Ø  Hospital Oversight and Consumer Protections.

SB1094 (Lara) amends existing law on Attorney General oversight of nonprofit hospital mergers and acquisitions. It extends the review period from 60 days to 90 days. It also gives the Attorney General authority to enforce conditions of hospital transactions. This bill is sponsored by the Attorney General. SUPPORT.

SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law (which Health Access California sponsored in 2006) by: defining a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses; allowing underinsured individuals with high health costs (over 10% of income) to receive the hospital fair pricing discount even if they receive a discounted rate on their cost sharing from their health plan or insurer. It is being sponsored by Western Center on Law and Poverty based on their experience assisting consumers. SUPPORT.

Ø  Prevention and Other

SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. Sponsored by California Pan-Ethnic Health Network. SUPPORT

AB 2731 (Perea) would allow Fresno County budget flexibility in their county budget to spend $5.5 million for indigent healthcare by deferring the county’s maintenance of effort requirement into a Proposition 42 transportation fund. SUPPORT.

Legislative Update

HEALTH ACCESS ALERT: Tuesday, August 25, 2014 

KEY PATIENT PROTECTIONS UP IN LAST WEEK OF LEGISLATIVE SESSION

*        Key health bills, including SB 964 (Hernandez) on network adequacy and timely access to care, are among hundreds of bills Legislature must pass by Sunday; If approved, Governor Brown would have September to sign or veto.

*       Also pending: key Medi-Cal bills: limiting Medi-Cal estate recovery (SB1124), and allowing State to accept foundation money for Medi-Cal renewal assistance (SB18).

*        Most closely-fought health bill SB1094(Lara), to expand the Attorney General’s authority to enforce conditions of non-profit hospital mergers and acquisitions, to assure that a nonprofit hospital will continue to serve its community after a transaction in which ownership changes. Advocates urged to call in support.

*        POST-LEGISLATIVE SESSION RECEPTION to wish Health Access’ Beth Abbott well as she transitions to her new post as director of the revamped Office of the Patient Advocate. Please RSVP here for the reception Tuesday, September 2nd, 4-7pm, Ambrosia Cafe in Sacramento.

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In this last week of the 2013-14 legislative session, the Assembly and Senate will voted on hundreds of bills by Sunday, including those of strong interest to California patients and health consumers. Bills must pass out of the Legislature by the end of the week and if passed, the Governor has the month of September to decide their ultimate fate.

Below is a list of specific bill pending in this crucial week. On the Assembly floor for a vote as early as today is a key bill to ensure network adequacy and timely access to care, SB 964 (Ed Hernandez), a Health Access California-sponsored bill which would require DMHC to do annual reviews for timely access and network adequacy, separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal and Covered California get timely access to necessary care. Consumer groups are actively working to get this bill passed.

Two important Medi-Cal bills are also up for a vote on the Senate floor: SB 18 (Leno/Hernandez) would have the State accept $6 million from the California Endowment to fund Medi-Cal renewal assistance, and drawing down federal matching funds as well; SB 1124 (Hernandez) would limit Medi-Cal estate recovery to long-term care, so those getting Medi-Cal managed care services would not find that their family home had a claim on it after death. Advocates are gearing up to generate calls and letters to the Governor’s office on these important bills.

A new bill that is advancing in the Legislature, AB 1578 (Pan), would extend until June 30, 2016, the operative date of the California Health Benefit Review Program (CHBRP) and further expand its role to include an assessment of legislation that impacts health insurance benefit design, cost sharing, premiums, and other health insurance topics. This short-term extension will give the Legislature and other stakeholders the opportunity to consider how the role of CHBRP should be revised post-ACA. This bill requires bipartisan support because it requires a two-thirds vote to extend funding.

The most contested health bill this week seems to be SB 1094 (Lara), which would expand the Attorney General’s authority to enforce conditions of non-profit hospital mergers and acquisitions, to assure that a nonprofit hospital will continue to serve its community after a transaction in which ownership changes. SB 1094 failed passage on the Assembly Floor in a vote last week, but has been granted reconsideration, and advocates ranging from Consumers Union to Planned Parenthood to the California Labor Federation to Health Access California are making a strong push for passage. The debate on the Floor was contentious, with Republicans and some Democrats siding with hospitals in opposition. Democrats in support, like Assemblymember Holden expressed “this is about protecting the interests of consumers.” Consumer and community groups are urged to support this key measure in this crucial week.

Other key bills are listed below.

RECEPTION: We hope to celebrate next week, after the legislative session ends, as Health Access California will host a reception to recognize our director of administrative advocacy, Beth Abbott, as she is about to start working as the Governor’s appointment to direct a revamped Office of the Patient Advocate. The reception will take place Tuesday, September 2nd, from 4-7pm, at Ambrosia Cafe in Sacramento. Please RSVP at this link to join our advocates and colleagues to wish her well.

BILL LIST

Here’s a broader list of the bills of interest to health care advocates, pending floor votes in the state legislature this week. It’s the last week for consumer and community groups to weigh in to the Legislature:

NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews for timely access and network adequacy to be done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal managed care and Covered California get timely access to necessary care. Sponsored by Health Access California.

PRESCRIPTION DRUG COST SHARING: AB1917 (Gordon): would cap prescription drug co-pays at 1/12 of the annual out-of-pocket limit so that patients with HIV/AIDS, cancer, MS, and other diseases will not be forced to pay high upfront costs for their medication. Sponsored by Health Access California.

JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez) while not banning limited benefit plans, makes them supplemental to comprehensive coverage. California law allows the sale of “insurance” that provides very limited benefits with a minimum actuarial value of less than 60%. This bill extends this consumer protection to large employer coverage, closing a loophole for some large employers to avoid offering comprehensive coverage to their employees. Sponsored by Health Access California.

SB1176 (Steinberg) makes the health plan or insurer responsible for tracking out-of-pocket costs for in-network providers, and reimbursing the consumer when they exceed their out-of-pocket limit. SUPPORT.

SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the ACA enacted in 2012 and 2013. SUPPORT.

AB 2533 (Ammiano) would seek to ensure timely access to necessary care at in-network cost sharing. SUPPORT.

Ø  Cost/Quality Transparency

SB1182 (Leno) would provide claims data or other detailed data to large purchasers.  SUPPORT.

AB1962 (Skinner) would make transparent what dental-only plans spend, as a percentage of premium, on patient care. It requires specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage. The bill is sponsored by the California Dental Association. SUPPORT.

AB 1578 (Pan) would extend until June 30, 2016, the operative date of the California Health Benefit Review Program and further expand its role to include an assessment of legislation that impacts health insurance benefit design, cost sharing, premiums, and other health insurance topics. SUPPORT.

Ø  Hospital Oversight and Consumer Protections.

SB1094 (Lara) amends existing law on Attorney General oversight of nonprofit hospital mergers and acquisitions. It extends the review period from 60 days to 90 days. It also gives the Attorney General authority to enforce conditions of hospital transactions. This bill is sponsored by the Attorney General. SUPPORT.

SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law (which Health Access California sponsored in 2006) by: defining a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses; allowing underinsured individuals with high health costs (over 10% of income) to receive the hospital fair pricing discount even if they receive a discounted rate on their cost sharing from their health plan or insurer. It is being sponsored by Western Center on Law and Poverty based on their experience assisting consumers. SUPPORT.

Ø  Medi-Cal

SB18 (Leno) provides $6 million to the State from the California Endowment to fund Medi-Cal renewal assistance Sponsored by Health Access California.

SB1124 (Hernandez) limits Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of all medical care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. Co-sponsored by Western Center on Law and Poverty (WCLP) and California Advocates for Nursing Home Reform. SUPPORT.

AB2325 (Speaker Perez) would create a Medi-Cal medical interpreter program. The bill was vetoed last year: this is a re-introduction of that measure. SUPPORT.

Ø  Prevention

SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. Sponsored by California Pan-Ethnic Health Network. SUPPORT

 

Update from the Financial Solvency Standards Board

The Financial Solvency Standards Board (FSSB) Meeting of August 20, 2014 covered several topics of interest to advocates, including initial findings on the Alameda Alliance and its corrective action plan (CAP). A common theme running through several agenda topics is the need to catch solvency problems before they get to the CAP stage. DMHC was questioned closely as to whether their gradations of “closely watched plans” and “those under a Corrective Action Plan” (CAP) were not meaningful since apparently those plans that were being “watched closely” did not generally prevent them from going into a financial tailspin.

Initial findings from the assigned conservator, Berkeley Research Group, suggest the Alameda Alliance, which serves Medi-Cal patients, is on the mend, though the devil may be in the details. The number of outstanding claims decreased to 175,000 from 300,000, and the time to process claims shrank from 100 to 50 days. So far so good, but what’s not clear is whether Alameda Alliance can—or should—handle the massive surge in enrollees, up to 230,000 members and counting. Financing and solvency are the tip of vast iceberg where utilization and care management come into play. Thankfully, most FSSB members prefer to look at the solvency issues in the deeper context of overall plan performance. FSSB members asked whether it is prudent to permit new enrollees to Alameda Alliance when its financial condition remains precarious.  DMHC’s position is that it will strengthen their financial underpinnings to have a bigger membership base, but some question whether it is wise to let more consumers join—particularly since its solvency is not yet assured.

Several members of the FSSB asked questions beyond the specific case of the Alameda Alliance.  What has DMHC learned now that they have undertaken the extraordinary step of installing a conservator at the plan?  This step, in essence, is very expensive and puts them in the unenviable position of actually running the health plan.  This should enable them to refine their oversight protocols to tailor them to predict more accurately these kind of failures.  Should they be asking for additional or different data?  Should they have intervened sooner?

This discussion also led to whether the standard of Tangible Net Equity (TNE) is the right one.  If a plan has one dollar in assets more than it has in debts, is that enough?  Many CFOs and actuaries on the board requested a re-examination of what that standard should be with an eye toward emulating market scrutiny tools which examine Risk Based Capital which are becoming much more commonplace than TNE.

Risk-Bearing Organization (RBO) Solvency in the Face of Increased Medi-CAL Enrollment

With more Medi-Cal enrollees than ever assigned to risk-bearing organizations (RBOs) as a result of the broader shift toward mandatory managed care and the state about to enter into a Medi-Cal waiver renewal process, it will be important to monitor RBOs closely, again before they trigger a CAP.  Board members are asking to consider the RBOs performance and solvency in context of overall plan solvency, something the DMHC examiner says is happening already. It’s not enough to look at contractual requirements, says Health Access’ Beth Abbott, or financial solvency indicators in isolation, especially given the reality that the shakiest plans are those that serve the most vulnerable Medi-Cal consumers.

Enrollment in Individual Market Plans Monitored by DMHC

Overall the ACA brought 1 million more covered lives into the individual marketplace, and the number of grandfathered and non-ACA compliant plans is steadily decreasing (see details here). That’s good news for California consumers, but now the focus shifts to practical issues that could easily make or break the long-term success of health reform: are consumers getting the care they need, at the right time and place? And are the agencies with oversight of plan performance, like the DMHC and DHCS, equipped to monitor the plans as California insurance marketplace and Medi-Cal shifts more of the risk to the plans and RBOs? The challenge for regulators (and advocates) is to minimize disruption for consumers as the landscape for insurance solvency and performance continues to shift.  This is clearly a work in progress.

Appropriations Committees Pass Key Health Bills

HEALTH ACCESS UPDATE: Thursday, August 14, 2014 

KEY HEALTH CONSUMER PROTECTION BILLS HEAD TO FINAL FLOOR VOTES, AFTER PASSING APPROPRIATIONS COMMITTEES TODAY

*        Important health bills advance, including ones sponsored by Health Access California, and head toward floor votes in final two weeks of legislative session.

*       Bills passed by Appropriations Committees today include those to help consumers once they get coverage, with ensuring network adequacy (SB964) and timely access to care (AB2253), avoiding junk coverage (AB2088), putting in place rate review (SB1182) for large employers, getting insurers to track out-of-pocket expenses (SB1176), limiting Medi-Cal estate recovery (SB1124), and accepting foundation money for Medi-Cal renewals (SB18) and more.

        Bills held and stalled for the year include two to create on all-payer claims databases, a bill on hospital community benefits, and a measure codifying Covered California privacy protections.

*        In other news, Health Access’ Beth Abbott appointed by Governor Brown to be director of the revamped Office of the Patient Advocate.

 

Today, the Appropriations Committee of both the California Senate and Assembly met, and decided the fate of hundreds of bills, including several to provide new consumer protections and oversight to benefit health care consumers.

Over 300 bills in the Senate and over 150 bills in the Assembly were “on suspense,” being evaluated in terms of their cost and fiscal impact, until today, where a portion of them were released, set to go to floor votes in the next two weeks. Bills must pass through final floor votes and the full Legislature by the end of August. If passed, the Governor would have the month of September to sign or veto.

Bills that passed Appropriations Committee today included key bills to ensure network adequacy and timely access to care: SB 964 (Ed Hernandez) would require DMHC to do annual reviews for timely access and network adequacy, separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal and Covered California get timely access to necessary care. AB 2533 (Ammiano) would ensure timely access to necessary care at in-network cost-sharing.

SB 1176 (Steinberg) gives health plans and insurers the responsibility to track out of pocket costs–and reimbursing when patients hit the out-of-pocket maximum.

Another bill, AB 2088 (Hernandez) would extend consumer protections against “junk” insurance to large group market, banning large employers from offering limited benefit plans to their employees, unless the limited benefit plan was supplemental to comprehensive coverage.

Two important Medi-Cal bills also passed.SB 18 (Leno) would have the State accept $6 million from the California Endowment to fund Medi-Cal renewal assistance, and drawing down federal matching funds as well. SB 1124 (Hernandez) would limit Medi-Cal estate recovery to long-term care, so those getting Medi-Cal managed care services would not find that their family home had a claim on it after death.

SOME BILLS HELD: afterNot all bill survived the Appropriations Committee process. Two bills, SB1322(Ed Hernandez) and AB1558(Roger Hernandez) to create versions of an all-payer claims database–to provide more cost transparency in our health system–were held. AB503(Wieckowski) on hospital community benefits was also held, as was SB974(Anderson) to codify Covered California’s privacy protections. These held bills, and others, are stalled for the year.

BILL LIST

Many bills did make it through the Appropriations process, and consumers groups are mobilizing in support. These are some of the bills of interest to health care consumers pending for floor votes in the state legislature in the next two weeks:

Ø  Insurance Consumer Protections

NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews for timely access and network adequacy to be done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal managed care and Covered California get timely access to necessary care. Sponsored by Health Access California.

·         STATUS – ASSEMBLY FLOOR

PRESCRIPTION DRUG COST SHARING: AB1917 (Gordon): would cap prescription drug co-pays at 1/12 of the annual out-of-pocket limit so that patients with HIV/AIDS, cancer, MS, and other diseases will not be forced to pay high upfront costs for their medication. Consumers would still have the annual out of pocket limit of no more than $6,350 for an individual or $12,700 for a family under the ACA, but the cost of any one drug can’t be more than 1/12 of the annual limit or $530 for a single month’s prescription rather than $6,350 as current law provides. Sponsored by Health Access California.

·         STATUS – SENATE FLOOR

JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez) while not banning limited benefit plans, makes them supplemental to comprehensive coverage. California law  allows the sale of “insurance” that provides limited benefits with a minimum actuarial value of less than 60%. This bill extends this consumer protection to large employer coverage, closing a loophole for employers to avoid compliance with the intent of the ACA. Sponsored by Health Access California.

·         STATUS – SENATE FLOOR

SB1176 (Steinberg) makes the health plan or insurer responsible for tracking out-of-pocket costs for in-network providers, and reimbursing the consumer when they exceed their out-of-pocket limit. SUPPORT.

·         STATUS – ASSEMBLY FLOOR

AB 2533 (Ammiano) would seek to ensure timely access to necessary care at in-network cost sharing. SUPPORT.

·         STATUS – SENATE FLOOR

SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the ACA enacted in 2012 and 2013. SUPPORT.

·         STATUS – ASSEMBLY FLOOR – CONSENT

SB20 (Ed Hernandez) modifies the individual market open enrollment period for the 2015 policy year to be November 15, 2014-February 15, 2015, so that it is consistent with the dates announced by the federal government exchange. SUPPORT.

·         STATUS – SIGNED BY THE GOVERNOR  

SB1034 (Monning) would delete 60 day waiting period for California insurance. California law would not permit any waiting period as a result of a pre-existing condition. Federal law would permit employers to impose a waiting period of as much as 90 days for workers and dependents. SUPPORT.

·         STATUS – GOVERNOR’S DESK 

Ø  Cost/Quality Transparency

SB1182 (Leno) would implement large group rate review for rate increases. It also provides claims data or other detailed data to large purchasers.  SUPPORT.

·         STATUS – ASSEMBLY FLOOR  

AB1962 (Skinner) would make transparent what dental-only plans spend, as a percentage of premium, on patient care. It requires specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage. The bill is sponsored by the California Dental Association. SUPPORT.

·         STATUS – SENATE FLOOR

Ø  Hospital Oversight and Consumer Protections.

SB1094 (Lara) amends existing law on Attorney General oversight of nonprofit hospital mergers and acquisitions. It extends the review period from 60 days to 90 days. It also gives the Attorney General authority to enforce conditions of hospital transactions. This bill is sponsored by the Attorney General. SUPPORT.

·         STATUS – ASSEMBLY FLOOR

SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law (which Health Access California sponsored in 2006) by: defining a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses; allowing underinsured individuals with high health costs (over 10% of income) to receive the hospital fair pricing discount even if they receive a discounted rate on their cost sharing from their health plan or insurer. It is being sponsored by Western Center on Law and Poverty based on their experience assisting consumers. SUPPORT.

·         STATUS – GOVERNOR

Ø  Medi-Cal

SB18 (Leno/Hernandez)would have the state Department of Health Care Services accept foundations funds (currently offered by the California Endowment) and get federal matching funds to help provide assistance for Medi-Cal renewals. Sponsored by Health Access California and Western Center on Law and Poverty.

·         STATUS – SENATE FLOOR

SB1124 (Hernandez) limits Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of all medical care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. Co-sponsored by Western Center on Law and Poverty (WCLP) and California Advocates for Nursing Home Reform. SUPPORT.

·         STATUS – –ASSEMBLY FLOOR  

AB2325 (Speaker Perez) would create a Medi-Cal medical interpreter program. The bill was vetoed last year: this is a re-introduction of that measure. SUPPORT.

·         STATUS – SENATE FLOOR

Ø  Prevention

SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. Sponsored by California Pan-Ethnic Health Network. SUPPORT

·         STATUS – ASSEMBLY FLOOR