Network Adequacy

New Timely Access to Care Standards Adopted by CA Department of Insurance

On March 9, consumer advocates cheered the new standards announced by the California Department of Insurance for health insurers to create and maintain accurate provider directories. The new standards also require insurers to have adequate numbers and types of providers in their networks so consumers can get the care they need when they need it. These new standards make sure all California consumers can find a provider in their network and access to the care they need in a timely manner. All insured Californians should have basic access to timely care and not have to deal with an inaccurate provider directory when looking for an in-network doctor. While many of these consumer protections have been in place for health plans […] Read More

Anthem Blue Cross-Cigna’s Troubling Track Records Spotlighted at DMHC Public Meeting

On March, 4, 2016, the Department of Managed Health Care (DMHC) held a public meeting on the proposed takeover of Cigna by Anthem Blue Cross. The public meeting was requested by consumer groups including Health Access, Consumers Union, and others to raise questions about the structure of the deal, its potential impact on California’s patients and health care systems, and ensure proper oversight as insurance companies merge and become larger. The proposed Anthem Blue Cross-Cigna merger is one of three pending insurer mergers being reviewed by DMHC. Late last year, DMHC approved a merger between Blue Shield and Care1st, following Health Access’ and other consumer groups’ requests for strong conditions to address potential negative impacts. Health Access is also monitoring the proposed Centene-Health […] Read More

DHCS Stakeholder Advisory Committee Digs Deeper into Medi-Cal 2020 Waiver, SB 75 Implementation (Health4Kids), and Other Care Transformation Initiatives

This blog was written by Tam M. Ma (Policy Counsel) and Judi Hilman (Director of Special Projects) DHCS held its quarterly Stakeholder Advisory Committee today, the first time since California’s Medi-Cal 2020 waiver was approved at the end of December, covering a range of topics, including the waiver renewal, SB 75 implementation of Health for Kids, and other Medi-Cal care transformation initiatives. Medi-Cal 2020 Waiver Details from the Special Terms and Conditions Medi-Cal Director Mari Cantwell provided an overview of the new waiver (See our earlier blog overview of the new waiver) and an update on implementation efforts. The Medi-Cal 2020 waiver provides more than $6.2 billion in new federal funding through programs that shift the focus away from hospital-based […] Read More

Covered CA Board Takes Big Steps on Standardized Benefit Design and Quality/Equity Measures; Considers New Barriers to Special Enrollment

Thursday’s Covered California Board meeting, the first since the last day of open enrollment 2013, offered a deep dive on the standardized benefit designs and the quality/equity framework that will guide contracting with insurers for the next 3-year cycle (2017-2019), and a heated discussion about the new documentation requirements that insurers are calling for to qualify as a SEP enrollment. Executive Director Report Covered CA Peter Lee shared observations about OE3 and the second renewal period: With 440,000 new enrollees and a decent number choosing new plans in renewal, competition and shopping tools seem to be working. Take up by diverse and subsidy-eligible populations affirms Covered CA’s more targeted approach to marketing and outreach. Even better for the risk mix and therefore […] Read More

DHCS & CMS Agree to Medi-Cal 2020 Waiver Framework!

This past Saturday (Halloween), the California Department of Health Care Services announced it had reached a new “conceptual agreement” with the federal Centers for Medicaid and Medicare Services (CMS) on the general framework of “Medi-Cal 2020,” the renewal of the 2010-2015 Medi-Cal waiver. Toplines With details to be specified in the coming months, the framework is likely to spur innovation in California counties with respect to delivery system reforms, care for the uninsured, and “whole person care” or integration of health care services with other human services. The current five-year “Bridge to Reform” waiver, which expired on Halloween, is extended through December 31, 2015. Once the new waiver is finalized, it would start in January 2016, and consumer groups should be ready […] Read More

Covered California Open Enrollment Started Sunday!

Yesterday marked the official start of Covered CA open enrollment, which will run through January 31, 2016. For coverage effective January 1, people must enroll by December 31, 2015. As always, Medi-Cal enrollment is open year-round and individuals experiencing any life transitions (losing a job or moving, among many qualifying events for Special Enrollment) may enroll anytime, even after January 31, 2016. For health care advocates and other consumer groups, it’s worth clicking around the much improved Covered CA website to explore the various tools available to maximize enrollment and target those eligible but not yet enrolled. Here are a few highlights:  The Shop and Compare Tool is more useful than ever—showing options for plans by county with estimates of consumer […] Read More

DHCS Stakeholder Advisory Committee October 14, 2015: Highlights for Consumer Advocates

Update on MCO (Managed Care Organization) Tax DHCS Director Jennifer Kent opened with an update on the MCO tax and the need to revise it to meet new federal guidelines to broaden the base to all health plans (learn more here).  Last Spring, the Governor called a special session to resolve this and related Medicaid financing issues—but the Legislature was not able during the regular session to strike a deal, as many had hoped. The Special Session will continue through the winter. Elizabeth Landsberg of Western Center on Law and Poverty noted the handful of Medi-Cal bills vetoed by Gov. Brown, as “collateral damage for the MCO tax.” “It’s poor people who pay the price” for delayed action on the MCO tax,” added […] Read More

Key Patient Protections Pass Legislature, Now On Governor’s Desk

With the California Legislature adjourning after midnight last Saturday, most of the action on priority bills for health consumers moves to the Governor’s desk. Most of the Heath Access-sponsored bills protecting consumers from unfair out-of-pocket costs are now one Governor’s signature away from enactment. There were disappointments in the final days of this year’s legislative activity, including the lack of action on a range of revenue and tobacco control measures in the special session. Health Access’ consumer protection proposal AB 533 (Bonta), to halt surprise bills, failed on a vote of 38-10—just 3 votes short of passage. Overall, though, many important patient protections passed in a productive session advancing health reform. Even if a bill makes it to the Governor’s desk and even […] Read More

Senate Appropriations Committee Hears Key Health Access Bill and Special Session Tobacco Control Legislation

Yesterday, the Senate Appropriations Committee heard Health Access sponsored bill, AB 533 (Bonta) on “surprise billing” and select special session tobacco control bills. AB 533 (Bonta), which would protect consumers from surprise bills from out-of-network doctors when a consumer does the right thing by going to an in-network hospital, lab or imaging center was not voted on in committee, however, Health Access, the American Cancer Society and AARP testified in support of the bill before the bill was referred to the Senate Appropriations Suspense. The following special session tobacco control bills were also heard: • SB X2 8 (Lieu) – would require all schools to be tobacco free. • SB X2 7 (Hernandez) – would increase the age of sale for […] Read More

Special Session on Healthcare – Informational Hearings

This week, the Legislature held two informational hearings as part of the 2015-16 Second Extraordinary Session on healthcare. These hearings were convened to help lawmakers, and the public, understand approaches to structuring a Managed Care Organization (MCO) tax and the state of Medi-Cal funding more broadly. The current MCO tax only applies to health plans that participate in Medi-Cal and these plans largely get their money back, with federal matching funds, through their capitated payments. New federal rules require the MCO tax to be broad-based, meaning it needs to apply to all health plans and not just those that participate in Medi-Cal. Senate Hearing on the MCO Tax Yesterday, the Senate Committee on Public Health and Developmental Services Committee held […] Read More