Timely Access

Report: CA Health Plans Still Struggle to Meet Timely Access Standards

CARE DELAYED IS CARE DENIED A new report by California’s Department of Managed Health Care (DMHC) released today is the first of its kind to provide data on timely access to care separating out commercial, individual/family, and Medi-Cal health plans. Health Access sponsored 2014’s SB 964 (Hernandez) that requires this annual report. The report found industry-wide difficulty providing timely access to care, with no plans providing an appointment within the designated time frame 100% of the time. Very few health plans provided timely access over 90% of the time. For commercial coverage, 14 out of 22 plans, a clear majority, provided timely access more than 80% of the time but for Medi-Cal managed care a distinct minority of plans, 7 out of 18 plans, […] Read More

Key Patient Rights Legislation Up Next Week

  Yesterday, the Assembly Health Committee passed one consumer protection measure, SB 923 (Hernandez) on a vote of 17-0, to prevent mid-year increases in co-payments and other cost-sharing by a health plan. Other key legislation also authored by Senate Health Committee Chair Dr. Ed Hernandez and sponsored by Health Access California to protect patients from unfair health care costs, including unjustified premium increases (SB908) and prescription drug price hikes (SB1010), was rescheduled from this week to next Tuesday in Assembly Health Committee. Letters of support are due today. These bills are part of a package of patients rights bills–including some of the most lobbied legislation this session–to help prevent unfair and unreasonable bills, premiums, and cost-sharing, inform consumers of their rights and options, […] Read More

First Patient Protection Bills Up in Committee Next Week

UPDATE: The hearing for these bills has been pushed backed to a later date. Stay tuned for more information. (3/25/2016) When the Legislature comes back from Spring Break next week, the Senate Health Committee will be hearing two consumer protection bills, SB 908 and SB 1135 on Wednesday, March 30. Both of these bills are sponsored by Health Access California. Unreasonable Rates: Notice/Opportunity to Shop: SB 908 (Hernandez) requires individuals and small business owners be notified if the premium for a plan they choose is “unreasonable” and “unjustified” and be given a new open enrollment opportunity to potentially find a new plan. Notification of Consumer Rights: SB 1135 (Monning) requires health plans and insurers to notify consumers and health care providers […] Read More

Budget Subcommittees Review DHCS and DMHC budget items

Last week, the Legislature’s budget subcommittees on health and human services held hearings on the budgets for the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC). Assembly Budget Subcommittee No. 1 (March 14, 2016) The agenda, which includes details about each item heard, can be accessed here. Health Access supported proposals to make the following policy changes in Medi-Cal: Increase the Medi-Cal Aged and Disabled Program income level to 138 percent of the Federal Poverty Level (FPL), creating a “brightline” of income eligibility and parity for elderly and disabled Medi-Cal beneficiaries with other adults. This is estimated to cost $30 million General Fund. Limit Medi-Cal estate recovery to federal requirements, which only requires recovery […] Read More

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

Federal Officials Approve New “Medi-Cal 2020” Waiver Renewal

Earlier today the U.S. Centers for Medicaid and Medicare Services (CMS) officially approved California’s “Medi-Cal 2020” waiver renewal for the next five years, providing new resources and new flexibility to deliver better care for the millions of low-income Californians who rely on Medi-Cal for their health coverage. The new waiver also includes support for a “smarter safety net” and innovative care solutions for the uninsured. The announcement comes one day before the extended deadline for final renewal. A waiver is a formal request by a state to the Secretary of Health and Human Services to waive specific Medicaid program requirements in order to test new ways to deliver care without spending more federal dollars than would otherwise be spent. Since […] Read More