Author: Kandis Driscoll


Register for ITUP’s Regional Workgroups

ITUP hosts a series of Regional Workgroups around the state each year to discuss the implementation of health care reform. Our Workgroups bring together a variety of stakeholders, including health plans, hospital and clinic associations, county personnel, community-based organizations, and advocates and unions. Click on the links below for more information about your region.

Bay Area Regional Workgroup 

May 2, 2013 from 11:00AM to 2:00PM

San Francisco Chamber of Commerce

235 Montgomery St, 12th Floor, San Francisco, CA 94105

CLICK HERE for more info.

 

San Diego Regional Workgroup

May 8, 2013 from 11:30AM to 2:30PM

Council of Community Clinics

7535 Metropolitan Drive, San Diego, CA 92108

CLICK HERE for more info.

 

Central Valley Regional Workgroup

June 4, 2013 from 11:30AM to 2:30PM

Central Valley Health Policy Institute

1625 E. Shaw Ave., Ste. 106, Fresno, CA 93710

CLICK HERE for more info.

 

*Please Note: Information about other Regional Workgroups will be posted as they are confirmed.

CHCF Host Briefing on SPD Transition

Yesterday, the California HealthCare Foundation hosted a briefing on the experience of seniors and persons with disabilities transitioning to Medi-Cal managed care plans. California’s 2010 §1115 Medicaid Waiver permitted the mandatory enrollment of SPDs into managed care beginning June 2011. The shift into managed care aims to help DHCS achieve better care coordination, improved management of chronic diseases, and better health outcomes.

The briefing provided information on UC Berkeley School of Public Health’s evaluation of the transition, which assessed beneficiaries’ experience with notifications, choice and enrollment, and access. Findings from the evaluation were gathered through telephone surveys and focus groups with input from a stakeholder advisory group and collaboration with DHCS’ Medi-Cal Managed Care Division. When asked about the usefulness of the notification packets on the transition, 33% of respondents found the packets very useful, 38% found them somewhat useful and 23% indicated the packets were not at all useful. Interestingly, when asked what questions were not answered in the notification packet, 39% of beneficiaries indicated the reason why the transition was occurring was not mentioned.

With the shift into managed care, SPDs were provided a selection of managed care plans to choose from. If beneficiaries failed to choose a plan, they were either defaulted to a health plan, or defaulted and linked to a health plan based on their provider history from fee-for-service data. Almost half of the respondents (46%) chose a plan, while 50% were assigned. While many beneficiaries were aware of their choices, a fair number did not make one, and reported that they didn’t have enough information and that the plans seemed the same.

When assessing continuity of care, 60% of respondents indicated that they were able to keep their PCP.

Similarly, 60% of respondents indicated that they were able to keep all of their specialists.

When examining lessons learned from the experiences of these beneficiaries, each of the following were clear:

  • Notices should explain why the transition is happening and include specific information about how the change will affect the care of the beneficiaries. It is also important that materials are written at the appropriate literacy level and that information about who to call for questions is clear.
  • Doctors, their offices and clinics are key venues for educating beneficiaries about changes and supporting them through the transition.
  • Managed care plans need to be strategic in helping beneficiaries navigate the system through phone calls and in-person support.

As eight California counties gear up for the Cal MediConnect demonstration for those dually-eligible for Medicare & Medicaid, and as the state gears up for Medi-Cal expansion, we all can find great value in these timely lessons from the SPD transition.

For other details on the evaluation, click here.

DHCS Host Webinar on Medi-Cal Managed Care Rural Expansion

Yesterday, DHCS hosted a webinar (agenda) on the expansion of Medi-Cal managed care into 28 Northern Rural counties.  The Governor’s 2012-13 Budget initiated the expansion in the 28 fee-for-service counties and is set to begin June 2013. DHCS informed stakeholders that seven Northern Rural counties, including Del Norte, Humboldt, Lassen, Modoc, Shasta, Siskiyou, and Trinity, are excluded from the RFA since they will be participating in a County-Operated Health System (COHS) with Partnership HealthPlan of California (PHC). Stakeholders from these counties worked collaboratively with PHC and advocated heavily for a COHS model during the latter part of last year.

Lake, San Benito, and Imperial counties were also excluded from the RFA as they were included in the Governor’s 2005 expansion. Lake County will participate in the COHS model with PHC, while Imperial County will implement a two-plan model. Plan selections for this model have yet to be determined.

Anthem Blue Cross and California Health & Wellness Plan (Centene) were announced as plan providers for the remaining 18 contiguous counties. Centene is the the newest Medi-Cal managed care plan in California. They have operated in 730 rural counties throughout the U.S., serving 2.5 million Medicaid beneficiaries. Anthem Blue Cross is already a Healthy Families and CMSP partner, and plans to use a community-based model to build on county infrastructures.

DHCS will notify beneficiaries about the expansion with two notices. The notices for the eight COHS counties being served by PHC will be informational, introducing beneficiaries to PHC and the shift into managed care; beneficiaries in the 18 contiguous counties will receive a packet of information that asks them to select the plan they would like to participate in. Individuals who do not select a plan will be auto-assigned by a designated algorithm.

Since the webinar was cut short due to technical difficulties, DHCS plans to reschedule another stakeholder meeting within the next two weeks.

For more information on the expansion, visit the DHCS webpage here.

You may email questions, comments, and concerns to  MMCD.TPGMC@dhcs.ca.gov

February Exchange Board Meeting: New Covered California Website, Updates on Service Centers and QHP Contracting

The February Exchange Board meeting began with the announcement that Covered California is now online at www.coveredca.com. The homepage of the website, which can also be viewed in Spanish, includes a countdown to January 1, 2014 when “new coverage begins for millions of Californians.” The webpage also includes a cost-estimate calculator and links to a fact sheet provided in eleven different languages.

 

 

In his executive director’s report, Peter Lee announced Covered California’s intention to hold town hall meetings around California this year. Advocates and stakeholders responded very favorably to the plan as it gives a larger, more diverse group of advocates and community members an opportunity to provide public comment on Covered California’s progress. A tentative schedule for the town hall meetings can be found below:

 

During the executive director’s report, Larry Bye of NORC at the University of Chicago presented on a study that assessed the level of awareness, general attitudes, and interest of small businesses owners to participate in the SHOP Exchange. Findings indicate that once small business owners were informed about how insurance reforms would affect them and how the SHOP exchange will operate, they became more inclined to explore and use Covered California.

Jim Brown and Keith Ketcher updated the board on the progress of the CalHEERS system, informing the Board that a number of features will need to be released at a later date. These include supplemental vision and dental plan functionalities, online filing of appeals and exemptions, Medi-Cal plan selection, authorized representatives, and bridge plan functionalities.

Katie Ravel presented information on recently released federal proposed rules and provided insight from CMS on the Basic Health Program. HHS expects to issue proposed rules for the BHP in 2013 with final guidance to follow in 2014. For states interested in pursuing a BHP, the program should be operational in 2015. Ravel also reviewed recommendations for the background check program for Covered CA employees and assisters. Key recommendations would:
• Require fingerprint-based background checks for all service center employees, employees working in eligibility and enrollment and IT, and assisters prior to hiring with periodic re-screening.
• Disqualify individuals with a conviction or pending charge of a felony or misdemeanor related to theft, fraud, dishonestly or a crime of moral turpitude.

Covered California will pay for employee and assister background checks and will consider mitigating factors for certain offenses, such as rehabilitation and the age and specifics of the offense. Some advocates argued the finger-printing process is overly intrusive and may exclude members of minority communities who may be disproportionately likely to have certain offenses on their records. Since employees and assisters will have access to sensitive information, it is important that their background offenses be considered based on a uniform standard.

To conclude the executive director’s report, Sarah-Soto Taylor provided an update on the Outreach and Education Grant Program. She informed the board that Covered California received at least one letter of intent from each county, with Los Angeles County leading the pack by submitting 94 LOIs. Covered California has been having ongoing discussions to coordinate their grant making activities with that of private foundations. Grant applications are due March 4, 1013. A timeline of other grant activities can be found below:

 

The staff also provided additional information about the warm handoff process in service centers. A “warm handoff” is defined as the transferring representative at the Covered California Service Center remaining on the line with the customer and introducing him or her to the County representative within 30 seconds. This applies to all callers, including Limited English Proficient (LEP) and hearing or visually impaired callers. Covered California has started thinking about the interagency agreements that will be necessary for the warm handoffs to counties. During the next board meeting, Covered California plans to will discuss the process for performance reviews (to ensure counties are responsive at the service centers and meeting specified standards) and contingency plans.

The February meeting ended with a discussion on qualified health plan contracting. Covered California has successfully designed a standardized benefit for health plans in the exchange. The board took the only action of the meeting and approved the bridge plan program to ensure continuity of care and affordability.

The next Exchange Board meeting will be March 21, 2013.

 

Meeting materials are available online.

 

GOP Governor in New Jersey expands Medicaid

Chris Christie, GOP Governor of New Jersey, announced his support for expanding Medicaid under Health Reform. The ACA allows states to expand their Medicaid programs for incomes up to 138%FPL with 100% federal funding for those newly eligible for the first three years.The federal contribution then drops to 90% thereafter. After the June SCOTUS decision, the expansion became optional for states. However, federal regulations prohibit states from receiving full federal funding for partial expansions.

Christie is the eighth GOP Governor to announce participation in the expansion, joining others like Florida and Ohio. These Republican Governors have been known for their outright opposition to the law. In fact, Christie is quoted as saying, ” I am not a fan of the Affordable Care Act. I think it is wrong for New Jersey and for America. However, it is now the law of the land. I will make all of my judgements as governor based on what I believe is best for New Jersey.”

Nevertheless, Christie noted Medicaid expansion as “the smart thing to do for [the state's] fiscal and public health” as it could save residents an estimated $227 million in the next fiscal year. The expansion will extend coverage to 300,000 uninsured New Jersey residents. The New Jersey Governor is also working with the Obama administration to create the insurance exchanges for individuals and small businesses.

 

Other details can be found here.

KCMU Examines Medicaid and Medicare Reimbursement

The Kaiser Commission on Medicaid and the Uninsured (KCMU) released an issue paper in December assessing how much the Medicaid physician reimbursement rate for primary care will rise in 2013. KCMU commissioned the Urban Institute to initiate a 50-state survey of Medicaid physician payment in 2012. The ACA allows states to expand eligibility for their Medicaid programs in 2014. In an effort to expand capacity before the expansion, the ACA requires states to raise their Medicaid reimbursement rates to Medicare levels. The difference between the two rates will be fully funded by the federal government. The paper compares states’ Medicaid reimbursement rates, how Medicaid payment rates compare to Medicare levels, and how Medicaid payment rates have changed over time. Key findings indicate that:

  • Medicaid reimbursement rates vary widely by state. California, Florida, Indiana, Michigan, Missouri, New Jersey, New York and Rhode Island had payment rates more than 10% below the national average in 2012.

  • On average, Medicaid pays 66% of Medicare payment rates, and as indicated below, California paid less than 60% of Medicare levels in 2012.

  • Most notably, the Medicaid physician payment rate for primary care services will rise by 73%(on average) in 2013. As seen below, the payment rate will more than double for six states, including California (136%), Florida (105%), New Jersey (109%), Michigan (125%), New York (156%), and Rhode Island (198%). This rate increase far exceeds any other past payment increase, and if it is successful in improving physician participation, the interest in extending the higher Medicaid rate will be substantial.

States are obligated to collect data on physician participation and primary care utilization during the rate increase so that the full impact of the law can be properly assessed. How the payment increase will impact California’s Medicaid program remains to be seen.

The full report is available online.

CA School Health Center Association to Host Conference in Long Beach

The California School Health Centers Association would like to invite you to join hundreds of health care providers, school officials, and children’s health stakeholders at the Vision & Voice for Healthy Students conference. The conference will be held March 14th and 15th at  The Westin in Long Beach.

School health services increase care access and utilization, prevent unnecessary hospital visits, and reduce health care spending. Attendees of the conference will have an opportunity to learn about the latest approaches and updates on providing health care in schools, network with hundreds of other health care providers, school officials, and children’s health stakeholders, attend engaging workshops, and hear a keynote address by The California Endowment’s Dr. Robert K. Ross. Workshops  will include discussions on each of the following:

·    Patient-Centered Medical Home: What Is It and How Do SBHCs Fit In?
·    First Aid at SBHCs: Improving Services through Collaboration
·    Preserving Adolescent-Friendly Services in an SBHC That Serves the Whole Community
·    Engaging Students and Schools to Maximize Health Insurance Coverage
·    Building Stronger Partnerships With School Administrations
·    Health Clinic Regulations: Important Updates for School-Based Providers
·    Engaging Schools and Students as Sex Education Advocates
·    Integrating Comprehensive Oral Health into an SBHC

To learn more, click here.

Register at www.schoolhealthcenters.org before February 8th to receive discounted rates!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Register Now for ITUP’s Upcoming Regional Workgroups

ITUP will be hosting the second half of its Regional Workgroups around the state. Although presentations, agenda topics and speakers vary by region, we generally provide updates on the California Health Benefit Exchange, explore coverage models for the residually uninsured post 2014, and discuss the integration of mental health services and transformations to the Medi- Cal program. You may find dates and times for each Workgroup below. Use the links to register for your region!

Central Coast Regional Workgroup

Tuesday, September 25, 2012

11:30AM to 2:30PM

Location:

Marian Medical Center Extended Care
1530 Cypress Way
Santa Maria, CA 93454

REGISTER FOR CENTRAL COAST

 

Inland Empire Regional Workgroup

Friday, October 19, 2012

10:30Am to 1:30PM

Location:

Inland Empire Health Plan

550 East Hospitality Lane

San Bernardino, CA

REGISTER FOR INLAND EMPIRE

 

North Central Regional Workgroup

Monday, October 22, 2012

12:00PM to 3:00PM

Location:

Sierra Health Foundation, Bannon Island Mtg Room,

1321 Garden Highway

Sacramento, CA 95833

REGISTER FOR NORTH CENTRAL

 

Orange County Regional Workgroup

Thursday, November 1, 2012

11:30AM to 2:30PM

Location:

The Coalition of Orange County Community Health Centers
17701 Cowan, Suite 220
Irvine, Ca. 92614-6057

REGISTER FOR ORANGE COUNTY

 

Northern Rural Regional Workgroups

Please note that a  call-in option will be provided at each Northern Rural Workgroup

Shasta County

Tuesday, December 18, 2012

12:00PM to 3:00PM

Health Alliance of Northern California (HANC)

2280 Benton Drive, Building C, Suite C

Redding, Ca 96003

REGISTER FOR SHASTA

 

Humboldt County

Wednesday, December 19, 2012

12:00PM to 3:00PM

Humboldt Area Foundation

Emmerson Room

363 Indianola Road

Bayside, CA 95524

REGISTER FOR HUMBOLDT

 

Mendocino County

Thursday, December 20, 2012

10:00AM to 1:00PM

Mendocino County Administration Center

Conference Room C

501 Low Gap Road

Ukiah, CA

REGISTER FOR MENDOCINO

 

Materials, executive summaries and other detail about ITUP’s Regional Workgroups are available on the Workgroup page, click here to view.

UCSF Releases Primer on Clinic Financing

The University of California, San Francisco (UCSF) recently released a clinic financial primer titled Maintaining Clinic Financial Stability: Navigating Change, Leveraging Opportunities. The report describes the factors shaping the future of California clinics as they seek to leverage opportunities in a changing delivery system that is facing huge financial pressures. The resource is a handy reference for individuals less familiar with the funding environment of clinics.

Findings from the report offer individual and collective strategies to help clinics achieve financial stability. Since the clinic-funding environment is fluid, Dr. Annette Gardner acknowledges the piece as a work in progress and plans to update the report after the November elections.

The report is a part of a collection of issue briefs produced by a partnership between the University of California, Berkeley; the University of California, Los Angeles; the University of California, San Francisco; and researchers from The Philip R. Lee Institute for Health Policy at UCSF.

The partnership, known as the University of California Health Care Safety Net Research Collaborative, is supported by a grant from the Blue Shield of California Foundation. The work of the Collaborative has helped assess the impact of health reform on providers serving low-income populations.

For more information on the Safety Net Research Collaborative, click here.

The full report on clinic financing can be accessed here.

DHCS post new LIHP Monthly Enrollment Numbers

The California Department of Health Care Services (DHCS) recently posted new monthly enrollment data for the Low-Income Health Program (LIHP) by county during August 2012. The Low-Income Health Program is a coverage initiative included in California’s §1115 Medicaid Waiver that allows counties to cover a larger portion of its MIA population. Counties receive a federal match on funds dedicated to caring for this population.

DHCS submits monthly enrollment data to CMS. The numbers are reported at point-in-time and since the count of enrollees change as individuals are determined eligible, there is continual adjustment to prior month’s enrollment data throughout the program year.

As seen below, Los Angeles County enrolled over 200,000 individuals in its LIHP (Health Way LA), while Alameda and Orange counties both enrolled 44,464 and 42,291 individuals respectively. Enrollment numbers for other counties can be seen below:

Overall, California had 487, 324 individuals enrolled in LIHPs across the state. Sacramento County plans to launch it’s LIHP on November 1st. The County originally planned to begin participating in LIHP in August but negotiations with hospitals required additional time. As enrollment continues to climb, we will remain hopeful that the demonstrated success of LIHPs will influence California’s decision to expand Medi-Cal in 2014.

For more information on LIHP, visit the DHCS website.

For details on Sacramento’s LIHP, view this article from California Healthline.