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CaliforniACA – August Newsletter

Data on the Newly Eligibles
A new publication from the Public Policy Institute of California (PPIC) gives us a snapshot of the low-income individuals who will qualify for Medi-Cal in 2014. Data from population survey data finds that within this population: 60% are under age 40 and no less healthy than current, non-disabled Medi-Cal enrollees; 30% are under age 25; and between 15 and 25% currently report fair or poor health status, with one in four reporting a chronic health condition. Read a summary here.

Cuts to Medi-Cal
Health advocates from the California Alliance for Patient Care met with CMS Administrator Donald Berwick on Thursday, August 4. Stakeholders of the alliance urged Berwick to reject lawmakers’ planned cuts to Medi-Cal. These cuts include reductions in state spending by: $623M through a 10% cut in provider reimbursement rates, $511M through a $5 copay for physician visits and a $50 copay for emergency department visits for Medi-Cal beneficiaries, and $41M through a soft cap of seven physician visits and a dollar limit on hearing aids for beneficiaries. California needs federal approval to enact the planned cuts. Officials are expected to make a decision by September 30th.

Medi-Cal Lawsuit
Friday, August 5 was the last day to file amicus briefs for the Maxwell-Jolly v. Independent Living Center of Southern California case. The case will determine whether Medicaid beneficiaries and providers have the right to sue state agencies in federal court over the sufficiency of Medicaid provider payments. Plaintiffs of the case, which also include the California Pharmacist Association and Santa Rosa Memorial Hospital, argue that a 10% reduction in Medi-Cal reimbursement rates for providers would jeopardize beneficiaries’ access to care and conflict with the federal Medicaid Act. California officials contend that providers and beneficiaries do not have the right to sue the state for allegedly violating federal Medicaid regulations. Oral arguments for the case are scheduled to be heard on October 3. For more, read ITUP’s blog post and this feature on California Healthline.

The California Health Benefit Exchange
California Receives Level I Establishment Grant
On August 12, California received a $39M Level I Establishment Grant from HHS to begin the creation of a state Exchange. The state had originally asked for $41M. The funds will be used to recruit staff and contract workers to create a three-year business plan, develop IT, and conduct consumer outreach. In June of 2012, California will apply for a Level II grant, funding the remainder of the development and year 1 operations. The Exchange must be self-sustaining and fully operational after its first year of operations (starting in 2015).

Summary of the July Board Meeting
At the Exchange Board’s July 22 meeting, the Board announced they will be taking comments on the Federal NPRM through August 18 (due to feds on September 28). The California HealthCare Foundation proposed four visions for California’s Health Benefit Exchange, including 1) Price Leader, 2) Service Center, 3) Change Agent, and 4) Public Partner. The Board also voted on whether to support bills that would impact the function of the Exchange. Read a full summary of the meeting on the ITUP blog.

§1115 Waiver
Updated Implementation Dates
Placer and Yolo Counties began their Low Income Health Programs (LIHP) on August 1. Merced, Monterey, San Bernardino, and Santa Cruz Counties will begin on September 1. See all implementation dates from this updated DHCS chart.

Newly Eligibles in Monterey County
Monterey County estimates that 11,000 of their 23,000 uninsured will be eligible for Medi-Cal coverage as early as September through LIHP. County officials say they can afford to cover only 1,000 to 1,500 eligible residents this year even though federal matching funds are available for the costs of additional enrollees. Read more here.

Adult Day Health Centers
The California Legislature appropriated $85M for a scaled down version of the ADHC program through December 1. On December 1, up to 300 ADHC centers will close, affecting approximately 35,000 seniors and persons with disabilities. About half of the $85M will fund the transition of these beneficiaries into managed care health plans. Read more here.

Notices of Proposed Rulemaking
Three Notices of Proposed Rulemakings (NPRM) have been released over the past few months. The IRS NPRM on implementing the ACA premium tax credit and cost-sharing subsidies can be found here. The CMS NPRM on the ACA’s Medicaid eligibility expansions can be found here.  Another CMS NPRM spells out the process for eligibility determination for Exchange programs (participating in the Exchange without subsidies as well as in the premium tax credit subsidy) and coordination of Medicaid and Exchange eligibility and can be found here. Read more about the Exchange NPRMs on the ITUP blog.

Pre-Existing Condition Insurance Plan
On August 7, MRMIB announced they had received federal approval to lower premiums for subscribers of California’s pre-existing condition insurance plan (PCIP). Monthly subscriber premiums will be reduced by an average of 18% across all age groups (between 8.2% to 24.3%, depending on age and geographic region). New rates take effect October 1. Subscribers enrolled this month and next will either receive credits they can use for future invoices or refunds (if they are no longer enrolled by October 1). Read more on the ITUP blog.

Accountable Care Organizations
Blue Shield of California has several ACO programs in operation in various stages of development throughout the state including San Francisco, the Central Valley, Orange County and Sacramento. Blue Shield of California and St. Joseph Health System plan to start another accountable care initiative come January 2012. Upon implementation, this ACO will care for 30,000 Blue Shield HMO members in Orange County, who are patients of SJHS. Affiliated health care providers include St. Joseph Hospital in Orange, St. Jude Medical Center in Fullerton, Mission Hospital in Mission Viejo and Laguna Beach, the St. Joseph Home Health Ministry, and three affiliated physician networks and three medical groups. Anthem Blue Cross announced their plan last week to establish an ACO in Northern California in a direct contract agreement between Anthem and Individual Practice Association Medical Group of Santa Clara.

Health Information Technology
The American Recovery and Reinvestment Act’s (ARRA) meaningful use program has lead to a nearly threefold increase in adoption rates of computerized physician order entry systems, according to a market report by Healthcare vendor research firm KLAS. According to the report, “CPOE 2011: The ARRA Effect”, 87 hospitals per year adopted CPOE systems before meaningful use requirements went into effect. After implementation of MU, that number expanded to 233. Health Data Management and iHealthBeat have slightly more information if you don’t want to purchase the report from KLAS. Meanwhile, CMS officials have distributed more than $400 million to 77,000 providers who demonstrated meaningful use, EMR Daily News reports.

Workforce Capacity
Scope of Practice
In conjunction with the Robert Wood Johnson Foundation, CA nurses are preparing to implement initiatives that would help them play a larger role in the health care system The Institute of Medicine (IOM) recommends that states and the federal government eliminate barriers that narrow advance practice nurses’ scope of practice.

Nurse-to-Patient Ratios
In response to newly implemented nurse-to-patient ratio laws, CA hospitals have hired more RNs and expanded access to nursing care.In CA hospitals, the amount of nursing care increased from 6.44 hrs per adjusted patient day to 7.11 hours following implementation of the staffing law. California was the first state to pass a law mandating nurse staffing levels.

Data on Pediatric Screenings
A UCSF study showed that pediatricians often neglect to conduct screenings for nutrition, exercise and emotional issues with teenagers who are overweight, and focus instead on obese teens. Such preventive screenings could prevent overweight teens from adopting behaviors that could lead to obesity.

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