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CaliforniACA – October Edition

Update on Health-Related Legislation
October 9 was Governor Brown’s deadline to sign legislation into law. Governor Brown signed bills related to MLRs (medical loss ratios), autism coverage, coverage for maternity benefits, standardization of applications, and extensions of Medi-Cal fees for hospitals and Medi-Cal managed care plans. To see a full list of bills and their descriptions, click here.

Medi-Cal Lawsuit by Doctors and Pharmacists 
The California Medical Association and the California Pharmacists Association filed a lawsuit against the state Department of Health Care Services to secure information regarding the impact proposed Medi-Cal cuts would have on beneficiaries’ access to care. State officials rejected the Public Records Act request filed by the associations. Read more from the Sacramento Bee and California Healthline.

Electronic Health Record Incentives
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for incentive payments under Medicare and Medicaid. California is now ready to distribute as much as $1.4 billion in federal incentive funding to hospitals and physician groups who treat beneficiaries of Medi-Cal, California’s Medicaid program. The application process will be staggered over three months: hospital registration opened on Oct. 3; physician groups are next in line, able to apply on Nov. 15; and individual physicians can file for the federal money beginning Dec. 15. Read more here.

§1115 Waiver
SPD Enrollment
Counties have seen steady enrollment of Seniors and Persons with Disabilities (SPDs) into managed care since the transition began on June 1. June enrollment was 23,743, July was 22,754, August was 24,345 and September was 20,396.

LIHP Enrollment
As of August, Low Income Health Program enrollment reached 196,500 total enrollees. Of total enrollment, 175,500 are in the Medicaid Coverage Expansion (0-133% FPL) and 21,000 are in the Health Care Coverage Initiative (133%-200% FPL).

CCS Pilots
Five counties have received California Children’s Services demonstration awards. Alameda will pilot the Enhanced Primary Care Case Management, San Diego and Orange County will pilot Accountable Care Organizations, Los Angeles will pilot a Supplemental Health Care Program, and San Mateo will pilot a Medi-Cal Managed Care Program. Read more here.

The California Health Benefit Exchange
Summary of the September Exchange Board Meeting
On September 27, the Exchange Board held their September meeting (agenda) in Sacramento welcoming  Peter Lee as the first Executive Director. The Board reviewed options for the design of the IT infrastructure to determine eligibility for coverage in the Exchange and Medi-Cal, strategic visioning, and the Board’s draft comments on the federal Notice of Proposed Rulemaking on the operation of Exchanges. Click here for a full summary of the meeting.

Defining the Essential Health Benefits
HHS asked the Institute of Medicine (IOM) to assist in developing criteria to determine the essential health benefits (EHB). To read the IOM’s recommended criteria, click here. IOM recommended that covered services offered in these plans should be equivalent on average to those purchased by small employers, that they be supported by strong evidence of medical efficacy and that the costs of coverage not grow faster than the over-all economy thus assuring long term sustainability.

Implementing California’s Small Business Health Exchange
On October 14, Small Business Majority hosted its first in a series of forums on implementing California’s small business exchange called “Providing Excellent Insurance at an Appealing Rate.” The panel, moderated by Micah Weinberg of the Bay Area Council, included Terry Gardiner (VP, Policy & Strategy, Small Business Majority), Shawn Nowicki (Health Policy Director, HealthPass New York), and Bill Wehrle (VP, Health Insurance Exchanges, Kaiser Permanente). The purpose of the forum was for panelists to present lessons learned from other exchanges and provide recommendations for creating a successful Small Business Health Option Program (SHOP) in California. Read more here.

Pre-Existing Condition Insurance Plan
This month, PCIP enrollment reached 5,000 enrollees. Enrollment growth is due in part to eased enrollment requirements and reduced premiums. Read more here.

Long-Term Care
CLASS Act Ends
On October 15, the White House officially announced they are not implementing the CLASS Act, a voluntary long-term care insurance program included in ACA. Under the Act, those who participate and pay the necessary premiums would receive an average of $50/day to pay for needed long term care services. Officials stated that premiums needed to fund the program would be too high to attract adequate enrollment. The program could collapse due to adverse selection if only those who need the services pay the requisite premiums. Read more here.

Results from Long-Term Care Services and Support Study
The first State LTSS Scorecard was sponsored by the AARP Foundation, The Commonwealth Fund and the SCAN Foundation. It measures performance across four dimensions: 1) Affordability and access; 2) Choice of setting and provider; 3) Quality of life and quality of care; and 4) Support for family caregivers. Using this multidimensional approach, California ranked 17th (second quartile) overall, landing in the top quartile for affordability and access (7th) and choice of setting and provider (9th), in the bottom quartile for quality of life and quality of care (39th), and in the third quartile (30th) for support of family caregivers. Read more here.

Accountable Care Organizations
On October 20, HHS released the final regulations for Medicare Accountable Care Organizations. Back in March, a proposed rule was released for stakeholder review. HHS received more than 1,300 comments on the proposed rule asking to increase incentives, streamline the Shared Savings Program, and extend the benefits to a broader range of beneficiaries. The final regulations establish two initiatives, the Medicare Shared Savings Program and the Advance Payment Model. Estimates are that these initiatives could save the federal government up to $940M over four years. Read more here.

Health Information Technology
Telehealth Advancement Act
On October 7, Governor Brown signed The Telehealth Advancement Act (AB 415). The bill would eliminate a doctor’s need to document a patient’s inability to be seen in-person and change the way a patient consents to telehealth services from written to verbal. The bill also eliminates restrictions on reimbursement of services provided by email or telephone and ends restrictions on the settings (ie doctor’s offices, hospitals) in which telehealth services may be provided. The Center for Connected Health Policy estimates this bill will save $1.3 billion per year to Medi-Cal alone through enhanced management of diabetes and heart failure.

Decreasing Mortality
A recent study found that while stage 1 meaningful use requirements of computerized order entry will not decrease mortality rates, stage 2 and 3 rates will reduce death rates among patients. The federal government’s health information technology committee has endorsed a delay of stage 2 implementation. The authors suggest that while proceeding at a careful pace is appropriate considering the short timelines to demonstrate meaningful use, policy makers and stakeholders should come to terms with the proven life-saving benefits of these regulations.

Workforce Capacity
In an effort to address the shortage of primary care providers, OSHPD has been awarded $2.6 million in federal funds under ACA to support residency programs that train family practice physicians in 26 hospitals.

Public Health and Prevention
Southern California’s beach cities, including Hermosa Beach, Manhattan Beach and Redondo Beach, are promoting healthy lifestyle habits through more than $5M in local and national grant funding. The Cities were selected as the Country’s first “Vitality City,” receiving $3.5M from Tennessee-based Healthways and $1.8M from the Beach Cities Health District. The region is working to reduce obesity and hypertension rates and lower hospital admissions and health care cost. For more, read ITUP’s blog post.

Blue Shield Provides Rebates to Customers
In June 2011, Blue Shield pledge to limit its profits to 2% of revenue. Based on 2011 earnings, Blue Shield announced that they would be returning $295M to consumers in the form of premium credits. Individual policyholders will be credited an average of $135, mid-large group policyholders (51+ employees) will be credited an average of $195-$230 and small group policyholders (2-50 employees) will be credited an average of $220. Self-funded groups and those covered under federal and state government contracts are not eligible for the credit. Blue Shield will provide approximately $10M to California Hospitals to help them participate in Accountable Care Organizations (ACOs). They will also designate approximately $2M for community investments. Click here to read Blue Shield’s press release.

Children’s Health
Vaccination Refusal Rates Up
More than 11,000 (2.5%) California kindergarteners did not receive at least one vaccine in 2010 because their parents opted out of immunization, the highest rate of refusal since 1978. Read more here.

Autism Legislation
Governor Brown recently signed SB 946 (Steinberg), which will require health insurers to cover applied behavioral analysis (ABA) treatment for children with autism. This bill will help 7,300 additional children gain access to ABA, and would also clarify the state’s mental health parity law. The law does not extend to children covered under public programs, such as Medi-Cal and Healthy Families.

Whooping Cough
A study by Kaiser Permanente Medical Center in San Rafael showed that the pertussis (whooping cough) vaccine loses its effectiveness earlier than previously thought. Children who had gone at least 3 years since their last vaccine were up to 20 times more likely to contract the disease than children who had been vaccinated more recently. Read more here.

Infant Mortality
Infant mortality in California fell to a new low of 4.9 deaths per 1,000 births in 2009. This beat the previous low that was reached in 2006 with five deaths per 1,000 births. Public health officials cite better health choices as a possible reason. Racial and ethnic disparities still exist with the mortality rate for blacks declining from 12.1 per 1,000 in 2006 to 10.6 in 2009. Also noteworthy, the overall birth rate in California reached its lowest point since 1935. Read more here.