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CaliforniACA March Newsletter

Special Session Bills See Mixed Progress
Two bills were discussed during the first Special Session hearings in late February:

  • ABX1 1 (Perez, D-Los Angeles)/SBX 1 1 (Hernandez, D-West Covina) – Medi-Cal Eligibility: implements key ACA provisions to expand Medi-Cal eligibility to childless non-elderly adults with incomes up to 138% of FPL, and streamlines eligibility/enrollment process
  • ABX1 2 (Pan, D-Sacramento)/SBX1 2 (Hernandez) – Health Care Coverage: prohibits insurers from charging more based on health status or denying coverage due to pre-existing conditions, and limits how much more insurers can charge based on age, geography and family composition
  • SBX1 3 (Hernandez) – Bridge Plans in the Exchange: allows the sale of bridge plans in the Exchange for lower-income Californians, and exempts bridge plan products from the requirement to offer each of the 5 tiers of coverage
  • The first two sets of bills have passed a floor vote, and are being considered in committee in the second house. The third set has seen less progress, with ABX 1-3 yet to be officially introduced; SBX 1-3 is in committee in its house of origin. Spring recess will end April 1.

    Bills to Expand Scope of Practice for Non-Physicians Introduced
    Senator Hernandez (D-West Covina) has introduced a set of three bills that would expand scope of practice for non-physicians to address provider shortage problems. SB 491, SB 492 and SB 493 would expand the roles of nurse practitioners, optometrists and pharmacists, respectively. Senator Pavley (D-Agoura Hills) has developed a separate bill (SB 352) that would expand the scope of practice for physician assistants.

    Legislation to Upgrade Rx Monitoring Database Introduced
    Senate President Pro Tempore Steinberg (D-Sacramento) and Senator DeSaulnier (D-Concord) have introduced SB 809, which would upgrade a database that monitors physicians who overprescribe certain medications. The Controlled Substance Utilization Review and Evaluation System (CURES), which tracks patients’ prescription drug history to curb illegal sales and misuse of medication, is currently operated by one full-time employee. The bill would upgrade CURES and establish two criminal enforcement teams to investigate suspicious prescribing patterns. To pay for the estimated $9.6 million in upgrades, the bill would implement a one-time assessment fees for health plans and workers’ compensation insurers; increase license fees on physicians, pharmacists, dentists and other drug prescribers; and tax drug manufacturers.

    Covered California
    March Board Meeting: QHP Contracting, Assisters Program, Health Disparities
    The March board meeting discussed final recommendations for a “narrow bridge” program (would allow Medi-Cal beneficiaries to keep their Medi-Cal managed plans and provider network when their incomes increase above 138% of FPL and permit Exchange parents and Medi-Cal children to be served in the same managed care plan), qualified health plan model contract issues and plan design, and health disparities and promoting health equity. The board took action to require background checks for in-person assisters, with Covered California paying for background checks through 2014. Covered California staff announced that Contra Costa County will operate a customer call center; Sacramento and Fresno will potentially house the other call center sites. All meeting materials are available online. The next board meeting will be held on April 23 in Sacramento, and the first town hall meeting will be held in the Inland Empire on April 25.

    CMS Approves State Plans to Coordinate Care for Dual-Eligibles
    CMS signed a Memorandum of Understanding with California, approving the state’s plan to test a new model for providing coordinated care to dual-eligibles enrolled in both Medicare and Medi-Cal. The demonstration project (Cal MediConnect) will provide vision and dental benefits, and will affect 456,000 beneficiaries, 200,000 of which will be in Los Angeles County. Enrollment in Cal MediConnect will begin no earlier than October 1, 2013, and all beneficiaries will be able to opt out of the demonstration at any time.

    LA County Partners with OneLA to Enroll Uninsured Residents
    To prepare for enrolling newly eligible Medi-Cal beneficiaries in 2014, Los Angeles County is partnering with OneLA, an organization of churches, synagogues and non-profits. The program will offer enrollment events at churches, schools and community centers, and will be managed by the county’s Department of Health Services and OneLA. Trained volunteers will screen residents to determine eligibility for Medi-Cal and Healthy Way LA, which is operating the county’s LIHP.

    Mental Health
    DMHC Report Finds Kaiser’s Mental Health Services Lacking
    According to a report by the Department of Managed Health Care, Kaiser Permanente has made patients wait excessively long periods between appointments, and provided patients with inaccurate information that may have dissuaded them from seeking long-term individual therapy. Kaiser has stated it has taken several steps to improve their services, including updating its educational materials, improving the process for tracking appointments, and working with the National Union of Healthcare Workers to shorten wait times between appointments.

    Provider Capacity
    The California Endowment to Invest $90M to Bolster Healthcare Workforce
    The California Endowment announced it will invest $90 million over four years to expand the state’s workforce to provide care to millions of newly insured residents:

  • $21 million for training to increase health professionals prepared to work in medically underserved areas;
  • $15 million to strengthen education programs that boost health care career opportunities for young people;
  • $14 million in 2013-14, $9 million in 2014-15 and $8 million in 2015-16 for medical student scholarships and loan repayment programs for health care workers in medically underserved areas;
  • $10 million for new career advancement programs for health care workers;
  • $8 million for community college health career training programs that support minority students;
  • $3 million to help clinics become teaching facilities; and
  • $2 million to support workforce pilot projects to boost new practice models and new classes of health care workers.
  • Data
    Healthiest Counties Have More Primary Care Physicians
    A RWJF/University of Wisconsin analysis found that U.S. residents living in healthier counties are 1.4 times more likely to have access to a physician and dentist than residents living in the least healthy counties. Counties where residents do not live as long and experience poorer physical/mental wellness also had the highest rates of smoking, teen birth and physical inactivity, as well as more preventable hospitalizations. In California, the highest-ranking counties according to health outcomes are: Marin, Placer, Santa Clara, San Mateo and Yolo. The lowest-ranking counties are: Lake, Siskiyou, Tehama, Kern and Del Norte

    California Receives D Grade for Health Care Price Transparency
    In a national report card from the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute, California received a “D” grade for its transparency on pricing for hospital/clinic services. Massachusetts and New Hampshire were the only states to earn an “A” grade, while 29 states received an “F” grade for having little to no transparency requirements. California was one of seven states to receive a “D” grade.

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