Friday, 11, October 2013
Governor Signs Hospital Fee Extension Bill and Revised Ballot Initiative Filed
On October 8, the Governor signed CHA-sponsored and Alliance-supported SB 239 (Hernandez-Steinberg) into law. The urgency measure extends the successful hospital provider fee program for three additional years (2014-2016). The next day, CHA filed with the Attorney General its revised ballot initiative language for a measure intended to go before state voters in November 2014. The initiative will protect hospital funds intended to provide care to low-income Californians and health care for children from being redirected for other purposes. For additional details, please refer to the attached CHA Press Release and text of the ballot initiative.
In another action the Governor signed AB 361 (Mitchell), which authorizes the Department of Health Care Services to seek federal approval to implement a health home program for adults, children, or both, with chronic conditions pursuant to the federal Affordable Care Act.
The Governor has through Sunday, October 13 to act on bills passed during the 2013 Legislative Session. The Alliance will continue to monitor bill-signing actions through the weekend on measures of interest to its members. As an example, the Governor has yet to act on SB 615 (Galgiani), sponsored by the State Building and Construction Trades Council. The bill would require the payment of prevailing wages on private hospital construction projects paid for in whole or in part with the proceeds of conduit revenue bonds, such as those administered by the California Health Facilities Financing Authority. The bill is opposes by many in the hospital community for a number of reasons including increasing project costs.
This week, Covered California released statistics on the first week of open enrollment. For the initial week (October 1-5) Covered California’s website had 987,440 unique visits. Online, 16,311 households completed their eligibility process and were determined eligible for subsidies, Medi-Cal or to enroll in an individual private plan. These household applications contained 28,699 individuals who completed eligibility determination. An additional 27,305 households had partially completed their online application. At Covered California Service Centers, 59,003 calls were logged over the five-day period.
One key missing component on the website during the first week of open enrollment was a search function that would allow consumers to determine whether their provider was in a plan network. That provider search function was finally launched over last weekend, and is now active. The lack of the provider search had greatly hampered enrollments from consumers signing up for any plan other than Kaiser Permanente, which has an exclusive provider network. This was fixed, along with other software glitches.
In an effort to keep interested parties informed and apprised on the latest developments of the Coordinated Care Initiative – the dual eligible project - the Department of Health Care Services (DHCS) has announced a series of webinars over the next two months. They have divided the webinars into “Stakeholder Updates” (October 8th, November 18th, and December 10th) and “Overview and Educational Webinars” (October 17th and 29th). Information and registration for the webinars can be found at http://www.calduals.org/2013/10/04/stakeholde%E2%80%8Br-update-general-overview-webinars-available/.
Friday, 30, September 2013
Covered California: Insurance Enrollment Begins
On Tuesday, October 1st, the state’s health benefit insurance exchange began its six-month open enrollment period to a huge response. The Covered California website allows consumers to determine their eligibility for premium assistance and no-cost or low-cost Medi-Cal and to shop for, compare and enroll in coverage. Although not totally unexpected given the magnitude of the IT infrastructure needed, the Covered California website faltered somewhat on the launch of its website, and had to be shut down for a period of time to make needed upgrades. Representatives of Covered California reported that on the first day there were 5.7 million visits on the website, with their call center receiving more than 19,000 calls. The response was so overwhelming that Covered California staff was reminding the public that they didn’t have to sign up on October 1st; rather, to receive coverage effective January 1st consumers have until December 15th to enroll, and open enrollment actually continues through March 2014. According to Covered California, it is estimated that during this initial six-month open-enrollment period, the state’s health benefit exchange will enroll 500,000 to 700,000 Californians who are eligible for premium assistance to make their care more affordable.
California’s early experience with the implementation of the Affordable Care Act has taken on national significance, given it is the biggest state, and is moving ahead quickly with implementation. The success of California is being viewed as a bellwether for the rest of the nation.
On a related note, last week the California HealthCare Foundation released a report entitled “All Together Now – Coordinating California’s Health Care Public Sector Health Care Purchasing.” The report explores the concept of having Covered California, Medi-Cal, and CalPERS coordinate their health insurance purchasing, in hopes of leveraging an extremely large risk pool. Taken together, these three state programs would represent an estimated 32% of insured Californians, and 25% of all health care spending in the state. The report espouses the concept that the three programs should be better aligning their performance measures to lower costs and drive delivery system reforms. The full report, along with a video presentation on the concept, can be found at http://www.chcf.org/publications/2013/09/all-together-now.
Friday, 20, September 2013Covered California
On Thursday, the Covered California board met to take action on several key regulations: eligibility and enrollment, SHOP, agents, plan based enrollment, and enrollment assistance programs. The most welcomed news was the announcement that the CalHEERS online portal would be ready to launch by open enrollment on October 1. Consumers will be able to both shop and compare health plans, as well as enroll in Covered California. Some other features will be added later in the year, such as enrollment in AIM (Access for Infants and Mothers). The full agenda and meeting materials can be found at http://www.healthexchange.ca.gov/BoardMeetings/Pages/Default.aspx.
Friday, 13, September 2013 Legislature Concludes 2013 Session
Just after midnight, the Legislature adjourned its 2013 Session. Attached is the most recent Alliance Summary and Status Report, and following are final legislative actions on a number of measures of interest to members of the Catholic health care ministry:
SB 239 (Hernandez/Steinberg) is the California Hospital Association (CHA)-sponsored urgency legislation, supported by the Alliance, to extend the hospital provider fee for an additional three years, passed both the Assembly (77-0) and the State Senate (38-0) with strong bi-partisan and near unanimous support. The bill was amended late this week with language negotiated between CHA, the legislative leaders and the Governor. With the Senate concurring in Assembly amendments late yesterday evening, the measure is on its way to the Governor’s desk and he is expected to sign it into law.
SB 493 (Hernandez), which expands the scope of practice for “advanced practice pharmacists,” was approved by both the Assembly (77-0) and the Senate (37-0) and is on its way to the Governor. This measure, supported by CHA, is the remaining active bill of a three-bill package of scope of practice measures authored by Senator Hernandez with the intent of increasing access to primary care providers in anticipation of increased demand associated with the implementation of the federal Affordable Care Act. The other two measures include SB 491, which would have allowed nurse practitioners, in certain circumstances, to practice independently of physician oversight. The measure, facing strong physician opposition, died in the Assembly Appropriations Committee but Senator Hernandez announced that he will pursue it again in 2014. SB 492, which would have expanded the scope of practice for optometrists, was made a two-year bill by the author and he has indicated that he plans to advance the bill in 2014.
SB 615 (Galgiani), sponsored by the State Building and Construction Trades Council, passed both the Assembly (52-22) and the Senate (23-11) and now goes to the Governor. The bill amends state law to expand the definition of public works, for purposes of prevailing wage payment requirements, to also include any construction, alteration, demolition, installation, or repair work done under private contract on a hospital or health care facility project when the project is paid for in whole or in part with the proceeds of conduit revenue bonds, such as those administered by the California Health Facility Financing Authority. While opposed by CHA, the final version of the bill does include a CHA-requested amendment that delays bill implementation until January 1, 2015. It is intended that this one-year extension would give hospitals needed time to seek conduit financing to fund state mandated seismic retrofit projects.
The Governor now has until October 13th to sign or veto bills passed by the Legislature. The Legislature will reconvene on January 6, 2014 for the final year of this two-year legislative session.
Friday, 23 August 2013
Legislative Fiscal Committees set to Complete Work on August 30
The Senate and Assembly Appropriations Committees continue to hold marathon-like weekly hearings so that they can complete their work by the August 30 fiscal committee deadline. In fact, both committees have scheduled rare Friday hearings for August 30 to take up their respective Suspense Files. These files contain bills exceeding General Fund and special fund cost thresholds. The Committees will decide which bills die and which will live and continue to the next step in the legislative process.
SB 239 (Hernandez/Steinberg), the California Hospital Association (CHA)-sponsored measure to extend the hospital provider fee program for two years, was approved on a unanimous vote by the Assembly Health Committee on August 20. The bill now moves to the Assembly Appropriations Committee for likely hearing on August 30. Since the bill is an urgency measure, it is exempt for most legislative deadlines. CHA reports that additional amendments are planned before the measure’s next hearing.
On a related note, CHA also reports that it continues to negotiate with the Administration and legislative leaders on the components of this legislation as well as a constitutional amendment, which would, among other things, contain protections for the fee program and provide predictability and stability for hospitals and the Medi-Cal program. Relief from AB 97 budget reductions to distinct part nursing facilities is also reported to be part of the negotiations.
SB 491 (Hernandez), which expands the scope of practice for nurse practitioners under certain conditions, was considered by the Assembly Appropriations Committee on August 21 and placed on the Suspense File. Another scope of practice measure, SB 493 (Hernandez), dealing with advanced practice pharmacists, awaits hearing by the Assembly Appropriations Committee and will likely be heard on August 30.
Friday, 16 August 2013
Legislature Takes Action on Key Bills as Fiscal Deadline Nears
This week the Legislature took action on several key bills. Among the bills of interest to the Catholic health ministry were two of Senator Ed Hernandez’s three scope of practice bills:
♦ SB 491 (nurse practitioners) was reconsidered and approved on Tuesday by the Assembly Business and Professions Committee. The measure, which failed passage in that committee on August 6, now moves to the Assembly Appropriations Committee. The author gained the two additional votes needed (8-2) to pass the bill by taking an amendment that limits a nurse practitioner (NP), qualifying for practice without physician supervision, to a NP who meets specified criteria and has practiced under the supervision of a physician for at least 4160 hours, and is practicing in a clinic, health facility, county hospital, ACO, or a medical group or practice. The amendment taken in committee on Tuesday deletes the second alternative pathway to unsupervised practice, which would have required that a NP practice under the supervision of a physician for at least 6240 hours. Based on reactions after this week’s hearing and vote it appears that the California Medical Association (CMA) and its affiliated physician organizations will likely remain opposed to the bill.
♦ SB 493 (advanced practice pharmacists) was passed by the Assembly Health Committee on Tuesday with a bi-partisan vote (18-0) after Senator Hernandez agreed to take an amendment calling for more patient care coordination between physicians and advanced practice pharmacists. CMA withdrew its opposition to this bill. This measure also moves to the Assembly Appropriations Committee.
As reported earlier, SB 492 (optometrists) is a two-year bill. It remains with the Assembly Business and Professions Committee and can be considered further in the 2014 Legislative Session.
Also considered this week was the California Hospital Association (CHA)-sponsored AB 900 (Alejo) by the Senate Appropriations Committee and, as expected, was placed on the Committee’s Suspense File because of the bill’s potential costs to the state General Fund. The measure would eliminate pending prospective reimbursement cuts to essential hospital distinct-part skilled nursing facilities (DP/SNFs), as enacted as part of AB 97 budget cuts in 2011. The Senate Appropriations Committee will take up all Suspense File measures at the end of August and decide which ones pass or fail.
In a separate but related action on Wednesday, the California Department of Health Services (DHCS) announced its implementation plan for the provider payment reductions required pursuant to AB 97 (copy attached). The legislation requires DHCS to implement 10 percent provider payment reductions to most categories of services in Medi-Cal fee-for-service as well as actuarially equivalent reductions in Medi-Cal managed care. However, the Department noted in its plan that DP/SNFs, Level B, classified as rural or frontier, based upon the California Medical Service Study Area’s definitions, will be exempted prospectively from the 10 percent payment reductions and will not be subject to the rate freeze at the 2008-09 levels on a prospective basis. The state’s proposed action is subject to prior federal approval.
Next Tuesday, August 20, the Assembly Health Committee will hear SB 239 (Hernandez/Steinberg). This CHA-sponsored bill would extend the successful hospital provider fee program for two years (January 1, 2014 to December 31, 2015).
August 30 is the deadline for the Appropriations Committees to approve fiscal bills. The Legislature is scheduled to adjourn its 2013 Session on September 13 and will reconvene on January 6, 2014.
Friday, 09 August 2013
Cover California Finalizes Participating Health Plans
This week, Covered California announced the final and official list of health plans that have signed contracts to participate in the state’s health benefit exchange. Twelve health insurance companies will offer coverage in the individual market, with six of those companies offering plans through the exchange’s Small Business Health Options Program (SHOP) market as well. One plan that was part of the tentatively selected organizations announced earlier this spring, Ventura County Health Care Plan, opted out of the exchange in the first year. The following insurance companies will offer plans in Covered California as follows:
Alameda Alliance for Health Kaiser Permanente
Anthem Blue Cross of California L.A. Care Health Plan
Blue Shield of California Molina Healthcare
Chinese Community Health Plan Sharp Health Plan
Contra Costa Health Plan Valley Health Plan
Health Net Western Health Advantage
SMALLL BUSINESS HEALTH OPTIONS PROGRAM (SHOP)
Blue Shield of California Kaiser Permanente
Chinese Community Health Plan Sharp Health Plan
Health Net Western Health Advantage
A health plan booklet with individual market plan rates for 2014 can be found at:
Friday, 26 July 2013
Hospital Provider Fee and MICRA Initiatives Files
Two initiatives of interest to the Catholic health care ministry were filed this week with the state Attorney General’s office. Both filings are the first step in the process required to qualify a measure for the November 2014 ballot. Once the Attorney General’s office issues a “Title & Summary,” the measure’s proponents will begin collecting the necessary number of qualified signatures to place the measure before the voters.
1) Hospital Provider Fee: The Medi-Cal Funding and Accountability Act of 2014. Sponsored by the California Hospital Association, this initiative will prohibit the Legislature and the Administration from imposing a provider fee (tax) on hospitals unless the monies and matching federal funds are used to pay for hospital care provided to Medi-Cal patients, which include the elderly, the disabled and children. The main purpose is to ensure that hospital funds intended to pay for care provided to low-income persons are not diverted by lawmakers for other, non-hospital patient care purposes. Since 2009, California hospitals have agreed to pay the state nearly $3 billion annually, with the monies then used by the state to draw down matching federal funds for the Medi-Cal program. As part of the agreement, hospitals have supported the state taking a small portion of the fee money to pay for health care for children. Since the inception of the program, however, the state has diverted some of the hospital fee money to the state’s General Fund for other purposes.
2) MICRA: The Troy and Alana Pack Patient Safety Act of 2014. Sponsored by a coalition of trial attorneys and consumer advocates, the initiative’s main provision makes changes to California’s Medical Injury Compensation Reform Act (MICRA) to increase the cap on speculative, “non-economic” damages from the current $250,000 to more than $1.2 million (based on an adjustment mandated in the initiative). The initiative also includes other provisions relating to physician drug testing and prescription drugs. Should the proponents succeed in securing the necessary signatures to qualify the measure, opposition will be lead by the California Alliance for Patient Protection (CAPP) coalition to establish a strategy to protect the MICRA cap and limit the unintended consequences that an increase in lawsuits against health care providers would generate. The Alliance is a member of CAPP, which includes many of the state’s hospitals, physicians, dentists, community clinics, health centers, nurses, emergency providers, police officers, local governments, labor unions, and other healthcare professionals.
Thursday, 11 July 2013
Summer Recess Begins; Special Session Concludes
While it is summer recess time for the California Legislature, as we reported last week this year is a departure from tradition where both Houses have historically observed Summer Recess at the same time. Because of differing scheduling priorities reportedly driven by time needed to complete bill hearings, the Assembly adjourned last Wednesday, July 3, and will reconvene on Monday, August 5. The State Senate is scheduled to begin its Summer Recess this Friday, July 12, and will return to the Capitol on Monday, August 12.
Special Session on Health Care. Last January, the Governor called for a Special Session of the Legislature to implement federal health care reform. Having completed work on five measures, the Legislature adjourned the Special Session last week. Unless measures approved in a special session are urgency, they take effect on the ninety-first day after the session is adjourned. Measures approved in the Special Session are as follows:
ABx1 1 (Speaker Perez). This bill implements specified Medicaid provisions (Medi-Cal in California) of the federal Patient Protection and Affordable Care Act (ACA), including the expansion of federal Medicaid coverage to low-income adults with incomes between 0 and 138 percent of the federal poverty level. It implements a number of Medicaid ACA provisions to simplify the eligibility, enrollment, and renewal processes for Medi-Cal. The bill is a companion measure to SBx1 1 (Hernandez/Steinberg). The measure was approved by the Governor on June 27, 2013.
ABx1 2 (Pan). The bill establishes health insurance market reforms contained in the ACA specific to individual purchasers, such as prohibiting insurers from denying coverage based on preexisting conditions; and makes conforming changes to small employer health insurance laws resulting from final federal regulations. The bill is a companion measure to SBx1 2 (Hernandez). The Governor approved the bill on May 9, 2013.
SBx1 1 (Hernandez/Steinberg). This bill establishes the existing Medi-Cal benefit package as the benefit package for the expansion population eligible under the ACA and expands the Medi-Cal benefit package for the existing population and newly eligible under the ACA to include mental health services and substance use disorder services required under the essential health benefit legislation adopted in 2012 that are not currently covered by Medi-Cal. It also implements a number of the Medicaid ACA-related provisions to simplify the eligibility, enrollment, and renewal processes for Medi-Cal. This is a companion bill to Abx1 1 (Speaker Perez). The measure was approved by the Governor on June 27, 2013.
SBx1 2 (Hernandez). The measure applies the individual insurance market reforms of the ACA to health care service plans (health plans) regulated by the Department of Managed Health Care and updates the small group market laws for health plans to be consistent with final federal regulations. This bill is a companion measure to ABx1 2 (Pan). The Governor approved the measure on May 9, 2013.
SBx1 3 (Hernandez). This bill requires the California Health Benefit Exchange (known as Covered California), by means of selective contracting, to make a bridge plan product available, as a qualified health plan (QHP), to what is often referred to as the “churn” population that moves in and out of Medi-Cal eligibility. The bill exempts the bridge plan product from certain requirements that apply to QHPs relating to making the product available and marketing and selling to all individuals equally (guaranteed issue) outside Covered California and selling products at other levels of coverage. It also requires the Department of Health Care Services to include provisions relating to bridge plan products in its contracts with Medi-Cal managed care plans. It requires Covered California to evaluate three years of data from the bridge plan products. Finally, it repeals Covered California's authority for enrollment in a bridge plan product on the October 1 that falls five years after the date of federal approval. The Governor signed the measure today (July 11, 2013).
Thursday, 11 July 2013Contraceptive Coverage Mandate
Last week we reported that that Department of Health and Human Services (HHS) issued a final rule regarding the “exemption” for religious employers and an “accommodation” for other non-profit religious organizations under the contraceptive coverage mandate. Attached is an overview
, and “frequently asked questions,” of the final rules that was recently disseminated by the Catholic Health Association of the United States.
Friday, 24 June 2013
Final Rule: HHS Preventive Services Mandate
Today, the Department of Health and Human Services (HHS) issued a final rule regarding the “exemption” for religious employers and “accommodation” for other non-profit religious organizations under the preventive services mandate. The final rules reflects public comment received (over 400,000) in response to the Notice of Proposed Rulemaking (NPRM) issued in February 2013.
In keeping with the NPRM, the final rule simplifies the definition of religious employers that are “exempted” from having to provide contraceptive coverage to entities that are organized and operated as a nonprofit organization under specific Internal Revenue codes. The final rule eliminates the criteria that a religious employer had to have the inculcation of religious values as its purpose; primarily employ persons who share its religious tenets; and primarily serve persons who share its religious tenets. By eliminating the three criteria, the religious employer exemption would apply to churches, as well as to integrated auxiliaries of churches that provide educational (elementary), charitable and social services. For-profit organizations/businesses whose owners object to the mandated contraceptive services on religious grounds are NOT considered under the exemption.
The final rule also sets forth the “accommodation” for other non-profit religious organizations, such as hospitals and universities, while also separately providing health plan beneficiaries contraceptive coverage with no cost sharing. The final rule retains the definition of an eligible organization set forth in the NPRM, which would be defined as an organization that 1) opposes providing coverage for some or all of the contraceptive services due to religious objections; 2) is organized and operates as a nonprofit entity; 3) holds itself as a religious organization; and 4) self-certifies that it meets these criteria and specifies the contraceptive services for which it objects to providing coverage.
Eligible organizations would not have to contract, arrange, pay or refer for any contraceptive coverage to which they object on religious grounds.
The final rule also sets forth the accommodation for both insured and self-insured health plans that object to contraception coverage, providing more details on the accommodation for both insurers and third party administrators. And, the final rule extended from August 1, 2013 to January 1, 2014 the “safe harbor” agreement that provides temporary relief from enforcement.
The Alliance will provide more detailed information once we conduct further analysis of this complex 110-page final rule.
Friday, 24 June 2013
State Budget Signed by Governor
Yesterday, Governor Brown and Democratic legislative leaders gathered to witness the Governor’s singing of the 2013-14 State Budget Act (AB 110), 18 budget “trailer” bills and two special session measures which implement Medi-Cal expansion as part of the state’s commitment to the federal Affordable Care Act (ACA). The Governor and legislative leaders emphasized that the $96.3 billion General Fund spending package is not only balanced, thanks to the voters’ passage last November of the Governor’s revenue generating Proposition 30, but is on time for the start of the new fiscal year, July 1, 2013.
The Governor “blue penciled’ (line-item vetoed) only about $40 million in expenditures, none of which were in the Department of Health Care Services’ (DHCS) budget, which includes Medi-Cal. In addition to the release of budget blue penciled items, the Governor’s Department of Finance also released a summary of the Budget Act as signed. Sections dealing with Health Care Reform and Health and Human Services, which includes DHCS, are attached. The Health Care Reform section discusses the state’s implementation of Medi-Cal expansion under the ACA. It highlights expanded eligibility, as authorized by ABx1 1 (John Perez) and enhanced benefits, pursuant to the provisions of SBx1 1 (Hernandez/Steinberg). It also provides additional information on the two approaches for determining county realignment savings, or “true up”, as Medi-Cal coverage is expanded to cover childless adults who are under age 65 and whose incomes are at or below 138 percent of the federal poverty level. The “county true up,” as authorized in AB 85 (Assembly Budget Committee), also contains other provisions intended to support the county safety net. The implications of those provisions for private safety net hospitals are currently the subject of analysis by the California Hospital Association and others in the hospital community.
Friday, 21 June 2013 State Budget
The Assembly and Senate passed the 2013-14 Budget Act (AB 110) on Friday, June 14, one day before the Constitutional deadline for sending a budget to the Governor. While both Houses were pleased with their efforts to pass an on-time, balanced budget, they worked through mid-day Saturday acting on about 20 budget “trailer” bills, which make the necessary statutory amendments to implement the Budget Act. The spending plan pays down about $4.2 billion in budget debt and contains a $1.1 billion reserve.
Compromises reached by the “Big 3” – the Governor, the Assembly Speaker, and the President pro Tem of the Senate – allowed the $96.3 billion General Fund spending plan to move to a vote in both Houses. The Governor generally prevailed in having the spending package based on more conservative revenue estimates. An agreement was reached on the Governor’s plan to overhaul the state’s education system with more funding going to all school districts, not just the less wealthy districts. Senate Democrats succeeded in gaining funding for mental health services and partial restoration of Medi-Cal adult dental benefits. Assembly Democrats were pleased to report success in gaining funding for middle-class college scholarships, including Cal Grants.
Consistent with earlier statements by the Governor and legislative leaders, the budget signaled California’s continued commitment to implementation of federal health care reform. In summary, the Budget package contains the following health care reform and Medi-Cal program provisions:
Federal Health Care Reform Implementation
- • Assumes $1.5 billion in federal funds to implement the “optional” Medi-Cal expansion. The optional expansion extends Medi-Cal eligibility to childless adults under age 65 with household income below 138 percent of the Federal Poverty Level.
- • Includes $104 million General Fund to implement Medi-Cal program simplifications required by the Affordable Care Act (ACA). These simplifications are part of the ACA’s “mandatory” Medi-Cal expansion.
- • Adopts a mechanism for calculating county indigent care savings that result from the Medi-Cal expansion and a state-counties sharing arrangement for those savings. Enacted as part of AB 85, a “trailer” bill to the Budget Act, the complex “mechanism” is the center of growing controversy among California’s counties attributable to the way in which savings are allocated among the counties. Similarly, provisions that seek to maintain the county hospital safety net are also garnering attention in the hospital community. As examples, the Department of Health Care Services (DHCS) would set health plan rates that include sufficient federal funding for county hospitals to be paid 100 percent of cost. Further, county hospitals would be assured of an adequate Medi-Cal patient base by management of default enrollment into managed care plans, which would seem to present continuity of care and patient choice challenges.
- • Extends Medi-Cal coverage to former foster youth reaching their 21st birthday between July 1 and December 31, 2013 – individuals who also will be covered beginning January 1, 2014 as a result of the Affordable Care Act.
• Requires DHCS to seek federal funds, to be matched with funding from The California Endowment, to support application assistors and community based organizations with outreach.
- • Appropriates $2.8 million General Fund to continue eligibility in Medi-Cal for newly qualified immigrant parents with their Medi-Cal-eligible children.
• Assumes $66.7 million General Fund for increased costs associated with an expansion of mental health and substance use disorder services in Medi-Cal.
Department of Health Care Services
• Restores basic adult dental benefits in Medi-Cal beginning May 1, 2014.
- • Restores the enteral nutrition optional Medi-Cal benefit so that it is no longer restricted to either tube feeding or specific diagnoses, beginning May 1, 2014.
• Repeals the seven-visit annual cap on physician visits.
• Reinstates the Managed Care Organization Tax to support the Healthy Families Program in 2012-13, and authorizes funding for children's health services and services for seniors and persons with disabilities, and dual eligibles thereafter. The budget assumes $128.1 million General Fund in current year savings and $342.9 million General Fund savings in 2013-14.
- • Assumes savings of $310 million General Fund in 2013-14 from extending the Hospital Quality Assurance Fee.
NOT INCLUDED in the Budget Act
• Restoration of previous health care cuts, such as reimbursement rate reductions to distinct part skilled nursing facilities. While the Senate Budget Committee restored $64 million ($32 million General Fund) on a prospective basis to undo the rate freeze required by AB 97 in 2011, the Joint Budget Conference Committee subsequently deleted the funding.
(On a related note, AB 900 (Alejo), the California Hospital Association-sponsored bill that would restore the Medi-Cal rate reimbursement for DPSNFs, passed the Senate Health Committee this week on a 9-0 vote. This bill now moves to the Senate Appropriations Committee. As you will recall, a bill that mirrored AB 900 – SB 640 (Lara) – was held on the Suspense File of the Senate Appropriations Committee in late May.)
- • Delay of the July 1, 2013 implementation of the All Patient Refined Diagnostic Related Groupings (APR-DRG) payment methodology. After CHA-sponsored SB 645 (Nielsen) was held on the Senate Appropriations Suspense File, hospitals attempted to include provisions authorizing a six or 12-month DRG implementation delay in the Budget.
It is anticipated that the Governor will soon announce his budget bill signing and "blue pencil" vetoes, since the new 2013-14 Fiscal Year begins July 1.